Polypharmacy and the Elderly: What Are the Risks and What to Do?

With an increase in age, the risk of elderly people getting ill or suffering from health problems also rises. In order to anticipate this so-called old age condition, the elderly often have to take various drugs. But be careful. The use of various drugs in large quantities poses health risks for older people.

What is Polypharmacy

Polypharmacy is defined as regular use of at least five drugs. This practice is common among the elderly. Elderly polypharmacy becomes a concern for several reasons. Older people are more vulnerable to adverse drugs reaction due to changes in metabolism and reduced ability to clear drugs that enter the body in relation to aging. The more drugs you take as a routine, the greater the risk.

Elderly polypharmacy risks may be caused by patient-related factors and system-level factors. Patient-related factors include the presence of comorbidities that are handled by a number of specialists and require a lot of medication. The elderly who need a long-term care in the hospital usually receive several drugs to treat their condition. Meanwhile system-level factors include medical records that are not properly updated.

Understanding the consequences of polypharmacy is very important because it serves as an indicator of medical treatment. Polypharmacy may cause patients to take a longer time to get back to work, increase drug costs, and trigger harmful drug interactions.

Clinical guidelines sometime recommend the combination of several drugs to treat a disease. Therefore, older people with comorbid conditions often need community geriatric services to care for the fragile elderly.

What is Drug Interaction

Medication aims to heal the patients and make them feel better. But sometimes problems may also arise from drug interaction. There are three types of drug interactions:

• Reaction between two or more drugs (drug-drug interaction)
• Reaction between drugs and food, drinks, or supplements (drug-food interaction)
• Reactions that occur when a person takes drugs while having particular medical problems (drug-condition interaction)

Drug interaction may alter the way drugs work in the body. One of the consequences is the drugs we take will be less effective. Drug interactions can also cause potentially harmful side effects. The risk of older people experiencing drug interactions increases if they undergo polypharmacy therapy.

STOP-START Criteria

To anticipate adverse drug reactions from polypharmacy in the elderly, there is STOPP-START method which was first published in 2008. STOPP (Screening Tool of Older Persons’ Prescriptions) and START (Screening Tool to Alert to Right Treatment) are criteria used as tools by medical personnel to review potentially inappropriate medications in adults and older people.

Inappropriate medication prescription in the elderly is a global problem that has to be taken seriously. The STOPP-START criteria can be used to anticipate the adverse effects of this practice. With these criteria, medical personnel will, among other things, check whether the prescribed medication is really needed by the patient, see if there is drug duplication in the polypharmacy, and make sure the patient has been given appropriate medication. Thus, prescribing will be more effective for the patients and reduces the risk of adverse effects.

What is Comprehensive Geriatric Assessment

Comprehensive geriatric assessment is a multidimensional interdisciplinary diagnostic and treatment process used to identifies medical, psychosocial, and functional limitations of the elderly. The aim is to develop a coordinated plan to improve the health conditions of older people related to aging.

In hospitals, comprehensive geriatric assessment has become the gold standard for caring for the frail older people. Unlike the younger age group, older people often have more complex health problems as they age and their body functions decline. Through geriatric studies, doctors from various fields of specialization can evaluate the condition of the elderly and formulate appropriate medical treatment according to the results of the evaluation in a coordinated manner.

Role of Comprehensive Geriatric Assessment for the Quality of Life of the Elderly and Polypharmacy

With comprehensive geriatric assessment, medical problems that affect the quality of life of olde people can be identified early. The identification process is carried out by doctors by examining the patient’s condition, interviewing the patients and their families, and utilizing specific medical equipment.

The risk of falling among the elderly, for example, can be evaluated by asking questions such as: “Have you fallen in this year?” The STOPP-START criteria and other methods of comprehensive geriatric assessment are also useful for assessing the accuracy of polypharmacy in the elderly.

Findings from the identification and evaluation process will be validated to determine appropriate intervention actions for the patient. For example, if there is a finding of a potential adverse drug interaction, the patient’s drug prescription will be revised. This assessment can be done at the hospital or through home visits. For better results, it may take several visits including to identify medical problems that may be hidden, such as depression.

Role of Doctor in Charge as Therapy Plan Coordinator

A patient may require treatments of several doctors in hospital related to his/her condition. In this case, there will be a medical team consists of doctors, nurses, and other medical personnel. Doctor in charge is the doctor who has the main authority over the entire management of the patient from the beginning to the end of treatment, both as outpatient and inpatient.

That authority includes being the therapy plan coordinator for the patient. The presence of a doctor in charge is important to ensure the implementation of hospital’s service and patient safety standards. This doctor is also the one who communicates with the patient’s family to inform the therapy plan and to provide other explanations needed by the family.

In a comprehensive geriatric assessment, for example, the doctor in charge will coordinate medical treatment so the actions of each doctor are mutually supportive and effective in identifying the health conditions of the elderly. By those means, an appropriate and accurate treatment plan can be drawn up for elderly patients.