Polypharmacy
Last week we explored Advance Care Planning, this week let’s jump into a Medication related topic - Polypharmacy.
Polypharmacy means taking multiple medications for a singular or multiple condition(s). It is not unique to geriatrics, but it is very common among older adults and can be the cause of a lot of problems. As we age, we are more likely to be diagnosed with multiple chronic diseases. Things like hypertension (high blood pressure), hyperlipidemia (high cholesterol), diabetes (high/uncontrolled blood sugar), and more! Each of these disease processes comes with its own set of rules for healthy living as well as medications. In fact, according to an older study done at Georgetown University, the average number of prescription medications an 80+ year old American is on is 22, and according to the CDC 20% of Americans over 40 are taking at least 5 medications! As far as numbers go, there is not a unifying definition of polypharmacy, but taking 5 or more medications seems to be the most agreed upon number.
I become concerned for patients when they are taking over 4 prescription medications because in my experience it is very unlikely that a person is able to take all their medications day to day without any errors or missed doses, and as the number of medications increases so do the chances of having bad side effects. In fact, there is a phenomenon in medicine that is called the “prescribing cascade” which occurs when a medication’s side effect begets another medication and the side effects of that medication beget another medication and so on. I tell patients it is so important to take their medications or a complete list of medications to every office visit else they become victim to the cascade. Electronic Medical Records (EMRs) are excellent to try to mitigate errors in prescription lists, but I find a lot of patients are surprised when they learn that the EMR I use may be different than the one their specialist(s) use and so keeping a running list is an excellent way for a patient to take charge of this portion of their health.
In my clinic I like to play a game with my patients and learners (students) called “Pick 3.” In Pick 3 I ask a patient or a student to pick only 3 meds from their current list that they have to keep taking but we stop all the other ones (spoiler alert, we don’t really stop the other ones). I find this game very enlightening because it highlights what a patient finds important. Whereas I or a student may pick a cholesterol medication, a diabetes medication, and a medication for high blood pressure, the patient may pick an antidepressant, an anti-inflammatory, and their baby aspirin. I always find it fascinating what a patient will pick and the reasons why they chose that medication - “It’s my happy pill,” or “My cardiologist told me I’d die if I ever stop taking this medication,” and the reasons continue on but ultimately lead to what that person holds dear in their life.
Because Polypharmacy is increasingly prevalent in healthcare, be sure to review your medications with your doctor any time you have new symptoms develop, or really anytime you want to review your medications necessity. Geriatricians are excellent specialists for this type of problem and often work in tandem with Board Certified Geriatric Pharmacists. The prescribing cascade is an extremely difficult ride to stop, but with a team-based approach is not impossible!
Key Points:
Polypharmacy is very common as we age
Medications have side effects and it is important to review your med list with your doctor at every visit
Keep an up to date medication list
