Most of us have seen how seniors often carry a box/pouch of medicines wherever they go. These medicines are often for multiple chronic issues, taken across the day. In pharma terminology, when people take more than five medications a day, it is called polypharmacy. Polypharmacy is widely prevalent among seniors. A 2021 study conducted in India found that polypharmacy prevalence among older Indian adults was 49%. Globally, seniors are said to intake two to nine medications on average per day. In the US, there are tools such as STOPP (Screening Tool of Older Person’s Prescriptions) and START (Screening Tool to Alert to Right Treatment) to review polypharmacy and take appropriate actions. Some studies are even exploring AI to try and bring about a positive impact.
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Reasons for polypharmacy prevalence
Why is polypharmacy so prevalent among seniors? The reasons are varied as listed below:
- Co-morbidities such as diabetes, hypertension, heart issues, etc.
- Self-medications for chronic issues like constipation, spasms, etc.
- In India, we also have multiple streams of treatment. So, while still on allopathic medicines, people are also willing to explore alternate options such as Ayurveda or Homeopathy, etc.
- Some people switch doctors because they are unhappy with the results and may mistakenly continue previous prescriptions with new ones.
- Consulting multiple specialists for different problems and each prescribing medicines for their speciality without looking at the existing prescriptions.
Therefore, while there is only one valid reason for practicing polypharmacy, that of co-morbidities, often, people who take many medicines may not be taking prescribed ones. Thus, polypharmacy is a major health risk for seniors, and many studies focus on this aspect to understand the reasons and the implications.
Risks
What are the risks arising from polypharmacy? One of the grave consequences is adverse drug reactions. The more medicines you take, especially, if unprescribed, the chances of adverse drug reactions increase. Interestingly, one study found that the fracture risk in seniors increased due to polypharmacy. Multiple drugs can affect your metabolism, alter your senses, and cause frailty and falls, leading to fractures. Therefore, cascading effects of polypharmacy cause health issues. However, you may not always be able to trace it back to this practice.
The symptoms of polypharmacy are:
- Sleepiness
- Decreased alertness
- Constipation
- Diarrhoea
- Dry mouth
- Incontinence
- Loss of appetite
- Confusion
- Anxiety or depression
- Weakness
- Tremors
- Dizziness
- Renal issues
If you notice, all these are the symptoms associated with many other ageing-associated issues. Therefore, it is not easy to link these symptoms to polypharmacy. Hence, misdiagnosis is common in such cases. Other than the health issues, there are also the extra expenses of purchasing multiple medicines.
Remedies
So, what is the solution? How can seniors understand the implications of polypharmacy and address it effectively? Here are a few steps you can take.
- If you visit different doctors for different problems, you must inform them about all your issues. A good practice is to create a file with your up-to-date medical history and prescriptions and carry it along whenever you go to a doctor, even for a minor issue. One suggestion is to consult a geriatrician, a specialist in treating seniors holistically. The geriatricians consult other specialists as required and manage your multiple medication issue to optimise them. If they are your primary contact, the polypharmacy is easily manageable because they know the implications.
- Avoid self-medication altogether. Even if you want to try alternate medicines, you must inform them about your allopathic ones and discuss the possibilities and consequences to avoid long-term use.
- Use pill dispensers and reminders to take the right medicine at the right time to avoid an overdose. If you miss a tablet, take the wrong one at the wrong time, or repeat one mistakenly, there are chances you may even need a hospital visit.
- Create awareness among your peers about this practice and its risks. Educate yourself and help others to avoid issues of polypharmacy. These days, most physicians are aware of the polypharmacy issue. You can discuss openly with your doctors to reduce or optimise medicines.
Polypharmacy is a real issue many seniors are dealing with. It is essential to understand that it is a health threat and can cause unwanted problems. Therefore, if you are overwhelmed with taking many medications, you could choose to have an open discussion with your doctor about it. Often, people get into an ‘I must live with it’, approach, which need not be the case. Open discussions can lead to happier solutions.
