Polypharmacy can be defined several different ways. The simplest definition is “concurrent use of many different drugs, including prescription medications, over-the-counter medicine, complementary and alternative medications, and dietary supplements.” However, the term is often used by clinicians to mean the excessive use of medications or the use of an excessive number of inappropriate medications.
Polypharmacy is an important issue when caring for older adults. Using multiple medications is often burdensome to older patients. It can increase the risk for adverse drug reactions and drug interactions. It makes adherence more difficult. It is expensive.
Clinics in Geriatric Medicine has devoted the entire May 2012 issue to the topic of polypharmacy. A variety of experts have weighed in on diverse issues around polypharmacy. Several of the articles are of specific interest for those caring for older adults, such as:
- Factors associated with polypharmacy in nursing home residents
- Outcomes of polypharmacy in nursing home residents
- Clinical Practice Guidelines for Chronic disease – Understanding and managing their contributions to polypharmacy
- Polypharmacy, adverse drug reactions, and geriatric syndromes
- Pharmacokinetics and pharmacodynamic changes associated with aging and implications for drug therapy
Take special note of the Tools to Reduce Polypharmacy article. The authors discuss multiple strategies and tools for reducing polypharmacy burden including the list below, among others:
- Beers criteria
- Medication Appropriateness Index (MAI)
- Fit for the Aged (FORTA) Criteria
- The Assess, Review, Minimize, Optimize, Reassess (ARMOR) tool
- Good Palliative-Geriatric Practice Algorithm
The article about outcomes in nursing homes gives a nice review of the evidence around the harms caused by polypharmacy (e.g., falls and fractures, hospitalization, mortality) and possible benefits of reducing polypharmacy.