Polypharmacy is a term that technically refers to using multiple medications, but more popularly is used in reference to five or more prescription drugs inappropriately being given to elderly patients. Commonly, geriatric patients have a number of specialist physicians who administer specific parts of their health care, but increasingly often do not have a primary care doctor who adequately coordinates all other medical providers and changes in medications. As naturopathic physicians we are often the first doctor to take a comprehensive look at our older patients and carefully examine all of their medications.
Polypharmacy . . . more popularly is used in reference to five or more prescription drugs inappropriately being given to elderly patients . . .
Statistics support the impression that large numbers of medications are being routinely prescribed in our elder patients. In 2010 the Centers for Disease Control (CDC) reported that in patients over the age of 60 more than 76% of them used two or more prescription drugs and 37% of them used five or more. That reflects a substantial increase in number of patients with five more meds over an eight-year period. More recent data is not yet available, but likely follows a similar trend. (http://www.cdc.gov/nchs/data/databriefs/db42.pdf
Polypharmacy isn’t necessarily inappropriate, but the use of multiple medications does increase risk for falls and is associated with higher rates of side effects and drug-drug interactions. The most common scenario I see clinically is when a patient has an acute illness, or is hospitalized for a procedure, they are given medication appropriate to that specific event, but then the medication is never eliminated. We live in a “defensive medicine” culture where one provider is reluctant to discontinue the medications prescribed by another, even when clinical need is no longer indicated. So what can we do? I recommend the following:
Carefully review all medications and supplements at each appointment. Even if you don’t prescribe Rx meds you need to be very familiar with each drug your patient is on.
Go over the common side effects and potential drug-drug interactions with your patients. Frequently patients never read the package inserts or talk to their pharmacist and are unaware that, for example, the dizziness they’ve been experiencing, might be due to a drug.
Don’t be afraid to recommend patients discontinue medications when appropriate. If you are not the prescribing physician it is polite to contact that doctor and bring up your concerns. If you are not in a state where you have prescription rights it is safest to articulate your concerns to the patient and recommend they bring it up with the prescribing physician.
Make sure you discontinue meds safely. Know which need to be weaned and which can be stopped.
Avoiding polypharmacy when possible creates better outcomes and quality of life for patients. Medication review is an essential part of working in geriatrics and a place where naturopathic physicians can be of great service.