Table of Contents
Abstract
This paper explores polypharmacy and how it affects the elderly individuals in the society. The primary focus will be on the negative health consequences that the users are exposed to when practicing it. According to Maher, Hanlon & Hajjar (2014), Polypharmacy refers to the use of multiple drugs or medications to manage or deal with health complications that include hypertension and diabetes. Polypharmacy has resulted to some health issues among the users. The problems occur when individuals who seek medical attention from multiple healthcare specialists receive too many medications. Similarly, drug interactions may take place and produce polypharmacy effects when there is no particular healthcare provider with the patient’s medical history. As such, each healthcare provider prescribes medications independently. Apparently, the phenomenon is common among women than in men. 57% of women aged over 65 years use more than five drugs per week while for men aged 65 years, the proportion that uses medications at a similar frequency is 44%. The commonly used drugs include aspirin, ibuprofen, and acetaminophen. These drugs are all available over the counter. They contribute to the extreme drug reactions in the older people. Consequently, the risks of adverse drug interactions and reactions rise with the increase in the number of medications one take. The types of drugs that often participate in extreme interactions and reactions in the human system include antibiotics, cardiovascular agents, anticoagulants, diuretics, steroids, non-steroidal anti-inflammatory drugs, opioids, hypoglycemic, and benzodiazepines drugs. This paper will also look at some counterarguments to the proposition that polypharmacy is detrimental to the elderly’s health.
Introduction
Polypharmacy refers to the use of multiple drugs or medications to manage or deal with health complications. The incidence also occurs when a patient gets multiple medical prescriptions from several doctors without the patient’s prescription history. This happens when there is a lack of coordination among the healthcare providers. Majority of individuals aged 65 years and above tend to have multiple health complications. Diabetes and hypertension are common among the elderly. Smoking, obesity, diabetes and hypertension are known risk factors for ischaemic heart disease, cardiovascular disease, and stroke.
Dealing with multiple health complications frequently creates problems for the medical specialists. The problem is due to the reason that they need to prescribe medications to treat the diseases while at the same time avoid polypharmacy risks. The healthcare providers face the problems associated with polypharmacy in their routine medical prescription to the elderly particularly during the management of various conditions. Hence, the management of cardiovascular, hypertension, diabetes, and hyperlipidemia create the tension faced by the drug prescribers.
One of the options given to people who develop such health problems is the lifestyle change. However, the variation of lifestyle may not be enough to deal with the health complications that the diseases causes to the older people. As such, medical prescription becomes imperative. Doctors may need to give the patients different drugs for glycemic control, anti-hypertensive, statins, and aspirins. In cases where the patients experience other diseases, the number of prescribed drugs may increase as well. The need for multiple medicine prescription, however, does not justify the practice of polypharmacy to the elderly.
During prescriptions, guidelines should be used to assess the risk of intended medication to the patient. It is therefore paramount for the practitioners to put deliberate efforts to maintain a low number of medicines during the management of chronic health issues. Also, simple and regularly reviewed regimes must be in place that checks the drug limits prescribed to the elderly patients with multiple health conditions. Several health complications come as a result of polypharmacy. These complications have dire consequences to the individuals that have had incidents of adverse drug reactions and interactions. Polypharmacy has the potential to increase the risks of cognitive disorders, hip fractures, falls, incontinence, depression, and risks associated with inappropriate prescriptions. Most of the medicines involved in polypharmacy have adverse drug reactions since some of them have increased half-life, particularly in elderly individuals. This paper focuses on the negative consequences of polypharmacy to the elderly. The paper will also look at the counterarguments that may be advanced in defense of the practice and will consequently evaluate their strength.
Adverse consequences of Polypharmacy
There are several health problems associated with polypharmacy. These issues range from high risks of experiencing adverse drug events, medication non-adherence, multiple geriatrics syndromes, lowered functional capacity, and drug interactions. With such negative consequences, the elderly should be wary of the dangers that they face when they allow themselves into the practice. The following discussion provides insights concerning the detrimental effects of polypharmacy on the health and social lives of the individuals who use multiple drugs.
Healthcare Cost
A significant proportion of individual patient budget goes to the medical expenses. Polypharmacy substantially contributes to this scenario. Intrinsically, the victim is forced to meet the extra cost of healthcare. Studies have indicated that polypharmacy increases the risks of getting an inappropriate prescription (Maher, Hanlon & Hajjar, 2014). As such, it is highly associated with hospitalization risks, and outpatients visit risks. These events have an approximated 30% increment in the healthcare cost for a patient. People who take five drugs and above face a 6.2% drug expenditure increase and 7.3% increase for the individuals who have more than ten drugs (Maher, Hanlon & Hajjar, 2014). The patients, therefore, face an additional budget burden as significant part of their income is spent on medications due to polypharmacy. Since most of the people who find themselves involved in polypharmacy are the elderly with an average age of 65 years, most of them at this time are in their retirement phase. Hence, financial difficulties are bound to arise. At such points, the individuals face a double dilemma; the negative consequences of the many medicines and the economic side of the healthcare which is equally stressful.
