Quebec City, Canada, when we see an older family member handling a bulky box of medications arranged by day of the week, we might stop and ask ourselves: Is it too much? How do all those pills interact?
The fact is that as we age we are more likely to develop different chronic diseases that require us to take several different medications. This is known as polypharmacy. The concept applies to people taking five or more medications, but there are all kinds of definitions with different thresholds (for example, four, 10, or 15 medications).
I am a pharmacist and pharmacoepidemiologist interested in polypharmacy and its impact on the population. The research I conduct with my team at the Faculty of Pharmacy at Laval University focuses on the appropriate use of medication by older family members. We have published this study on the perceptions of older adults, family caregivers, and physicians on medication use among people over 65 years of age. Polypharmacy among older adults
Polypharmacy is very common among older adults. In 2021, a quarter of people over 65 in Canada were prescribed more than ten different classes of medications. In Quebec, people over 65 years of age used an average of 8.7 different drugs in 2016, the last year available for statistics.
Is it a good idea to take so many medications? According to our study, the vast majority of seniors and family caregivers would be willing to stop taking one or more medications if their doctor told them it was possible, although the majority are satisfied with their treatments, they have trust in their doctors and feel that their doctors are taking care of them the best they can.
In most cases, drug prescribers help the person they are treating. Medicines have a positive impact on health and are essential in many cases. But while treating individual illnesses is often adequate, the entire package can sometimes be problematic.
The risks of polypharmacy: 5 points to consider When we evaluate cases of polypharmacy, we find that the quality of treatment is often compromised when many medications are taken.
1. Drug interactions: polypharmacy increases the risk of drug interactions, which can cause undesirable effects or reduce the effectiveness of treatments.
2. A medication that has a positive effect on one disease may have a negative effect on another: what should be done if someone has both diseases?3. The greater the number of medications consumed, the greater the risk of suffering undesirable effects: for adults over 65 years of age, for example, there is a greater risk of confusion or falls, which have important consequences.
4. The more medications a person takes, the more likely they are to take a potentially inappropriate medication. For older people, these medications generally carry more risks than benefits. For example, benzodiazepines, medications for anxiety or sleep, are the most widely used class of medications. We want to reduce its use as much as possible to avoid negative impacts such as confusion and increased risk of falls and car accidents, not to mention the risk of dependency and death.
5. Finally, polypharmacy is associated with various adverse health effects, such as increased frailty, hospital admissions, and emergency room visits. However, studies to date have not always been able to isolate the specific effects of polypharmacy. As polypharmacy is more common among people with multiple diseases, these diseases may also contribute to the observed risks. Polypharmacy is also a combination of medications. There are almost as many as there are people. The risks of these different combinations may vary. For example, the risks associated with a combination of five potentially inappropriate medications would certainly be different from those associated with blood pressure medications and vitamin supplements.
Therefore, polypharmacy is complex. Our studies attempt to use artificial intelligence to manage this complexity and identify combinations associated with negative impacts. There is still much to learn about polypharmacy and its impact on health.
3 tips to avoid the risks associated with polypharmacyWhat can we do as a patient or as a caregiver? Ask questions: When you or someone close to you is prescribed a new treatment, be curious. What are the benefits of medication? What are the possible side effects? Does this fit with my treatment goals and values? How long should this treatment last? Are there any circumstances under which suspension should be considered?
Keep your medications up to date: Make sure they are all still useful. Is there still any benefit to taking them? Are there any side effects? Are there drug interactions? Would another treatment be better? Should the dose be reduced?
Let's think about deprescribing: it is an increasingly common clinical practice that involves stopping or reducing the dose of an inappropriate medication after consulting a healthcare professional. It is a shared decision-making process that involves the patient, their family and health professionals. The Canadian Medication Appropriation and Deprescribing Network is a world leader in this practice. It has compiled a series of tools for patients and doctors. You can find them on their website and subscribe to the newsletter. The benefits must outweigh the risks.
Medicines are very helpful in staying healthy. It is not uncommon for us to have to take more medications as we age, but this should not be seen as a foregone conclusion.
