Polypharmacy Update
Hi
Readers, I wrote about the dangers of polypharmacy here in the AgeDoc blog on
9/15/10 but in six years, there are new developments I want to share with you. On April 26, 2016, The New York Times featured a story by reporter Paula Span that
caught my attention and I accessed the scholarly studies discussed in her
story. I hope you find this update
useful.
Drug interactions are a
risk at any age, but older adults are especially vulnerable because they have
multiple chronic conditions and take more drugs. The “danger” is threefold. First, care is
fragmented and several physicians may be writing prescriptions without knowing
the about all drugs the patient is currently taking. For example, an older adult may have a
primary care physician, cardiologist, ophthalmologist, hematologist, urologist,
endocrinologist, and gynecologist all writing prescriptions. Second, some prescriptions written by various
healthcare providers may be contraindicated.
Third, patients take OTC, herbal, and vitamin formulas without informing
their doctors and that may cause dangerous side effects.
According to a Harvard
study conducted between 1999-2012, 40% of older adults [age 65+] take an
average of five or more prescription medicines daily, primarily for chronic
conditions. This represents an increase
of 70% over the last twelve years (Span, 2016).
However, much of this increase is related to the dramatic increase in
the older population that began on January 1, 2011, when baby boomers started
turning sixty-five.
Medical researchers Qato
et al. (2016) found polypharmacy to be a major public health problem. As the principal investigator, Qato and his
colleagues conducted a longitudinal study of drug usage among 2,351 persons age
62-85 in 2005-2006 and again in 2010-2011.
Their study, published in JAMA
Internal Medicine on April 1, 2016, revealed that herbal supplements,
vitamins, and OTC drugs are on the increase among older adults. This, combined with increased prescription
drug usage, means that older adults are at risk for major drug interactions.
Here
is an excerpt of their findings:
“While the use of over-the-counter medications
declined from 44.4% to 37.9%, the use of dietary supplements increased from
51.8% to 63.7%. There were clinically significant increases in the use of
statins (33.8% to 46.2%), anti-platelets (32.8% to 43.0%), and omega-3 fish
oils (4.7% to 18.6%). In 2010-2011, approximately 15.1% of older adults were at
risk for a potential major drug-drug interaction compared with an estimated
8.4% in 2005-2006. Most of these interacting regimens involved medications and
dietary supplements increasingly used in 2010-2011” (Qato et
al., 2016, p. 473).
“In this study, the use of prescription
medications and dietary supplements, and concurrent use of interacting
medications, has increased since 2005, with 15% of older adults potentially at
risk for a major drug-drug interaction. Improving safety with the use of
multiple medications has the potential to reduce preventable adverse drug
events associated with medications commonly used among older adults (Qato et
al., 2016, p. 473).
Dr.
Michael Steinman, a geriatrician at UC San Francisco, specializes in
polypharmacy and issues related to aging.
Using serial cross-sectional surveys of outpatient visits, Steinman and
his colleagues investigated the use of opioids and analgesics among older
adults from 1999-2010. Their study found
that opioid use more than doubled! Even more troubling is the increased risk
for falling and confusion while taking prescription opioids (Steinman et al., 2015). When older adults become dizzy, they are at
increased risk of falling, and falls are the number one cause of
institutionalization.
References:
Qato,
D.M., Wilder, J., Schumm, L.P., Gillet, V., & Alexander, G.C. (2016). Changes in prescription and
over-the-counter medication and dietary supplement use among older adults in the
United States, 2005-2011. JAMA Internal
Medicine, 176(4),
473-482. doi:
10.1001/jamainternmed.2015.8581
Span, P. (2016, April 26). An ever-mounting
pile of pills. The New York Times, pp. D5.
Steinman,
M.A., Komaiko, K.D., Fung, K.Z., & Ritchie, C.S. (2015). Use of opioids and other analgesics by older adults in
the United States, 1999-2010. Pain Medicine, 16(2), 319-327. doi:
10.1111/pme.12613. Epub 2014 Oct 28.
