Dangers of Polypharmacy

Taking a lot of medications? You could experience higher health risks

By Deborah Jeanne Sergeant

Jinjiao Wang, Ph.D., is assistant professor of nursing at University of Rochester Medical Center.

People aged 60 to 64 take an average of 13 prescription medications, according to Georgetown’s Health Policy Institute.

That number rises to 20 by age 65.

But just taking five or more daily medications is what Jinjiao Wang, Ph.D., assistant professor of nursing at University of Rochester Medical Center, calls “polypharmacy.”

“Its danger is not because of the number, but the risk of potentially unnecessary or inappropriate medications that increases along with the number of medications one is taking,” Wang said.

Wang is co-editor-in-chief of the research journal JMIR Aging.

Unnecessary polypharmacy or inappropriate polypharmacy happens when a patient is prescribed a medication initially intended for a specific time period or for specific symptom but the patient is still taking it even though the issue it should address is no longer present.

“That this ‘legacy’ medication may no longer be needed or, even worse, causing side effects,” Wang said.

Some patients take medication to treat side effects caused from other medication which providers may mistake as new symptoms.

Wang calls this phenomenon “prescribing cascade.”

This often happens with older adults who see multiple specialists. They may prescribe medication that the others don’t know about. Even with electronic medical records, if the patient sees providers associated with different health systems, that information may not be shared.

Taking unneeded medication costs patients and insurance companies money. It also takes out of the drug supply medication that someone else may need and in some cases struggle to find. Unnecessary polypharmacy also taxes the patient’s body as it must process yet more prescriptions.

It’s also taxing on the patient. Swallowing numerous pills daily can cause pill fatigue. It can become troublesome to take them at the right time and in the right fashion, such as before breakfast, with food or at bedtime. Taking medication incorrectly can hamper its ability to work correctly and with more medications comes more changes to make mistakes.

Swallowing numerous pills increases risk for drug interactions.

“A lot of drugs interact with other drugs,” said Sarah Phillips, supervision pharmacist at Clifton Springs Hospital. “One drug from one prescriber may interact with drugs from other prescribers. Older adults don’t metabolize drugs in the same way. The liver and kidney function is lower so drugs build up in their systems and have drug toxicity.”

Phillips said that polypharmacy can raise risk for side effects such as confusion, falls, loss of appetite, increased sedation and other contributors to hospitalization.

To reduce polypharmacy, Phillips recommends scheduling an annual medication review with the primary care provider or pharmacist. It can take an hour to go through the list. Phillips reminded that any over-the-counter medication, supplements and herbal preparations used should also be part of the conversation, as these can all interact with prescriptions.

“Once we have the full picture, we can analyze what you’re on,” Phillips said. “We look for indications, outcomes and interactions. We’re talking with the patient and understand what they’re taking, why they’re taking it and how it’s making them feel.”

A meeting such as this can help providers identify prescriptions that are no longer needed or suggest trying a different medication that could reduce side effects.

“Find a pharmacy you like and stay with that one pharmacy,” Phillips added. “If you use multiple pharmacies, we’re all segmented. If you use one, they see your whole drug list and can see if there are any interactions. But it doesn’t remove the need for that medication management session annually.”

Wang wants patients to know more about their medications, including their names, dosage, desired effects and potential side effects.

“Let your providers know when you have symptom changes that may be related to side effects of certain medications; do not be afraid to have an open discussion with your providers, if you have questions or concerns about your medications or simply wonder if some of your medications are still needed,” she said. “One hint, if you don’t know what a medication does for you — that is a good place to start this conversation with your providers.

However, never stop taking a medication without consulting your provider.”