Adverse Drug Reaction
Adverse Drug Reaction is the uncomfortable or destructive reaction that comes as a result of intervention associated with the medicinal product. The event provides a prediction of future dangers due to drug administration. As such, preventive measures must be introduced, or the dosage regime should be altered or withdrawn entirely. The majority of visits made to the healthcare facilities are associated with adverse drug events. The events are common among the old people particularly among the ones who are hospitalized. The polypharmacy increases chances of visiting the emergency rooms. According to Sultana, Cutroneo & Trifiro (2013), adverse drug reactions are the undesirable effects of medication that have significant clinical as well as economic costs since they result in prolongation of patients’ hospital stay, hospital admissions and frequent visits to the emergency department.
ADRs present social and medical complications due to constant movements and restlessness. It forces the old patients to make numerous tiresome trips to the healthcare centers as they seek emergency treatment. Their continued stay in the hospitals due to the adversity of their situation also complicates their life as they lack the freedom to enjoy their old age. Research indicates that outpatients under more than five prescribed medication face 88% increased chances of developing adverse drug reaction (Maher, Hanlon & Hajjar, 2014). Apparently, these rates are lower for the individuals who take fewer medicines but progressively increase with the increase in the number of drugs one takes. As such, the primary factor for ADR is polypharmacy. Elderly should thus make an effort to avoid polypharmacy as it leads to further deterioration of their health status.
Drug Interactions
According to the US National Library of Medicine (2016), drug interactions may alter the action of one medicine or both. When such event happens, two possible outcomes are likely; the drug may fail to cure the intended condition since it may be prohibited from functioning properly or cause a series of side effects. The results of the medicinal product interactions are not pleasant as seen from the discussion. First, when the drug fails to function as intended by the pharmacist, it implies that the patient has very minimal chances of recovering from the health problem. As such, challenges and complications concerning the individual health are bound to exacerbate. Secondly, when the interaction causes an adverse side effect, the patient will be in more troubles since additional medical complication will have set in. Some of the side effects due to drug interactions are severe and might threaten the patient’s life.
Drug allergies are common issues associated with drug interactions. Some of the allergic reactions are extreme and may overwhelm the patient. For example, anaphylaxis is a type of allergic reaction with profound health consequences. Therefore, elderly taking multiple drugs have increased chances of experiencing such events due to high risks of inappropriate prescriptions caused by polypharmacy. Such mistakes are due to the human error. They frequently occur because of negligence such as misinforming the healthcare providers or having multiple medical prescribers each working independently without the knowledge of other drugs taken by the patient. The drug-disease interaction is currently prevalent with the elderly patients who have attained over 65 years according to Doan, Zakrewski-Jakubiak and Roy (2013). Consequently, drug-disease interaction risk increases as one takes several medications. As such, the drug interaction disease is a primary concern for the medical specialists when it comes to dealing with the patients with various chronic conditions and relies on medication for their survival.
According to Dumbreck et al. (2015), severe drug-drug interactions are common among individuals with multiple health issues. Patients suffering from depression, heart failure, and type-2 diabetes have increased chances of experiencing drug-drug interaction. Other people who are likely to develop drug-disease interaction are individuals with comorbid chronic kidney disease. Although anyone can suffer from the mentioned diseases, elderly have high chances of suffering from the conditions than the young people. As such, they are more exposed to the drug-drug interaction effects than any other group. Elderly with polypharmacy have 80% prevalence of drug interaction as most studies indicate (Doan, Zakrewski-Jakubiak & Roy, 2013). The chances of a drug-interaction, mainly hepatic cytochrome enzyme-mediated in the old adults are high. Such findings show that adults should avoid polypharmacy as much as they can.
Medication None-adherence
One of the consequences of polypharmacy is medication non-adherence. Older adults often experience non-adherence with medications as a result of problematic regimes and effects of polypharmacy. The proportions for non-adherence with drugs among older individuals range between 43% and 100% (Maher, Hanlon & Hajjar, 2014). Medication non-adherence is related to medical treatment failure, diseases progression, increased incidences of adverse drug events, and patient hospitalization. All these complications pose significant dangers to life. Drug adherence has always been a problem for most people. Since the older members of the society have increased chances of multiple comorbidities, their risks of polypharmacy are also increased. As such, they also have a high chance of developing non-adherence to medications as compared to the rest of the members.
