Polypharmacy, or using a number of drugs, is widespread in older adults. Whereas 89% of individuals aged 65 and older take no less than one prescription medicine, 54% take 4 or extra.1 Knowledge from Merck equally discovered that just about 80% of older adults frequently take no less than two prescribed drugs whereas 36% frequently use 5 or extra totally different medication — and this doesn’t embrace over-the-counter drugs.2
Adversarial results from polypharmacy are widespread and will drive sufferers to hunt out ever-more medication to deal with the unwanted effects attributable to their unsafe drug routine. It’s a vicious cycle, one which’s perpetuated by a damaged well being care system that revolves round pharmaceutical-driven, fragmented care.
Not solely do many sufferers see a number of medical doctors, every of whom could prescribe their very own set of medicines, however sufferers could stress medical doctors to prescribe medication they’ve seen on direct-to-consumer commercials. As a substitute of wanting on the huge image of methods to get wholesome, tending to important elements like weight loss plan, stress and bodily exercise, “well being care” for seniors typically turns into “drug care,” with doubtlessly disastrous outcomes.
One Affected person — 43 Prescription Medicine
A commentary by Dr. Mark E. Williams revealed on Medscape highlights simply how excessive polypharmacy can change into. In some circumstances, it’s not “simply” 4 or 5 drugs however dozens of them, and within the case of Williams’ affected person “Allison,” it was 43. The girl had been transferred to a continual care facility for long-term care resulting from bipolar sickness.
Days earlier, she was handled at a hospital for psychological well being points, which Williams mentioned “was in all probability associated to inappropriate polypharmacy.”3
“Regardless of being admitted to the hospital for adversarial drug reactions associated to polypharmacy, Allison was discharged to my facility on 43 prescription drugs and an nearly equal variety of over-the-counter (OTC) medication. It took greater than 10 minutes for the nurse to evaluate the admission drugs with me over the telephone,” he wrote.4
Allison’s signs included fatigue, dizziness, muscle aches, headache, nausea, insomnia and extra, and he or she requested further drugs to deal with them. Not solely was the girl taking duplicate drugs meant to deal with the identical signs, however she was additionally taking drugs meant to deal with widespread adversarial results.
“The ‘chemical soup’ in her physique is resulting in psychological and bodily issues,” Williams advised the affected person’s daughter, however she, too, purchased into the notion that extra medication equaled higher care. After overcoming the affected person’s resistance to going off the medication, over a three-month interval Williams was capable of cut back Allison’s drugs to about 15 — nonetheless a staggering quantity, however much less so than 43.
“Allison improved, each mentally and bodily,” Williams wrote,5 however challenges nonetheless ensued, together with the affected person demanding a reminiscence drug she had seen marketed on tv, and an incident through which her daughter gave her an over-the-counter sleep help, resulting in lethargy, confusion and slurred speech.
Finally, Allison was transferred to a different facility, the place the damaging polypharmacy undoubtedly continued. Whereas Williams’ commentary highlights an excessive case, it’s not distinctive — polypharmacy is prevalent amongst seniors.
Polypharmacy Worsens Well being
When drugs are prescribed in extra, together with to deal with the unwanted effects of different medication, the affected person’s well being suffers. “Using quite a few drugs could lead to medication-related issues akin to inappropriate indications, therapeutic duplication, adversarial results, drug interactions, pointless drugs, poor adherence and a pressure on well being care sources,” in accordance with a featured article in The Journal for Nurse Practitioners.6
It additionally famous that polypharmacy is a preventable threat issue for hospital admission in older adults, resulting from adversarial drug occasions. The dangers of polypharmacy, in the meantime, are properly famous. In BMC Geriatrics, adversarial outcomes together with mortality, falls, adversarial drug reactions, elevated size of hospital keep and hospital readmission are listed, and the chance of hurt will increase with the variety of drugs.7 In response to the systematic evaluate:8
“Hurt may result resulting from a large number of things together with drug-drug interactions and drug-disease interactions. Older sufferers are at even better threat of adversarial results resulting from decreased renal and hepatic perform, decrease lean physique mass, decreased listening to, imaginative and prescient, cognition and mobility.”
In 2007, Dr. Michael Stern, geriatric emergency medication specialist at New York Presbyterian Hospital, even advised a New York Occasions reporter that polypharmacy accounts for greater than one-fourth of all admissions to the hospital and that it will be thought of the fifth main explanation for demise if it had been categorized that means.9
Older Individuals Are Extra Susceptible to Drug Facet Results
The truth that older persons are extra more likely to be taking extra prescribed drugs is a double-edged sword, because the aged are already at elevated threat of drug unwanted effects. Actually, the aged are estimated to be twice as prone to adversarial drug occasions in comparison with youthful folks.
