Polypharmacy in Older Adults

According to the National Institute on Aging (NIA) polypharmacy is the use of multiple drugs to treat diseases and other health conditions.  Polypharmacy is common in older adults, many of whom have two or more chronic conditions, and about a third of whom take five or more prescription drugs. Often, these different powerful drugs have been prescribed by different doctors.  Some drugs mask or neutralize others, some are dangerously incompatible with others and some may worsen conditions that naturally occur in the aging population — such as loss of appetite, less efficient digestive systems and increased cardiovascular risk.

Inappropriate polypharmacy — the use of excessive or unnecessary medications — increases the risk of adverse drug effects, including falls and cognitive impairment.  Harmful drug interactions and drug-disease interactions may also occur, where a medication prescribed to treat one condition worsens or creates a new one.

Enter the new field of “deprescribing”.  The NIA is developing a network of scientists to advance the field of deprescribing to improve the quality of care and health outcomes for older adults. According to Parag Goyal, MD, “despite its role as an integral part of patient-centric and goal-concordant prescribing practice, deprescribing is not frequently incorporated into routine clinical practice”.

In seeking to view medications in a way that is more patient-centered and less disease-oriented and guideline-driven, the NIA advises talking to your doctors about deprescribing if you feel a drug is not working or is causing harmful side effects.  Make sure to bring a list of all medications you are currently taking, prescription and over-the-counter.  Ask if there are any that may not be necessary.

For the American Geriatrics Society’s (AGS) list of medications that older people should avoid or use with caution, google “Beers List”. The Beers List is recommended for assessing your medications, however AGS advises not to stop taking any medication without talking to your doctor first.

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