The primary concern in non-adherence to medications is the reduction in therapeutic benefits. Patients have to make numerous trips to hospitals as their health deteriorates. At such moments, they also experience other social and economic burden such as over treatment of a complication, increased expenditure on healthcare, and restlessness. Medication non-adherence predisposes most elderly people to risks of hyperglycemic and hypoglycemic episodes. These conditions have detrimental health consequences when not managed properly. The patients, mainly the old members in the population, may not have some of the chronic diseases they suffer from if adequately controlled. As such, their conditions will finally result in disease progression. At that point, they may fail to obtain proper medical care as their body systems are not likely to respond positively to the treatments.
Falls
Polypharmacy is highly linked to falls among the elderly people. It is related to high rates of morbidity and mortality among individuals who use multiple medications. The chances of experiencing falls increases as patients use different drugs. Using four or more drugs increases the risk of falling (Hammon & Wilson, 2013). Besides, the multiple drugs, according to studies increase the likelihood of experiencing recurrent falls in future. This condition is common among the older people. In this view, any act of increasing the number of medication is detrimental to their health as the drugs predispose them to frequent falling. People who frequently fall also have a high prevalence of polypharmacy. Hence, there is an association between the types of drug prescribed for a patient and the frequency of falling. Most people have postulated that there are definite drug types that increase the risks of falling as opposed to polypharmacy.
Incident of falling may be viewed from a different perspective in connection to polypharmacy according to Hammon and Wilson (2013). Issues such as inappropriate prescription and medication come into play when looking at the impacts of medicines on falls among the elderly people. However, polypharmacy remains the most significant factor that causes falls. Since the prevalence of polypharmacy tends to be high among the older people, they often experience falls compared to any age group. Persons under medications due to chronic diseases have increased risks of falling as well as high chances of having such events on a recurrent basis. This is because; risks associated with falls tend to increase proportionally with the number of drugs used by a person.
Urinary Incontinence
People suffering from urinary incontinence cannot control the bladder. As a result, it is one of the difficult conditions to the patients. Urinary incontinence may occur in the form of urine leaks when the person sneezes or coughs. In most severe conditions, the complication may make someone to develop an intense urgency of urinating to the extent that they may not get time to reach the toilets. Therefore, they are highly likely to urinate on themselves frequently. This problem is linked to the use of multiple drugs. Several studies have revealed the close association between urinary incontinence to multiple medications. According to Maher, Hanlon & Hajjar (2014), a study of elderly women showed that polypharmacy had a relationship with increased chances of urinary tract symptoms. Nonetheless, usage of several medications has the potential to worsen the condition in older people.
Impaired Cognitive and Nutrition Status
According to Heuberger and Caudell (2011), polypharmacy negatively affect the nutritional status of an individual. Previous studies indicate that almost half of the population that was under ten different types of medications and above were at high risk of malnourishment. Findings reflect the truth since further investigations show that polypharmacy is highly related to reduced intake of B vitamins, fat-soluble, minerals and accelerated rates of cholesterol, sodium, and glucose absorption (Heuberger & Caudell, 2011). This implies that older people with a high prevalence of polypharmacy are exposed to increased risk of malnutrition since their systems cannot take the essential elements. The outcome of impaired nutritional status may be life threatening, since, as the individual experience malnourishment, their body defense mechanisms weaken. A weak body defense system in the older people hardly fights new diseases. Another problem suffered by the elderly with polypharmacy is cognitive impairment. Taking several medications is the primary causal factor for cognitive impairment. This medical condition is related to dementia and delirium. Both dementia and delirium develop as a result of multiple medications. Impaired cognition among the older people is common, particularly with the individuals taking many drugs such as ten and above. Such people have increased risks of developing adverse complications.
Reduced Functional capability
Polypharmacy is highly associated with functional decline in older people. Several studies conducted on community-dwelling among elderly individuals showed that use of multiple medications reduced the capability to do Instrumental Activities of Daily Living (IADLs). Heavy consumption of drugs also reduced physical functioning. Data analysis concerning medication use among older women revealed the same trend (Maher, Hanlon & Hajjar, 2014). In Finland, a study that involved three hundred elderly people aged 75 years and above was conducted to find out the relationship between functional ability and polypharmacy. The findings indicated that individuals under ten or more drugs had their functional capacity significantly diminished and therefore find it difficult to do daily activities (Maher, Hanlon & Hajjar, 2014). There is therefore a high association between polypharmacy and problematic nutritional status, cognitive capacity and functional ability; all of which are directly influenced by the number of medications one receives.
