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Unlikely Outcomes in Elderly Patients Using Polypharmacy

Older adults taking five or more drugs are likely to exhibit negative side effects.

According to the Worldwide Health Organization (WHO), polypharmacy, the use of five or more drugs, has shown compelling evidence throughout the years. However, when medications with different mechanisms are combined, it becomes a risk to individuals, especially older adults. One example is with people who have type 2 diabetes taking various hypoglycemic drugs with different mechanisms when taken simultaneously. These people usually have other comorbidities in conjunction with their diabetes that also require the use of other medications. The combination of various medications raises the potential risk of drug-drug interactions. For example, the risk of developing severe hypoglycemic or hyperglycemic risks becomes widely possible. Therefore, the goal of this article is to examine the effects that polypharmacy has on individuals’ health outcomes, especially the elderly.

As mentioned previously, the combination of various diabetic drugs can have a negative impact on elderly individuals who have diabetes, especially when combined with other drugs to control other comorbidities. When medications are not prescribed properly, or are given simultaneously with other medications with various side effects, the risk of harmful events ensue. However, because elderly patients are often characterized by comorbidity, the use of polypharmacy becomes inevitable. This is due primarily in part to the rising incidences of aging, biological disorders, as well as cognitive and social deteriorations. As such, the rise in administration of several medications to treat different disease states becomes difficult to avoid. As we know, with an increase in different medications prescribed comes an increase in numerous drug-drug interactions, increased hospitalizations and ultimately poses a threat to one’s life.  In fact, one study showed that adverse drug-related events are 10-fold higher in elderly adults when compared to other age groups. In addition to this, authors found that approximately 70% of patients used polypharmacy and were at risk for these adverse drug-related events.

In a recent study titled Older Adults Taking More Than 5 Drugs Walk Slower, researchers aim to reveal that polypharmacy can have negative side effects such as frailty, falls, and death among elderly individuals. Researchers performed a cross-sectional study using 482 ‘community-dwelling older adults’ who were over the age of 65 years. These individuals were enrolled in the Central Control of Mobility in Aging study that measured a person’s ability to walk in relation to changes in one’s brain and central nervous system. Studies assessing the individual’s physical health, mental well-being and mobility were conducted at the beginning of the study, and every year thereafter. Researchers defined polypharmacy as the use of five or more medications used to treat an individual’s comorbid state. Medications whether they were prescription, over-the-counter, or herbals, were taken into account. Moreover, each elderly patient was assessed for his/her walking ability without the use of canes or walkers. The walking speed was examined by having the participant walk while talking at a normal pace, over a 20-foot long walkway. Prior to this, individuals were broken up into two groups: polypharmacy and non-polypharmacy.

Results indicated that approximately 30% of participating individuals were using five or more medications during the study and 10% used more than eight medications. Furthermore, individuals using more than five medications at a time were more likely to suffer from other comorbidities such as congestive heart failure, increased history of falls, heart attacks, and diabetes when compared to individuals in the non-polypharmacy group. Walking speed assessed between both groups showed that individuals in the polypharmacy group had a slower walking speed than those in the non-polypharmacy group. In addition, participants taking eight or more medications had an even slower walking speed between individuals taking five medications in the polypharmacy group. Moreover, individuals in the polypharmacy group were more overweight than those in the non-polypharmacy group, thus contributing to their chronic disease states.

Researchers concluded that individuals using polypharmacy had an increased likelihood of developing adverse drug-related events, thus indicating that there is a link between polypharmacy and one’s walking speed as well as other comorbidities. It is imperative to note, though, that medications should be used in moderation and individualized to the patient’s need. Underprescribing and overprescribing medications can significantly affect an individual’s health and well-being, imposing greater drug-related events. Tailoring medications to each individual by administering the adequate number of drugs to his/her condition can increase safety and effectiveness of treatment.

Practice Pearls:

  • Polypharmacy is the use of five or more medications used to aide with one’s comorbid state.
  • There is a link between polypharmacy and increased adverse drug related events.
  • Elderly patients taking five or more medications are at an increased risk of reduced mobility, increased falls, frailty, obesity, and congestive heart failure among others.

References:

“Study: Older Adults Taking More than 5 Drugs Walk Slower.” UPI. UPI, 27 June 2017.      Web. 04 July 2017.

Wojtczak, Dominik, Jacek Kasznicki, and Józef Drzewoski. “Pros and cons of polypharmacy in elderly patients with diabetes.” Clinical Diabetology. N.p., 20 June 2017. Web. 04 July 2017.

 

Nuha Awad, Doctor of Pharmacy Candidate: Class of 2018; ACCP FSHP