This article reviews the current challenges associated with polypharmacy in older adults and outlines effective strategies for clinicians to mitigate associated risks.

Introduction

Polypharmacy, defined as the concurrent use of multiple medications, is a common issue among elderly patients, leading to increased risks of adverse drug reactions (ADRs), drug interactions, and overmedication. By focusing on comprehensive medication management, regular medication reviews, and improved communication among healthcare providers, this paper aims to improve therapeutic outcomes for elderly patients while minimising the risks inherent in polypharmacy.

The ageing population is increasing globally, and with it, the prevalence of chronic diseases requiring pharmacotherapy. Polypharmacy is often a necessary consequence of managing multiple health conditions. However, it is also associated with significant health risks, including an increased likelihood of ADRs, drug-drug interactions, and the potential for overmedication [4].

Understanding polypharmacy

Polypharmacy can be classified as either intentional or unintentional. Intentional polypharmacy occurs when multiple medications are prescribed for legitimate therapeutic purposes, while unintentional polypharmacy involves the unnecessary addition of medications that may be inappropriate [1]. The consequences of polypharmacy can be severe and include falls, hospitalisations, and increased healthcare costs [8].

Risks associated with polypharmacy

1. Adverse Drug Reactions (ADRs): Older adults are particularly vulnerable to ADRs due to physiological changes associated with ageing, including altered pharmacokinetics and pharmacodynamics[9].
2. Drug interactions: The more medications a patient takes, the higher the probability of interactions that can lead to diminished therapeutic efficacy or increased toxicity [10].
3. Overmedication: The addition of medications without a comprehensive review can lead to unnecessary prescriptions, compounding risks and contributing to poor health outcomes[3].

Strategies for managing polypharmacy

Effective management of polypharmacy in elderly patients requires a multifaceted approach, incorporating the following strategies:

1. Comprehensive medication review

Regular medication reviews are essential to assess the necessity of each prescribed drug. This process should ideally involve identifying medications that may no longer be appropriate, optimising dosages, and discontinuing drugs that pose a high risk of harm without significant benefit [12].

2. Utilisation of clinical guidelines

Clinical guidelines, such as the Beers Criteria and STOPP/START criteria, can help healthcare providers identify potentially inappropriate medications in older adults. These tools offer evidence-based recommendations to minimise polypharmacy-related risks [2].

3. Enhanced communication

Improved communication among healthcare providers, patients, and caregivers is crucial. This involves sharing medication lists, discussing treatment goals, and educating patients about their medications. Structured medication reconciliation during transitions of care can help ensure safe medication use [11].

4. Patient-centric approach

Engaging patients in shared decision-making fosters adherence to medications and empowers patients to discuss concerns about their prescriptions. Encouraging patients to report any side effects or concerns regarding their medication regimen can facilitate timely interventions [7].

5. Interprofessional collaboration

Encouraging an interprofessional, team-based approach to care, which includes pharmacists, physicians, and nurses, can enhance medication management practices. Pharmacists can participate in medication therapy management, identify potential drug interactions, and provide valuable input on medication selection [6].

6. Non-pharmacological alternatives

Where appropriate, consider non-pharmacological interventions, such as lifestyle modifications, physical therapy, or dietary changes, which may reduce the need for pharmacotherapy [13].

Disclaimer- The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy or position of M3 India.

About the author of this article: Dr Partha Ghosh, BNYS, MD(YS), is a general physician and a medical writer from Siliguri, Darjeeling.