Polypharmacy is the use of several concurrent medications by one individual. It is an increasingly common phenomenon in an ageing population with multiple morbidities, and can often be a challenge for the GP. When used appropriately, medication can prolong life and aid symptom control. When medications are used unnecessarily, polypharmacy can have adverse effects, particularly on elderly patients. This article aims to help the GP manage patients on multiple medications, be aware of potential problems this may cause, and give guidance on medication reviews.
Get full access to this article
View all access options for this article.
References
1.
AbdulraheemI. S. (2013) Polypharmacy: A risk factor for geriatric syndrome, morbidity & mortality. Aging Science1: e103, doi: 10.4172/2329-8847.1000e103.
2.
AlagiakrishnanK.WiensC. (2004) An approach to drug induced delirium. Postgraduate Medicine Journal80: 388–393. doi: 10.1136/pgmj.2003.01723.
3.
AnathhanamS.PowisR.CracknellA.RobsonJ. (2012) Impact of prescribed medications on patient safety in older people. Therapeutic Advances in Drug Safety3(4): 165–174. doi: 10.1177/2042098612443848.
4.
BarberN. D.AlldredD. P.RaynorD. K.DickinsonR.GarfieldS.JessonB.ZermanskyA. G. (2009) Care homes’ use of medicines study: Prevalence, causes and potential harm of medication errors in care homes for older people. Quality & Safety in Health Care18(5): 341–346. doi: 10.1136/qshc.2009.034231.
5.
BarnettK.MercerS. W.NorburyM.WattG.WykeS.GuthrieB. (2012) Epidemiology of multimorbidity and implications for health care, research, and medical education: A cross-sectional study. The Lancet380(9836): 37–43. doi: 10.1016/S0140-6736(12)60240-2.
6.
BeckettN. S.PetersR.FletcherA. E.StaessenJ. A.LiuL.DumitrascuD.BulpittC. J. (2008) Treatment of hypertension in patients 80 years of age or older. The New England Journal of Medicine358: 1887–1898. doi: 10.1056/NEJMoa0801369.
7.
BrodyT. M.LarnerJ.MinnemanK. P. (1998) Human pharmacology: Molecular to clinical, third edition, St Louis MO: Mosby Inc.
8.
CapodannoD.AngiolilloD. (2010) Antithrombotic therapy in the elderly. Journal of the American College of Cardiology56(21): 1683–1692. doi: 10.1016/j.jacc.2010.04.063.
9.
ChoudhryN. K.FischerM. A.AvornJ.LibermanJ. N.SchneeweissS.PakesJ. (2011) The implications of therapeutic complexity on adherence to cardiovascular medications. Archives of Internal Medicine171(9): 814–822. doi:10.1001/archinternmed.2010.495.
10.
ColN.FanaleJ. E.KronholmP. (1990) The role of medication non-compliance and adverse drug reactions in hospitalisation of the elderly. Archives of Internal Medicine150: 841–845.
11.
CouplandC.DhimanP.MorrissR.ArthurA.BartonG.Hippisley-Cox (2011) Antidepressant use and the risk of adverse outcomes in older people: Population based cohort study. British Medical Journal343: d4551, doi: 10.1136/bmj.d4551.
FickD. M.CooperJ. W.WadeW. E.WallerJ. L.MacleanJ. R.BeersM. H. (2003) Updating the Beers criteria for potentially inappropriate medication use in older adults: Results of a US consensus panel of experts. Archives of Internal Medicine163(22): 2716–2724. doi: 10.1001/archinte.163.22.2716.
14.
GallagherP.RyanC.ByrneS.KennedyJ.O’MahonyD. (2008) STOPP (Screening Tool of Older Persons’ Prescriptions) and START (Screening Tool to Alert Doctors to Right Treatment): Consensus validation. International Journal of Clinical Pharmacology Therapeutics46(2): 72–83.
15.
GuthrieB.MakubateB. (2012) The rising tide of polypharmacy and potentially serious drug interactions 1995–2010: Repeated cross sectional analysis of prescribing in one region. Primary Health Care & Development13(S1): 45 2E.2, doi: 10.1186/s12916-015-0322-7.
16.
HanlonJ. T.SchmaderK. E.SamsaG. P.WeinbergerM.UttechK. M.LewisI. K.FeussnerJ. R. (1992) A method for assessing drug appropriateness. Journal of Clinical Epidemiology45(10): 1045–1051. doi: 10.1016/0895-4356(92)90144-C.
HowardR.AveryA.SlavenburgS.RoyalS.PipeG.LucassenP.PirmohamedM. (2006) Which drugs cause preventable admissions to hospital? A systematic review. British Journal of Clinical Pharmacology63(2): 136–147. doi: 10.1111/j.1365-2125.2006.02698.x.
MagazinerJ.CadiganD. A.FedderD. O.HebelJ. R. (1989) Medication use and functional decline among community-dwelling older women. Journal of Aging Health1(4): 470–484. doi: 10.1177/089826438900100404.
22.
MahtaniK. R.HeneghanC. J.GlasziouP. P.PereraR. (2011) Reminder packaging for improving adherence to self-administered long-term medications. Cochrane Database of Systematic Reviews9. art. no. CD005025. doi: 10.1002/14651858.CD005025.pub3.
MilosV.RekmanE.BondessonÅ.ErikssonT.JakobssonU.WesterlundT. (2013) Improving the quality of pharmacotherapy in elderly primary care patients through medication reviews: A randomised controlled study. Drugs & Aging30(4): 235–246. doi: 10.1007/s40266-013-0057-0.
26.
MiltonJ.Hill-SmithI.JacksonS. (2008) Prescribing for older people. British Medical Journal336(606): 9, doi: 10.1136/bmj.39503.424653.80.
27.
MonaneM.BohnR. L.GurwitzJ. H.GlynnR. J.LevinR.AvornJ. (1996) Compliance with antihypertensive therapy among elderly Medicaid enrollees: The roles of age, gender, and race. American Journal of Public Health86(12): 1805–1808. Retrieved from www.ncbi.nlm.nih.gov/pmc/articles/PMC1380739/pdf/amjph00523-0127.pdf.
28.
National Office for Statistics. (2012). Population ageing in the United Kingdom, its constituent countries and the European Union. Retrieved from www.ons.gov.uk/ons/dcp171776_258607.pdf.
29.
OsterbergL.BlaschkeT. (2005) Adherence to medication. New England Journal of Medicine353(5): 487–497.
30.
RedmondP.GrimesT. C.McDonnellR.BolandF.HughesC.FaheyT. (2013) Interventions for improving medication reconciliation across transitions of care (protocol). Cochrane Database of Systematic Reviews10. art. no. CD010791. doi: 10.1002/14651858.CD010791.
Social Care Institute of Excellence. (2005). Research Briefing 15: Helping older people to take prescribed meditation in their home: What works? Retrieved from www.scie.org.uk/publications/briefings/briefing15/—evidence-in-practice.pdf.
WynneH. A.BlagburnJ. (2010) Drug treatment in an ageing population: practical implications. Maturitas66(3): 246–250. doi: 10.1016/j.maturitas.2010.03.004.
36.
ZiereG.DielemanJ. P.HofmanA.PolsH. A.van der CammenT. J. M.StrickerC. H. (2006) Polypharmacy and falls in the middle age and elderly population. British Journal of Clinical Pharmacology61(2): 218–223. doi: 10.1111/j.1365-2125.2005.02543.x.
