If you ever took a Latin class, or if you just pay attention to word parts and their meanings, you can probably decipher the meaning of many unfamiliar words. Here is one for you: polypharmacy. My computer doesn’t like this one (red lines) but it is a real word. You might think it means a street corner with multiple drugstores on it, but that’s not it. Polypharmacy is the word that is used when a person, often elderly, is taking an excessive number of drugs for diseases or conditions that are affecting their health.
In the United States, people over 65 make up approximately 13 percent of the population but use about 30 percent of all prescriptions written, according to a 2005 article written by James Wooten, PharmD, and Julie Galavis, RN, BSN. At any given time, an elderly patient takes, on average, four or five prescription drugs and two over-the-counter medications.
The authors also note that elderly patients are more likely than younger ones to be taking a medication that has been prescribed inappropriately, which could mean it is not necessary, it’s not effective or it could even be dangerous. As a consequence, the risk of suffering a bad outcome because of a medicine they thought was helping them is higher in the elderly population. In a study that Wooten and Galavis refer to in their article, 29 percent of the elderly participants received at least one of 33 potentially inappropriate drugs.
There are a few factors that contribute to this issue of polypharmacy in the elderly. There has been an explosion of drugs that have come on the market in the last 30 or 40 years to treat conditions that may have never been treatable before. This is not a negative phenomenon, but it certainly makes it more complicated for the patients, their caregivers and their health care providers to keep track of all the medicines and the possible side effects and drug combinations that may be harmful.
Along with this increase in the number of medications available by prescription has come a rise in the drugs that are now obtainable over the counter that used to be prescription-only. That kind of access can increase the number of medications an individual is taking. In addition, the use of complementary and alternative remedies has skyrocketed in the last 20 years and not all patients are aware of the need to share the use of these substances with their health care provider.
If you ever took a Latin class, or if you just pay attention to word parts and their meanings, you can probably decipher the meaning of many unfamiliar words. Here is one for you: polypharmacy. My computer doesn’t like this one (red lines) but it is a real word. You might think it means a street corner with multiple drugstores on it, but that’s not it. Polypharmacy is the word that is used when a person, often elderly, is taking an excessive number of drugs for diseases or conditions that are affecting their health.
In the United States, people over 65 make up approximately 13 percent of the population but use about 30 percent of all prescriptions written, according to a 2005 article written by James Wooten, PharmD, and Julie Galavis, RN, BSN. At any given time, an elderly patient takes, on average, four or five prescription drugs and two over-the-counter medications.
The authors also note that elderly patients are more likely than younger ones to be taking a medication that has been prescribed inappropriately, which could mean it is not necessary, it’s not effective or it could even be dangerous. As a consequence, the risk of suffering a bad outcome because of a medicine they thought was helping them is higher in the elderly population. In a study that Wooten and Galavis refer to in their article, 29 percent of the elderly participants received at least one of 33 potentially inappropriate drugs.
There are a few factors that contribute to this issue of polypharmacy in the elderly. There has been an explosion of drugs that have come on the market in the last 30 or 40 years to treat conditions that may have never been treatable before. This is not a negative phenomenon, but it certainly makes it more complicated for the patients, their caregivers and their health care providers to keep track of all the medicines and the possible side effects and drug combinations that may be harmful.
Along with this increase in the number of medications available by prescription has come a rise in the drugs that are now obtainable over the counter that used to be prescription-only. That kind of access can increase the number of medications an individual is taking. In addition, the use of complementary and alternative remedies has skyrocketed in the last 20 years and not all patients are aware of the need to share the use of these substances with their health care provider.
Wooten and Galavis point out that compared to the general population, a patient over 65 is more likely to have several chronic disorders, each requiring at least one medication. Elderly patients with more than one health condition are likely to receive care from several providers, each of whom may prescribe a different medication to treat the same symptoms.
If a patient purchases drugs from more than one pharmacy, it is difficult for anyone to keep track of what they are taking or should be taking and how those drugs may interact with each other. Another factor in the equation is what’s called the prescribing cascade: An elderly patient develops side effects from a medication he’s taking; however, his healthcare provider interprets the symptoms not as side effects of the drug but as symptoms of a disease. The healthcare provider then prescribes yet another drug, creating the potential for even more side effects. A statement published in 1995 in the Brown University Long-term Care Quality Letter sums this up well: “Any symptom in an elderly patient should be considered a drug side effect until proved otherwise.”
If all that weren’t enough, as people age, their bodies can react to medications differently than younger people. Tissues don’t absorb as well, the liver and kidneys may slow down and not be able to clear a drug from the body as quickly. The proportion of water and fat in the body can also change as a person ages, and that can affect how much and how quickly a drug is absorbed and how long it stays in the body.
So what is the answer to this growing issue? Being aware of the problem is obviously the first step. Next week, this column will give some specific steps to take for anyone who suspects that they or a loved one may be entering this polypharmacy zone.
Pam Maxson is a health educator at Noyes Hospital in Dansville. If you have questions or suggestions for future articles, she can be reached at pmaxson@noyes-hospital.org or 585-335-4327.
