Polypharmacy is a problem for many of the elderly. As we age, many people often develop more chronic
health conditions. These chronic health conditions mean that the
elderly often are taking many medications. This means polypharmacy
for many of the elderly and it can increase the risk for harmful side
effects.
Interestingly, taking more than five
medications is linked to frailty; perhaps because the medications
interact to affect our ability to function well as we age. Frailty is
a problem associated with aging. Someone who is frail can be weak,
have less endurance, and be less able to function well. Frailty
increases the risk for falls, disability, and even death.
Recently, a team of researchers
examined information from a large German study of older adults called
ESTHER (Epidemiological Study on Chances for Prevention, Early
Detection, and Optimized Therapy of Chronic Diseases at Old Age) to
learn how taking more than five medicines might affect frailty in
older adults. The study was published in the Journal of the American
Geriatrics Society.
The researchers looked at information
from nearly 2,000 participants in the ESTHER study, which began in
2000 with nearly 10,000 participants. Follow-ups on participants
were conducted after two, five, eight, and 11 years. People in the
study were between 50- and 75-years-old when the study began.
At the eight-year follow-up, study
physicians visited the participants at home for a geriatric
assessment. During the visit, participants were asked to bring all
the medications they took--both prescription and over-the-counter
(OTC)--to assess the kinds and number of medications participants
were taking. The researchers then separated participants into three
groups:
1. People who took
from 0 to 4 medicines (non-polypharmacy)
2. People who took
5 to 9 medicines (polypharmacy)
3. People who took
10 or more medicines (hyper-polypharmacy)
Two pharmacists individually reviewed
all medications taken and excluded medicines and supplements that
were not known to cause side effects.
After adjusting for differences in
patient characteristics including illnesses, the researchers learned
that people who were at risk for frailty, as well as people who were
frail, were more likely to be in the polypharmacy or
hyper-polypharmacy groups compared with people who were not frail.
Researchers also discovered that people who took between 5 to 9
medicines were 1.5 times more likely to become frail within 3 years
compared with people who took fewer than 5 medications.
People who took more than 10 medicines
were twice as likely to become frail within three years as people who
took less than five.
The researchers concluded that reducing
multiple avoidable prescriptions for older adults could be a
promising approach for lessening the risks for frailty.
If you're an older adult, or if you're
caring someone who is older, it's important to understand that taking
multiple medicines can cause interactions. The medicines can
interact with each other and with the human body in harmful ways (by
increasing negative side effects or decreasing desired effects, for
example). As a result, the risk for falls, delirium, and frailty
also increases.
Primary care providers are aware of
these negative effects, but they cannot properly react if they are
not fully informed about all the medicines you or an older adult in
your care may be using. That's why it's extremely important to let
your healthcare provider know about all medicines you or a person in
your care is taking, as well as about OTC medicines and medicines
prescribed by other healthcare providers. Your can then evaluate
whether one or more drugs might be changed or discontinued.
"In a perfect world, your
physician would talk about your medications with a pharmacist and a
geriatrician. This might help to reduce avoidable multiple drug
prescriptions and possibly lessen medication-induced risks for
frailty and other negative effects of unnecessary, avoidable
polypharmacy," said study co-author Kai-Uwe Saum, PhD, MPH.
This research summary was developed as
a public education tool by the Health in Aging Foundation. The
Foundation is a national non-profit established in 1999 by the
American Geriatrics Society to bring the knowledge and expertise of
geriatrics healthcare professionals to the public. We are committed
to ensuring that people are empowered to advocate for high-quality
care by providing them with trustworthy information and reliable
resources. Last year, we reached nearly 1 million people with our
resources through HealthinAging.org. We also help nurture current and
future geriatrics leaders by supporting opportunities to attend
educational events and increase exposure to principles of excellence
on caring for older adults. For more information or to support the
Foundation's work, visit http://www.HealthinAgingFoundation.org.
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