Several observational studies among women, especially in longitudinal studies have revealed that older women tend to experience incident disabilities when they take multiple drugs. It also happens often due to inappropriate prescription whose risk is increased by polypharmacy. For cancer patients older than 65 years, use of several medications increases the risks of exacerbating their health conditions (Maher, Hanlon & Hajjar, 2014). The main problem is created by the higher risk of inappropriate prescription. Elderly people using five or more have a high risk of potentially inappropriate medication (PIM). Various studies conducted on individuals in the United States receiving home health indicated that such patients are at high risk of experiencing PIM. Therefore, polypharmacy among older people should be avoided. Instead, older generation should adopt minimal but appropriate medication to prevent further health uncertainties.
Reasons for Polypharmacy
As the population of the elderly in the society is growing, cases of chronic diseases are also on the rise. There could be a need to manage the diseases among the older people since they experience the highest prevalence of the chronic medical conditions. These individuals may have several medical complications that need medications independently. As a result, it is almost inevitable to use multiple drugs for their survival. For instance, the society is full of elderly men and women aged 65 years and above with various health issues such as hypertension and diabetes. The healthcare providers prescribe different medications to such people to ensure that they survive the adversities and live longer. The health conditions that most of the older people experience entirely depend on the availability of drugs that put their effects under control.
Since every health complication requires specific medical attention, polypharmacy becomes an inescapable event. In this context, multiple drug use is the lifeline to the persons with chronic conditions. The usefulness of several medications is reflected by the fact that it assures the continuation of life. It can be argued that there are several people whose daily survival is almost dependent on the drugs they use. To such people, multiple drug use is not an issue. In fact, it is the most important lifestyle that ensures that they stay alive. As known, chronic conditions refer to health complications that take one or more years to cure and need medical attention with the limitation of daily activities that someone may engage. They include heart diseases and arthritis. Behavioral health conditions also exist and may require a substantial amount of medical expertise to control. They may include cognitive impairment, dementia, and mental problems. When old people suffer from such chronic conditions, they may require medical intensive care because of their advanced age and reduced vigor. Without proper medical regimes, it will be easy to create a high prevalence polypharmacy. In certain conditions, the specialists are left with no choice but to prescribe multiple drugs to the patients. At such points, the most important thing is to save a life. This fact, to some extent, justifies the prescription of multiple medications to the older patients.
According to Thompson (2016), healthcare providers may require different medications to manage cancer cases. Thompson’s (2016) advice to the users of such multiple drug prescription is to stick to the directions provided by the physician. By following the guidelines, patients will get the maximum benefits from the medications. Medical healthcare providers agree that hypertension is a health complication that sometimes presents challenges when being managed or treated. As such, patients receive several drug prescriptions that put them at increased risks of polypharmacy. Hypertension treatment sometimes forces the medical specialists to give many antihypertensive medications. Here, the patient survival, particularly when they are elderly relies on proper use of the multiple drugs prescribed by the doctor. Therefore, polypharmacy is not always a bad practice. When the guidelines concerning the utilization of the medications are adhered to, elderly patients may still find reasons to accept the medicines and ease the pain of various chronic conditions that they may be struggling to cure.
Although some complications need multiple medications, the reasons advanced in support of polypharmacy are not sufficient to overlook the massive health problems it causes. Besides, according to Maher, Hanlon & Hajjar (2014), studies indicate that chronic diseases among the elderly could be managed without necessarily prescribing multiple medications. The research reveals that most of the drugs used by the patients are unnecessary. They can be done away with and still their health will be stabilized by the appropriate medical regimes.
Conclusion
The growing population of older people increases the prevalence of polypharmacy since they tend to suffer from chronic diseases that require multiple medications. The effects of polypharmacy are many and life threatening. They include substantial expenditure on medical care, drug interaction, urinary incontinence, falls, impaired cognition, problematic nutritional status, Medication None-adherence, and adverse drug reactions. Each of the side effects has numerous negative consequences to the health of the multiple drug users. Medication non-adherence is related to medical treatment failure, diseases progression, increased incidences of adverse drug events, and patient hospitalization. All these complications pose significant dangers to life. Drug adherence has always been a problem for most people. Polypharmacy is highly related to reduced intake of B vitamins, fat-soluble, minerals and accelerated rates of cholesterol, sodium, and glucose absorption. Therefore, older people with a high prevalence of polypharmacy are likely to develop health issues associated with malnourishment. The chances of experiencing falls increases as patients use different medications. Using four or more drugs increases the risk of falling. Besides, the multiple drugs, according to studies increases the likelihood of experiencing recurrent falls in future. Hence, adverse drug reactions are the undesirable effects of medication that have significant clinical as well as economic costs since they result in prolongation of patients’ hospital stay, hospital admissions and frequent visits to the emergency department.
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