Clinical consequences of polypharmacy in elderly: expect the unexpected, think the unthinkable

Abstract

Multiple medication use has been coined 'polypharmacy'. Polypharmacy is highly prevalent in older patients secondary to the increased number of co-morbid disease states with ageing. Existing practice guidelines recommend multiple drug use for certain chronic diseases (i.e., HIV, tuberculosis, hypertension, etc.). A polypharmacologic approach for certain diseases has been shown to improve therapeutic response, decrease morbidity and mortality. On the contrary, polypharmacy may induce iatrogenic complications that are often unseen prior to the initiation of medicinal regimens. This paper will review the potential clinical consequences of polypharmacy in the elderly and common medication administration errors that may occur. Consequences of polypharmacy include adverse drug effects, drug-drug interactions, disease-drug interactions, food-drug interactions, nutraceutical-drug interactions and medication cascade effect. Medication administration errors, such as phonetic confusion, flip-flopping dosing errors and pill visual-cue errors, are also reviewed. Prescribing for the elderly, whose medications are vast in number, is often uncharted physiologic territory. The clinician must expect the unexpected and think of the unthinkable in the geriatric patient, when dealing with polypharmacy and the potential consequences.

The Janus face of polypharmacy – overuse versus underuse of medication

“…As already mentioned, treatment guidelines for various conditions recommend many drugs, based on the fact that drug combinations have improved the therapeutic response and decreased morbidity and mortality (29). An aging population implies more morbidity and will result in the use of many drugs.…”

Utilization of antibiotics among physicians in the general outpatient unit of a tertiary health facility in North Central Nigeria

“…9 The more drugs a patient is exposed to, the more likely they are to be prescribed inappropriately. 10,11 There was a statistically significant difference between pattern of antibiotic prescribing between male and female patients.…”

Revisiting medication use in a frail 93-year-old man experiencing possible adverse effects

“…6 Recognizing and addressing the contribution of a drug to a symptom may prevent prescribing cascades, whereby new drugs are given to treat an adverse effect instead of stopping the drug causing the effect. Reviewing the indications and evidence for continuing long-standing drugs, and weighing the benefits against the risk of adverse events, can reduce the number of medications a patient is taking.…”