Introduction
Polypharmacy does not have one standard definition accepted by the literature; however, its impact on older adults is clearly prevalent. It has become a popular topic in pharmacy recently, as the population is getting older and is being prescribed more medications. The number of adults aged 65 years or older who are impacted by medication overload has nearly tripled in the United States (Thompson & McDonald, 2024). Its frequency increases throughout time in older adults, parallel to diagnosed chronic conditions (Remelli et al., 2022). Prescribing these medications may be necessary for their treatment; however, there is an overwhelming concern that many older adults are prescribed drugs no longer required, leading to harms outweighing the benefits of the prescribed medication (Nicholson et al., 2024). Factors contributing to polypharmacy include the culture of prescribing, providers’ lack of time, knowledge, and current education on medications, and the fragmentation of the healthcare system. Many patients go to multiple specialists who may not keep consistent communication with the rest of the team. Moving forward, this article will identify risks of polypharmacy, detail the method of deprescribing, and list the barriers to deprescribing.
Risks of Polypharmacy
One impact of polypharmacy is increased economic pressure due to increased risk of hospitalization due to adverse drug events. Potentially inappropriate medications, or PIMs, are medications that are noted to be inappropriate for prescription (Hagiwara et al., 2024). A PIM could even be a medication that was once beneficial to a patient at a given time, but is no longer due to changes in the body or treatment. Potential harmful outcomes of polypharmacy include non-adherence to medications, drug-drug interactions, inappropriate prescriptions, and a higher risk of hospitalizations and mortality (Remelli et al., 2022).
Polypharmacy is linked to various negative outcomes for the older patient population. The first example is that it has been linked to frailty in older adults. 75% of adults impacted by polypharmacy are determined to be either pre-frail or frail. It has also been associated with a higher risk of death, although other factors likely have a role in the impact. Hospitalizations and falls are greatly increased by polypharmacy. Additionally, polypharmacy has been shown to affect cognitive impairment and physical function in older adults (Pazan & Wehling, 2021).
Deprescribing as a Tool
Everyone’s body goes through many changes throughout life; therefore, one medication that used to be effective or safe may no longer be. Deprescribing, commonly defined as “planned and supervised stopping or dose reduction of medication”, creates a chance to have an open conversation between healthcare workers and patients regarding prescribed medications (Thompson & McDonald, 2024). As people age, healthcare goals and comfort goals change. Additionally, biological aging often leads to changes in individuals’ pharmacokinetics and pharmacodynamics (Pazan & Wehling, 2021).
There is no standard to the process; however, the overall goal is to identify deprescribing opportunities during a patient assessment. The provider will assess the medication history and prioritize medications for deprescribing, if any seem appropriate. Examples of these chances include the identification of a harmful drug, an unnecessary drug, or a drug that has questionable benefits in the current time (Thompson & McDonald, 2024).
Barriers to Deprescribing
While some patients are hopeful to reduce the number of pills that are prescribed to them, some patients remain hesitant to pursue the conversation with their provider regarding their medications. Occasionally, though, patients feel that it is safer for them to keep the prescribed medications on their list and may fear what will happen if the medication is discontinued. On the other hand, prescribers may feel like they have inadequate resources to initiate deprescribing and may fear potential reactions by the patient or the caregiver. There remains to be some lack of communication between the different professions involved in patient care, as well (Thompson & McDonald, 2024).
Conclusion
Although polypharmacy remains a highlight in clinical practices, studies in the last few years have greatly varied in results and methods. Currently, there is more of an association rather than causation found in the studies. For example, the number of polypharmacy in the literature vary from around 4% to about 96.5% depending on factors (Pazan & Wehling, 2021). While studies are still being conducted, the number of impacted adults continues to increase. Focusing on polypharmacy in older adults is vital to ensure the safety of the older population.
References
Hagiwara, S., Komiyama, J., Iwagami, M., Hamada, S., Komuro, M., Kobayashi, H., & Tamiya, N. (2024). Polypharmacy and potentially inappropriate medications in older adults who use long-term care services: a cross-sectional study. BMC Geriatr, 24(1), 696. https://doi.org/10.1186/s12877-024-05296-4
Nicholson, K., Liu, W., Fitzpatrick, D., Hardacre, K. A., Roberts, S., Salerno, J., Stranges, S., Fortin, M., & Mangin, D. (2024). Prevalence of multimorbidity and polypharmacy among adults and older adults: a systematic review. Lancet Healthy Longev, 5(4), e287-e296. https://doi.org/10.1016/S2666-7568(24)00007-2
Pazan, F., & Wehling, M. (2021). Polypharmacy in older adults: a narrative review of definitions, epidemiology and consequences. Eur Geriatr Med, 12(3), 443-452. https://doi.org/10.1007/s41999-021-00479-3
Remelli, F., Ceresini, M. G., Trevisan, C., Noale, M., & Volpato, S. (2022). Prevalence and impact of polypharmacy in older patients with type 2 diabetes. Aging Clin Exp Res, 34(9), 1969-1983. https://doi.org/10.1007/s40520-022-02165-1
Thompson, W., & McDonald, E. G. (2024). Polypharmacy and Deprescribing in Older Adults. Annu Rev Med, 75, 113-127. https://doi.org/10.1146/annurev-med-070822-101947