Polypharmacy – When Less is More

Polypharmacy has always been a concern in post-acute and long-term care, but with the chaos and challenges of the COVID pandemic, this could get lost in the shuffle. But make no mistake – When specialists and primary care providers are both involved in the delivery of care communication failures may result in medication duplications, unnecessary medications, and other issues may result in adverse drug reactions (ADRs). This is a good time to remind clinical colleagues, caregivers, and others of the red flags they should watch for ADRs. 

According to researchers, the risk of ADRs increases in the elderly as a result of:

  • Age-related physiologic changes in pharmacokinetics and pharmacodynamics
  • Polypharmacy
  • Inappropriate prescribing (IP) (medications that pose more risk than benefit) 
  • Female gender
  • Frailty
  • Genetic predisposition

It is important to note that frailty is on this list, as up to 59% of the older adult population have various levels of frailty. One study looked at the frailty index (FI) to indicate risk for ADRs and potentially inappropriate prescription (PIP):

  • At the mean FI score of 0.16 patients experienced at least one instance of PI
  • Patients above this threshold were twice as likely to experience PIP
  • Patients above this threshold were twice as likely to develop an ADR
  • Patients taking over six medications were 3 times more likely to experience PIP

In essence, polypharmacy is a significant problem for the elderly; and the dangers of adverse reactions to medication are exacerbated as frailty increases. In the absence of reminders from pharmacy consultants and without knowing the degree of frailty, there are other things to keep in mind when prescribing:

  1. As people age their medication needs often change. Review them periodically.
  2. As people age the pharmacokinetics of medication in the body change.
  3. As people age chronic conditions may resolve and some drugs discontinued.
  4. Some drugs may improve function (pain managed) and lower frailty index.
  5. Some drugs may worsen function (sedation) and increase frailty index.
  6. Consider changing the message for “more is better” to “less is more”.

Contact us to learn more about frailty and polypharmacy and their impact on care in the nursing home population.