Polypharmacy Leads to Health Problems in Older Adults

Many Americans over age 45; between the baby boomers, including the late-boomers, and Generation X, doctors are busily dealing with growing health and aging problems.

Some doctors specialize in older people - and before you say to yourself, "I'm not there yet" - you will be, and you know friends, neighbors, and loved ones who already are!

Geriatricians are primary care physicians who have additional specialized training in treating older patients. Many doctors get rotations as interns in geriatric medicine. A recent episode of a popular FOX-TV drama dealt with geriatric medicine and, specifically, the growing issue of polypharmacy.

There is little question that our society focuses on the young and treats older people as disposable despite still having a lot of life left to live. Award-winning actress Vicki Lawrence and actor George Wyne portrayed a couple living in an assisted living facility when visited by the doctors of the fictional Chastain Park Memorial Hospital.

Doctors from Chastain Park Memorial Hospital visit residents at an assisted living facility on Fox-TVs “The Resident.”

George Wyne played retired doctor Arthur Kravitz, who was once a well-known geriatrician but now suffers from short-term memory loss. His lady friend, Gloria Ortiz, played by Vicki Lawrence, watches over him in the long-term care facility. However, while the doctors and interns of Chastain Park Memorial Hospital visit them, Lawrence's character collapses and is rushed to the hospital.

It is there that co-star Manish Dayal who plays Dr. Devon Pravesh, discovers that Gloria Ortiz's health problem is caused, in part, by taking too many prescription medications. These meds were masking an underlying medical condition; however, it was too late as she died in surgery. 

Doctors Tend to Add New Medications to Address Symptoms

One of the themes of this episode was too many doctors ignored her overall health issues and just gave her another medication. Many of our loved ones - and perhaps all of us someday in the future - may be faced with growing health problems related to aging.  

Medications can be fantastic things that cure and improve our health. The problem, too many medications can cause drug interactions which can cause serious health problems. Plus, doctors who are not paying close attention to older patients can just be adding to a problem instead of addressing the issue. 

According to the National Institute on Aging (NIH), taking too many drugs can be dangerous, especially for older adults. Polypharmacy is defined as the use of multiple medications, generally five or more, to treat diseases and other health conditions.

Older People Take More Meds

The NIH reports that adults aged 65 and older tend to take more prescription drugs than other age groups. The high number of medications being prescribed for older people is due to older people suffering from several diseases or other health problems simultaneously. These comorbidities increase with age and declining health, especially for those receiving long-term health care.

According to Amit Shah, MD, FACP, of the Mayo Clinic Division of Community Internal Medicine, 50% of the senior population in the United States is on five or more medications, including over-the-counter drugs, with 37% on five or more prescription medications and 12% on ten or more medications. 

Drug Reactions Cause More Health Problems Than Most Chronic Health Issues

"Nearly one-half of older adults take five or more medications, and as many as one in five of these prescriptions is potentially inappropriate. Older adults prescribed more medications are more likely to be hospitalized for an adverse drug reaction. Moreover, adverse drug reactions account for more morbidity and mortality than most chronic diseases, with death rates higher than many common cancers," wrote Barbara Farrell, PharmD, FCSHP, Bruyère Research Institute and University of Ottawa, Ottawa, Ontario, and University of Waterloo, Waterloo, Ontario in a 2019 editorial published in "American Family Physician."

Some Drugs Can Cause Harm

Farrell points out that drugs offer potential benefits but can also cause harm. She says that polypharmacy is a clinical challenge as the health care system is geared toward starting medications, not reducing or stopping them. Doctors tend to add medications, not eliminate them over time.

"I like to say that I have cured more diseases by stopping medications than by starting them," said Mayo's Dr. Shah. "Now, that's a bit of an overstatement, but it gets people's attention."

Mayo Clinic’s Dr. Amit Shaw

Shah recommends that physicians ask themselves several questions before adding medications. Family members can help by asking the doctor the same questions. These are just two of many questions that should be asked:

1. Does the doctor know all the medications the patient is taking? Many medical records have errors or omissions, and family members may not be aware of every medication being taken by the individual. Patients and their families should be sure the doctor and all health care providers are aware of all the medicines, including supplements and over-the-counter drugs the patient is taking. 
2. Is the medication being recommended harmful? What are the side effects, and will the drug interact with other medicines being taken?

Another concern is that a drug is being offered to a patient to take care of a symptom without understanding the underlying cause of the symptom. Some doctors may not take the time to correctly diagnose the health issue causing the problem in older people. Plus, communication with older people can be more complex, and doctors are often busy juggling other patients. 

Medication Management is Essential

Don't forget that medication management is a significant concern in older people, not just those with dementia. Some older adults are not taking their medications correctly as prescribed or failing to take them at all. Those with dementia are especially vulnerable to medication mismanagement. 

Home health care providers, family members, and staff in long-term care facilities should pay special attention to taking medication as prescribed by the doctor. If there is a question about whether all the drugs are necessary, it should be addressed with the doctor. 

TV drama shows real-life issues that affect our families and finances in the real world. Failure to address polypharmacy can have serious outcomes, including death, as shown in the episode of "The Resident" which airs Thursdays at 8 pm eastern/7 central on FOX.

Aging has many challenges. The cost of medications and long-term health care are rising. The quality of life for older people can be improved when proper medication management is in place, and unnecessary drugs are withdrawn.