Nearly 50% of people in the U.S. older than 65 take at least five prescription drugs per day. In older adults, polypharmacy can affect medication adherence, lead to poor health outcomes and put them at risk for falls, behavioral changes, and other geriatric syndromes. Prescribers should be cognizant of physiological changes in the elderly that can affect how the body handles drugs (pharmacokinetics) and how drugs affect the body (pharmacodynamics).

Estimated Rates of Hospitalization Due to Implicated Drugs

Guiding Questions

• How common is polypharmacy, and what defines it?

• What health and social consequences can arise from polypharmacy?

• Which drugs are potentially problematic and can lead to adverse side effects in the elderly?

• When is it appropriate to discontinue certain medications for reduction of chronic disease risk?
  
  

Polypharmacy

According to a surveillance study using 2007–2009 data from a nationally representative sample of 58 hospitals, the following four medications accounted for more than two-thirds of nearly 100,000 emergency hospitalizations for adverse drug events in U.S. adults aged 65 or older annually:

• warfarin (33%)

• insulins (14%)

• oral antiplatelet agents (13%)

• oral hypoglycemic agents (11%)
  
  

Read a summary of the study from NEJM Journal Watch here.

Polypharmacy can be reduced by regularly reviewing medications and discontinuing those for which the risks outweigh the benefits or have no clear indication. For certain classes of medications, tapering is necessary to prevent withdrawal.

Helpful tools, such as the evidence-based Screening Tool of Older People's Prescriptions (STOPP) criteria, identify drugs that should be discontinued. Polypharmacy review will help identify medications that should be discontinued for the following reasons:

• if there is no longer an indication

• if the benefit is unlikely to be commensurate with the patient’s life expectancy

• if it causes adverse drug reactions

• if the patient is nonadherent