A Prescription for Providers: Prevent Polypharmacy

As your elderly patients come to you with aches and pains, a reconciliation of current medications is critically important before you write their next prescription. Polypharmacy – the use of five or more medications to manage coexisting health problems – is becoming a significant problem.

It is estimated that 30 to 40 percent of elderly patients take five or more medications daily. Often, they seek treatment from multiple healthcare providers who work independently. Their cardiologist may prescribe 2 or 3 medications for heart failure based on evidence-based guidelines, and their endocrinologist may do the same to manage diabetes. This same patient may also take over-the-counter medications to treat acid reflux or indigestion, plus vitamins and herbal supplements. Before you know, a patient is taking 10 or more medications daily.

A side effect from one drug might go unrecognized or misdiagnosed, causing a new medication to be prescribed rather than considering stopping or changing the dosage of the offending agent to solve the problem. This is prescribing cascade can greatly increase the risk of an adverse event, particularly in the elderly.

Without complete documentation on why a medication was prescribed, reconciliation and decisions to discontinue medications become difficult, especially for providers who are not the initial prescriber.

Why should you be concerned? In general, the more medications a person takes, the greater the risk of an adverse event or drug interaction. Polypharmacy increases the burden on elderly patients to remember when and how to correctly take their medications, and it can result in an adverse event due to non-adherence or inappropriate usage. These adverse events contribute to avoidable medical costs since most will require physician intervention or could result in an emergency department visit or even hospitalization.

So what can you do? Be sure to complete a comprehensive review of all the medications a patient is taking at every office visit, and don’t forget to document why each medication is being used. Encourage your patients to keep a list of all of their medications, including any OTC or herbal supplements, as this can help you to identify and mitigate potential drug-interactions. Consider stopping unnecessary medications where appropriate in order to reduce the risk of an adverse drug event from happening.