Medications Can Cause Harm? An Analysis of Polypharmacy in the Perspective of Geriatrics

By: Minjae Shin, Design Environmental Analysis ‘27

Have sleeping issues? Take melatonin. Have diabetes? Take drugs that promote insulin secretion. People often approach prescriptions in a disease-centered perspective, as if they are simple one-to-one instantaneous solutions to certain diseases. In fact, the current healthcare systems generally have a single-disease focus. However, the conditions are more complicated than we think, especially for elders who commonly suffer from multimorbidity, the co-occurrence of two or more chronic conditions [1]. Prescribing multiple medications is often clinically required to deal with multimorbidity, but excessive prescriptions can lead to threatful health outcomes due to adverse, often unexpected, interactions between drugs. This condition, often referred to as polypharmacy, is even more detrimental to the health-related quality of life of elders due to their vulnerability [2]. With the increasing significance of the multimorbidity of geriatric patients, the threat of polypharmacy must be addressed and improved within the healthcare field. 

Significance of Polypharmacy and The Potential Impacts on Individual Patients

Polypharmacy, the prescription of multiple (usually five or more) medications to a patient at the same time, has emerged as a significant health issue due to the increase in the elderly population. According to the National Health & Nutrition Examination Survey held in the United States, the proportion of polypharmacy among adults aged 65 or older tripled from 12.8% to 39.0% between 1988 and 2010 [3]. 46% of the hospitalized elderly patients in Korea have experienced polypharmacy [4]. The threats of polypharmacy due to drug-drug interactions, drug-disease interactions, and medication errors are often more detrimental to the elderly because of metabolic changes and reduced drug clearance associated with aging [5]. 

Prior studies put emphasis not only on the direct metabolic effect on each individual but also on the indirect consequences that appear in the process of caregiving and handling medications after consuming the medications. Polypharmacy is linked to increased risks of disability and cognitive decline; it also reveals a correlation with prolonged hospitalization, which is associated with increases in healthcare costs and the onset of disuse syndrome [6][7]. The physical decline due to a decreased lack of physical activity as a side effect of a longer hospitalization period leads to frailty, another predominant chronic disease associated with aging. The inability of physical activity due to muscle loss (sarcopenia) significantly impacts elders’ physical and psychological health, developing as a public health problem [8]. Since polypharmacy frequently initiates additional health issues, it sets off a positive feedback loop where more medications are needed by the patient, thus even more exacerbating the negative effects of polypharmacy. 

The costs of polypharmacy are not limited to health but also extended to the patients’ economic conditions and quality of life. Although the prevalence of polypharmacy itself does not show evident differences between populations of different poverty levels [9], costs of recovering from the same threats may impact more heavily on underprivileged patients, for reasons such as aggravation of costs for medication and caregivers or aftereffects of long term deviation from work due to hospitalization. Combination of these health and personal costs emphasizes the necessity of patient-centered care that may alleviate the problem of polypharmacy. 

Current Solutions to Polypharmacy

The problem of polypharmacy, unfortunately, cannot be alleviated merely by decreasing the number of prescriptions in elders because the conditions derived from polypharmacy are often demented with normal aging signs, such as tiredness, sleepiness, or decreased alertness [5]. The symptoms are consequently often disregarded as another new health issue that should need a prescription, instead of the side effects of medications already prescribed, leading to a negative feedback loop of even more medications being consumed by the patients. Thus, the complexity of diagnosis and prescription indicates a need to view a patient’s condition from multiple perspectives and emphasizes the importance of collaboration and communication between healthcare providers about decision-making that best fits individual patients’ unique needs [10]. The complexity also sheds more light on the analysis of adverse health outcomes due to multi-drug combinations that should be monitored and expanded by healthcare professionals. 

References

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