“Unwanted effects are additionally more likely to be extra extreme, affecting high quality of life and leading to visits to the physician and in hospitalization,” in accordance with the Merck Guide, which additionally explains a number of the reason why older persons are so susceptible to drug unwanted effects:10
- Older folks have much less water and extra fats tissue within the physique; this enables increased concentrations of medicine that dissolve in water and elevated accumulation of medicine that dissolve in fats
- The kidneys are much less efficient at excreting medication into urine
- The liver is much less capable of metabolize medication, so that they’re not eliminated as readily from the physique
- “Older persons are extra more likely to have continual medical issues which may be worsened by medication or that will have an effect on how the medication work”
Some widespread examples of how medication could have an effect on seniors otherwise embrace blood stress medication, which can result in extra dramatic drops in older folks, resulting in signs of dizziness and falls. Older adults may additionally change into confused and sleepy when utilizing antianxiety medication, extra so than sometimes seen in youthful folks. Such results could solely be compounded when a number of medication are being taken on the identical time.
Actually, resulting from adjustments that happen throughout organic growing older, it’s now acknowledged that drugs ought to be clinically examined particularly with older adults in thoughts. Nevertheless, older adults are sometimes excluded from scientific trials, which implies the security and efficacy of medicine on this inhabitants is commonly unknown, with supportive proof missing.
“Inevitably, this lack of proof has typically led to inappropriate drug therapy and, consequently, to numerous adversarial scientific outcomes,” in accordance with a evaluate revealed in March 2021 in European Geriatric Medication.11
Why Are so Many Extra Seniors Taking Antidepressants?
Overprescribing is rampant among the many senior inhabitants, and antidepressants are one such instance. There’s been a serious rise within the variety of antidepressants being prescribed for older adults over the past 20 years, with no equally sharp improve within the quantity depressed, in accordance with a examine revealed in The British Journal of Psychiatry.12
The findings recommend seniors could also be being overprescribed antidepressant medication, which might have severe implications for his or her well being, though the researchers weren’t keen to state this, noting as an alternative, “we won’t infer that older sufferers are prescribed antidepressants unnecessarily.”13
Within the first examine group, 4.2% of the adults had been taking antidepressants, however this jumped to 10.7% within the later examine. Throughout this time, the prevalence of melancholy decreased, however solely barely, from 7.9% to six.8%.14 Additionally noteworthy, amongst older adults residing in care houses, the prevalence of melancholy was unchanged however using antidepressants rose from 7.4% to 29.2%.15
There have been a couple of recommendations provided for why antidepressant prescribing charges elevated so steeply with no related improve in melancholy, together with overdiagnosis or prescribing the medication for circumstances apart from melancholy. Nevertheless, most of these prescribed antidepressants had not been identified with melancholy.
Additional, antidepressants carry a threat of unwanted effects that might simply spiral into extra drug prescriptions. As an illustration, antidepressant customers have an elevated threat of creating Kind 2 diabetes,16 and antidepressant use has been linked to thicker arteries, which might contribute to the chance of coronary heart illness and stroke.17
Practically Half of Over 75s Take Statins
Statin cholesterol-lowering medication are one other instance of a wildly overprescribed drug class that’s contributing to polypharmacy dangers. Within the U.S., near 50% of U.S. adults over 75 years take a statin,18 despite the fact that their use may additionally hurt mind well being — greater than doubling threat of dementia in some circumstances.19
A connection additionally exists between statins and diabetes, to the extent that individuals who take statins are greater than twice as more likely to be identified with diabetes than those that don’t, and people who take the medication for longer than two years have greater than triple the chance.20,21 With a diabetes analysis, after all, comes extra medication.
Typically, statins are pointless within the first place. Whereas they’re efficient at decreasing ldl cholesterol, whether or not that is the panacea for serving to keep away from coronary heart illness and lengthen lifespan is a subject of heated debate. In 2018, a scientific evaluate introduced substantial proof that top LDL and complete ldl cholesterol usually are not a sign of coronary heart illness threat, and that statin therapy is of uncertain profit as a type of major prevention for that reason.22
Medicine Don’t Equate to Good Well being
Overprescribing drugs is organising seniors for a downward spiral of accelerating unwanted effects and worsening well being. A holistic strategy is required, one which addresses the important thing tenets of excellent well being and creates actual wellness as an alternative of trying to cowl up signs with extra drugs.
As only one instance, in a examine of older depressed adults, 80% skilled a big discount in depressive signs after taking on power coaching for 10 weeks, such that researchers concluded that the train was “an efficient antidepressant in depressed elders, whereas additionally enhancing power, morale and high quality of life.”23
It’s necessary to work with a well being care supplier who understands the dangers of polypharmacy and the truth that good well being doesn’t come from a capsule. Solely by constructing a well being plan that addresses weight loss plan, train, sleep, emotional wellness and poisonous exposures, together with solely focused and actually obligatory drugs and/or dietary supplements, are you able to attain optimum well being.