Every medication we take must have direct or future benefits that outweigh the risks associated with them. As with many other issues, when it comes to polypharmacy, the saying “everything in moderation” often applies. (The conversation) NSANSA
The fact is that as we age we are more likely to develop different chronic diseases that require us to take several different medications. This is known as polypharmacy. The concept applies to people taking five or more medications, but there are all kinds of definitions with different thresholds (for example, four, 10, or 15 medications).
I am a pharmacist and pharmacoepidemiologist interested in polypharmacy and its impact on the population. The research I conduct with my team at the Faculty of Pharmacy at Laval University focuses on the appropriate use of medication by older family members. We have published this study on the perceptions of older adults, family caregivers, and physicians on medication use among people over 65 years of age. Polypharmacy among older adults
Polypharmacy is very common among older adults. In 2021, a quarter of people over 65 in Canada were prescribed more than ten different classes of medications. In Quebec, people over 65 years of age used an average of 8.7 different drugs in 2016, the last year available for statistics.
Is it a good idea to take so many medications? According to our study, the vast majority of seniors and family caregivers would be willing to stop taking one or more medications if their doctor told them it was possible, although the majority are satisfied with their treatments, they have trust in their doctors and feel that their doctors are taking care of them the best they can.
In most cases, drug prescribers help the person they are treating. Medicines have a positive impact on health and are essential in many cases. But while treating individual illnesses is often adequate, the entire package can sometimes be problematic.
The risks of polypharmacy: 5 points to consider When we evaluate cases of polypharmacy, we find that the quality of treatment is often compromised when many medications are taken.
1. Drug interactions: polypharmacy increases the risk of drug interactions, which can cause undesirable effects or reduce the effectiveness of treatments.
2. A medication that has a positive effect on one disease may have a negative effect on another: what should be done if someone has both diseases?3. The greater the number of medications consumed, the greater the risk of suffering undesirable effects: for adults over 65 years of age, for example, there is a greater risk of confusion or falls, which have important consequences.
4. The more medications a person takes, the more likely they are to take a potentially inappropriate medication. For older people, these medications generally carry more risks than benefits. For example, benzodiazepines, medications for anxiety or sleep, are the most widely used class of medications. We want to reduce its use as much as possible to avoid negative impacts such as confusion and increased risk of falls and car accidents, not to mention the risk of dependency and death.
5. Finally, polypharmacy is associated with various adverse health effects, such as increased frailty, hospital admissions, and emergency room visits. However, studies to date have not always been able to isolate the specific effects of polypharmacy. As polypharmacy is more common among people with multiple diseases, these diseases may also contribute to the observed risks. Polypharmacy is also a combination of medications. There are almost as many as there are people. The risks of these different combinations may vary. For example, the risks associated with a combination of five potentially inappropriate medications would certainly be different from those associated with blood pressure medications and vitamin supplements.
Therefore, polypharmacy is complex. Our studies attempt to use artificial intelligence to manage this complexity and identify combinations associated with negative impacts. There is still much to learn about polypharmacy and its impact on health.
3 tips to avoid the risks associated with polypharmacyWhat can we do as a patient or as a caregiver? Ask questions: When you or someone close to you is prescribed a new treatment, be curious. What are the benefits of medication? What are the possible side effects? Does this fit with my treatment goals and values? How long should this treatment last? Are there any circumstances under which suspension should be considered?
Keep your medications up to date: Make sure they are all still useful. Is there still any benefit to taking them? Are there any side effects? Are there drug interactions? Would another treatment be better? Should the dose be reduced?
Let's think about deprescribing: it is an increasingly common clinical practice that involves stopping or reducing the dose of an inappropriate medication after consulting a healthcare professional. It is a shared decision-making process that involves the patient, their family and health professionals. The Canadian Medication Appropriation and Deprescribing Network is a world leader in this practice. It has compiled a series of tools for patients and doctors. You can find them on their website and subscribe to the newsletter. The benefits must outweigh the risks.
Medicines are very helpful in staying healthy. It is not uncommon for us to have to take more medications as we age, but this should not be seen as a foregone conclusion.
Every medication we take must have direct or future benefits that outweigh the risks associated with them. As with many other issues, when it comes to polypharmacy, the saying “everything in moderation” often applies. (The conversation) NSANSA
