Polypharmacy in Older Adults: Are You at Risk?

Reviewed by Dr. Richard Foxx, MD — Taking multiple pills and prescription drugs throughout the day can increase the risk of adverse health effects. In fact, the more medications a person takes, the more dangerous the outcome could be. Older populations already carry increased risk for a series of illnesses. Many are currently taking medications to treat existing conditions, and those numbers are likely to increase. Many may be falling victim to polypharmacy.

Estimates suggest that by 2040, there will be roughly 82 million people ages 65 and older in the United States, representing more than 20% of the population.

Current estimates suggest that a quarter of Americans between 65 and 69 take at least five prescription drugs. For people aged 70 to 79, that number jumps to nearly 46%.

Managing all of these medications can pose multiple risks to aging populations.

What Is Polypharmacy?

Polypharmacy is a term you may not be familiar with. It is likely more prevalent among the doctors, pharmacists, and other professionals involved in providing your medication.

But that doesn’t mean you shouldn’t be aware of it or its potential dangers.

As the name suggests, polypharmacy means taking multiple medications at once.

The exact number is sometimes up for debate, but the journal American Family Physician defines polypharmacy as regularly taking five or more medications.

These medications can include any prescription drugs used to treat or manage chronic health conditions, while extending to over-the-counter (OTC) medicine and even supplements.

Polypharmacy in older adults is very common, and has the potential to increase their risk of various negative health outcomes and physical and financial hardships.

The Dangers of Polypharmacy

The concurrent use of multiple medications can present many risks.

The drugs may interact negatively with each other. The ingredients in one medication could cancel out the effects of those in another. Some ingredients in different medications can combine to create a toxic environment.

Going further, different combinations of ingredients may impair brain function and mobility. The more pharmaceuticals a person is taking, the higher the chance that one of those substances creates a problem.

Let’s take a closer look at some of the issues that can result from polypharmacy.

Negative Drug Interactions

The risk of some type of drug interaction increases with every drug added into the mix.

One study found that more than 20% of adverse drug reactions are caused by underlying drug interactions between medications. This can be very dangerous for vulnerable people with severe health issues.

Another study found that older hospitalized adults taking five or more medications were 80% more likely to have a negative drug interaction than those taking fewer meds.

Patients taking five to nine medications had a 50% probability of interactions, and that number jumped to 100% when patients were taking 20 or more.

Increased Fall Risk

Common medications that influence the central nervous system (CNS) can lead to drowsiness and confusion that boost the risk of falling. Some examples include:

• Opioids
• Antidepressants
• Tranquilizers
• Antipsychotics

A study published in JAMA Internal Medicine found that CNS polypharmacy more than doubled between 2004 and 2013, creating a huge risk for hip fractures.

Negative Side Effects from Medications

As mentioned, each additional medication increases the risk of severe side effects.

The same JAMA Internal Medicine study mentioned above found that certain combinations of blood thinners (including aspirin) were likely to increase the risk of bleeding following long-term use.

Other research has shown that hospital outpatients taking five or more medications had an 88% higher risk of experiencing an adverse drug effect, compared to those taking fewer drugs.

Higher Healthcare Costs

Clearly, the more medications you have to take, the higher your healthcare costs will be. Factor in treatment or hospitalizations for potential adverse reactions, and those costs can go even higher.

It’s even possible that you’re taking medication that is not effective. This also adds to the cost of treatment.

Non-Adherence

It can be a daunting task to take multiple pills each day. Remembering how to take each as prescribed can become increasingly difficult, especially if you have to take certain medications on specific days, at specific times, at certain doses, etc. All of this can contribute to lower medication adherence.

Cognitive Impairment

Polypharmacy has also been linked with dementia and delirium.

One study looked at 294 elders, and noted that impaired cognition was associated with medication intake.

Researchers found that:

• Twenty-two percent of patients taking five or fewer medications experienced cognitive impairment.
• Impaired cognition jumped to 33% in subjects taking between six and nine medications.
• Fifty-four percent of subjects suffered from cognitive impairment when taking 10 or more medications.

How to Prevent Polypharmacy

Preventing polypharmacy really comes down to transparency and your doctor’s opinions on which medications you should be taking and which ones you can do without.

Open Communication

Do your best to tell your doctor everything you’re taking—from supplements to OTCs and prescriptions—for every condition. This provides them with the information they need to determine what may be unnecessary, any alternatives that may work better for you, or different combinations of pills.

It is also a good idea to talk to your local pharmacist when you’re thinking about buying an OTC medication or supplement or filling another prescription.

Deprescribing

Deprescribing is a strategy that physicians can use to reduce the risk of polypharmacy. The term “deprescribing” can describe a systematic review of medications to be either reduced or discontinued.

Your doctor would have to look at your specific case to determine a risk-benefit analysis, and then decide if there is a way to simplify a drug regimen while ensuring you’re still being adequately treated.

It is highly advised that you speak to your doctor if you’re concerned about the medication you are taking, or if you are taking products they are unaware of.

Under no circumstance should you stop taking a prescribed medication of your own volition in an attempt to limit the risk of polypharmacy. Always consult your physician before making a change to your treatment plan.

A couple of screening tools you can ask a physician to employ to assess your medication use are:

• START (Screening Tool to Alert Doctors to the Right Treatment)
• STOPP (Screening Tool of Older Persons’ Potentially Inappropriate Prescriptions)

Talk to Your Doctor about Polypharmacy

Talk to your doctor if you are taking five or more medications. They can help determine if you’re taking anything redundant or putting your health at risk. The fewer medications you can safely take, the better your chances of avoiding a negative interaction or adverse effect.