Polypharmacy and Adverse Drug Events in Older Adults

The last sixty years have witnessed an extraordinary growth in the number of medications for chronic health conditions at the same time that the average life expectancy has increased by over 10 years. Despite the “good news” of health care advances associated with being able to live longer with multiple chronic illnesses, treatment with numerous medications can also make some older adults sicker rather than healthier. With each additional medication taken by an older adult, there is an increasingly greater the risk of adverse drug events (ADEs), including adverse drug reactions, allergic reactions, medication errors, and drug-drug interactions. ADEs in older adults are associated with increased emergency room visits, hospitalizations, morbidity, and mortality. Fortunately, ADEs are among the top five most frequent preventable health problems in older adults after congestive heart failure, breast cancer, hypertension, and pneumonia. Geriatric care managers can play a critical role in preventing dangerous polypharmacy and ADEs by being aware of the risk factors and by advancing good management practice.

How common is polypharmacy?

The vast majority of adults over age 65 (84%) have two or more chronic health conditions, and approximately one third of older adults take five or more medications each day. Over one third of older adults are prescribed five or more medications, and almost one in five take 10 or more medications.

Who is most at risk?

Older adults make up approximately 13% of the US population but account for over one third of all prescription drug use. Those older adults taking the greatest numbers of medications are among those at the greatest risk of ADEs. The likelihood of experiencing an adverse drug event doubles when the number of prescriptions increases from one to four, and an older adult taking seven or more medications has 14 times the risk of an adverse drug event compared to an individual taking only one prescription.

Older age is also a risk factor for experiencing an adverse drug event. The number of prescriptions tends to increase with age. Whereas 65 to 69-year-olds use approximately 13 prescriptions per year, 80 to 84-year-olds average 18 prescriptions per year. Moreover, older age is associated with physical changes that increase the risk of an adverse drug event. Older adults are two to three times more likely than younger adults to experience side effects of medications. Unfortunately, there is a lack of data on effectiveness and safety lists of many medications in older adults because the elderly population is frequently excluded from research trials. In short, physicians have been left to extrapolate from research on younger people when treating the oldest old.

Why are older adults at increased risk for polypharmacy and ADEs?

In addition to being more likely to have multiple health care problems, there are a variety of reasons that older adults are at greater risk:

  • Older adults are more likely to see a greater number of specialty physicians who independently prescribe medications for different conditions and specialty health problems. A fragmented service delivery system that often poorly communicates vital medical information can result in a physician prescribing a medication without knowing that it duplicates another medication or may have an adverse drug-drug interaction. This may be further complicated by an older adult with memory problems who might not recall accurately their entire list of medications or recent physician visits.
  • Older adults are more likely to have an ADE due to changes in physiological ability to absorb, breakdown, and distribute medications in the body. Not only are lower doses often indicated for older adults compared to younger persons, but combinations of medications are often harder for an older body to process.
  • Older adults are at greater risk for potentially life-threatening events such as falls and delirium that are both highly associated with polypharmacy and with overuse of specific types of medications commonly prescribed to older adults.
  • Older adults are more likely to experience healthcare transitions, including transfers between hospitals and nursing homes and community-based settings, exposing them to a greater likelihood of prescribing errors and failures to reconcile different medication lists.

What are the consequences of polypharmacy and ADEs?

Polypharmacy is associated with the most common geriatric syndromes. For example, the total number of medications, regardless of type or class, has been shown to be an independent risk factor for falls and fractures. The risk of falls is especially high among older adults on psychoactive medications. Older adults taking multiple psychoactive medications are more likely to have sustained two or more falls than patients taking no such medications over a given year. Psychoactive medications increase the fall risk of older adults by 71%. Remarkably, although using sedative hypnotic medication has been shown to be associated with a greater risk of falls and other adverse effects, one third of older adults are prescribed a sedative hypnotic medication during hospitalization.

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Reprinted with permission from Aginglife.org. Contact the trained professionals at Advocare Care Management today.