Medication Mania – Polypharmacy

My father was recently hospitalized and has come to live with me since his discharge. He was discharged on 5 new medications from the hospital. What complicates the situation is that he was not on any of his home medications in the hospital (he forgot to take his list and was unable to tell the physicians what he was taking). I have enclosed both lists with this letter. I have made an appointment for him to see his primary care physician in a month, but until then, how do I make sure he is taking the correct medications.

Medication Mania

Dear Medication Mania,

Thank you so much for your letter.

Polypharmacy, defined as taking more than 5 prescription medications is a growing epidemic in the older population. The older population makes up only 15% of the population, but consumes 1/3 of the prescription medications in this country and an even higher percentage of vitamins and herbal medications. While the data varies greatly, studies show that 15-40% of hospital admissions are due to an adverse effect or complication from medications.

The more medications a person takes the higher the risk of drug interactions and adverse events from drug interactions. There are some studies that show that if adverse drug reactions from medications were listed as a cause of death, then it would be fifth leading cause of death in the older population.

Why are older people more susceptible to medication interactions and side effects? First, they tend to have more complicated health issues and require more medications. Secondly, as people grow older the rate of medication absorption, metabolism, and elimination changes. Lastly, older people physiologically respond to medications differently; for example, Metoprolol which is a blood pressure medication is often used to slow the heart rate down; it is much more effective in a younger person than someone older than 65.

To prevent polypharmacy, geriatric physicians follow some rules when prescribing medications to older adults:

1. Drugs should only be used if non-pharmacological therapy has not been successful in treating the issue.
2. The physician should make sure that the patient’s complaint is not due to a side effect of another medication; the doctor should review the patient’s complete medication list (including herbal supplements, over the counter pills, and vitamins) for side effects and drug interactions.
3. The severity of the patient’s other illnesses must be taken in to consideration when prescribing medications.
4. In general medications in the elderly should be started at lower doses and increased slowly; the final medication regimen should be kept as simple as possible.
5. Lastly, the primary care physician should provide a list of medications for patients to share with other physicians and healthcare worker

Unfortunately, without knowing your father’s complete medical history, I cannot tell you which medications he should and should not take. However, this looks like a case of polypharmacy, and I encourage you to speak with your physician and perhaps reschedule his appointment to help resolve the issue. Perhaps your neighborhood pharmacist can help as well.

The Doctor

Medication Mania – Polypharmacy