There is no denying that medications save lives, but
prescription medications are not completely free of risks or side effects. The
more medications we take at the same time, the greater the risk of adverse
events. Polypharmacy is defined as an increase in the number of medications
or the use of more medications than are medically necessary. There
are several settings,
reasons, symptoms, problems and outcomes associated with polypharmacy.
Polypharmacy is much more likely to occur in the elderly population who often
suffer from multiple chronic diseases requiring multiple medications. 7-11 Polypharmacy
increases the risk of numerous negative health concerns in the elderly.
There are multiple settings for
polypharmacy, the most common include: ambulatory care, hospitals, and nursing
homes. A survey indicated that 25% of the overall population takes five or more
medications per week.3 In reference to the elderly the percentage
increases to about 50%, taking five or more medications per week and 12% taking
10 or more prescriptions per week.4
There are some reasons for polypharmacy. As the population ages, polypharmacy increases.
The elderly often require multiple medications to treat multiple health-related
conditions. According to the World Health Organization
(WHO), polypharmacy is a safe and effective treatment with at least five drugs
that is consistent with evidence based medicine. A patient
with multiple conditions who requires multiple medications to treat each
condition is the perfect candidate for polypharmacy since it would not
unreasonable for the patient to be on more than 5 medications. 22 Patients are at risk in a hospital encironment because
medications are started and stopped. There is also the situation with
medication prescription by different doctors for the same patient. Lack of patient education is apparently the most common
reason. Doctors do not inform patients or patients do not ask questions.
symptoms are overlooked because the symptoms can be
confused with symptoms of normal aging or another disease. Potentially, the
overlooking of symptoms can result in more damage because more drugs will be
prescribed. Examples of symptoms include: sleepiness, constipation, diarrhea, loss of appetite, falls, depression, weakness, hallucinations, and
Polypharmacy in of itself is not problematic. One example of pro for instance would be a patient
with diabetes and existing heart disease. It is not unreasonable for the
aforementioned patient to be on more than 5 medications to reduce their long-term
risk for diabetes complications and secondary coronary events. *** Patients may contribute to the problem by self-medicating,
failing to follow prescribed directions.
Polypharmacy offeres a plethora of consequences that increase the
risk of negative health consequences
in the elderly population. Consequences include: increased healthcare costs,
adverse drug events, nutrition, falls, and drug interactions. Polypharmacy
contributes to costs not only for patients, but insurance and healthcare as
well. In nursing home residents, rates of adverse drug events have been noted
to be higher in patients taking 9 or more medications 14.
A prospective cohort study found that 50% of those taking 10 or more
medications were found to be malnourished or at risk of malnourishment 31.
A study comparing patients who have not fallen compared to those who have
fallen once and those multiple times, reported that the number of medications
was associated with an increased risk of falls 35.In the past,
polypharmacy was referred to the mixing of many drugs in one prescription.
Today polypharmacy implies to the prescription of too many medications for an
individual patient, with an associated higher risk of adverse drug reactions
(ADRs) and interactions. Situations certainly exist where the combination
therapy or polytherapy is the used for single disease condition. Polypharmacy
is a problem of substantial importance, in terms of both direct medication
costs and indirect medication costs resulting from drug-related morbidity.
Polypharmacy increases the risk of side effects and interactions. Moreover it
is a preventable problem. A retrospective study was carried out at Bhopal
district (Capital of Madhya Pradesh, India) in the year of September-November
2009 by collecting prescriptions of consultants at various levels of health
care. The tendency of polypharmacy was studied and analyzed under the various
heads in the survey. Available data suggests that polypharmacy is a widespread
problem, and physician, clinical pharmacists and patients are all responsible.
These risks can be minimized through identifying the prevalence of this
potential problem in a high-risk population and by increasing awareness among
patients and healthcare professionals. Physicians and clinical pharmacists have
the potential to combating this problem through a variety of interventions such
as reducing the number of medications taken, reducing the number of doses
taken, increasing patient adherence, preventing ADRs, improving patient quality
of life and decreasing facility and drug costs.
As future nurses we are responsible for
avoiding polypharmacy. Nurses should obtain as much history data from patients
as possible, the nurse should ask what medications the patient is on, question
about any and all reactions the patient may be experiencing resulting from
medications as they can be indicative of polypharmacy. The appropriateness of the medication for the
patient and the potential for side effects must be considered. Any drug that is
unnecessary, inappropriate, or has a high likelihood for causing side effects
that would require additional therapy should be avoided.