Polypharmacy patients at risk for problems

Taking multiple medications can increase the chance of unexpected drug interactions.
Published April 23

BY FRED W. WRIGHT JR.

Times Correspondent

As we age, we collect things — memories, souvenirs from our travels, even coins and stamps. We also tend to collect more drug prescriptions to help us with chronic conditions.

The risk with multiple medications, though, is that we’re sometimes in danger of unexpected pharmaceutical interactions. This amassing of multiple prescriptions, even unintentionally, is increasingly of concern to medical industry professionals.

Polypharmacy patients are defined as those who regularly take five or more drugs on a daily basis.

“The older and more infirm we become, the more drugs we are prescribed for our problems,” Andreas Sonnichsen, director of MedUni Vienna’s Department of General Practice and Family Medicine in Austria, said in a news release.

“At least a quarter of people over 65 are polypharmacy patients, and after the age of 80, this increases to one in two,” Sonnichsen reported after a clinical study that involved family physicians and their patients in Austria, Germany, Italy and the United Kingdom.

The research showed that 97 percent of all polypharmacy patients studied, in this case people taking 10 medicines on average, had at least one prescription error or negative interaction with their medication. “Often it is a case of so-called prescribing cascades, whereby a symptom is not recognized as a drug side effect and, consequently, a new drug is prescribed to combat this side effect,” Sonnichsen explained.

This risk develops quickly when people are treated by different doctors and no one keeps an overview of all the prescribed drugs.

Just how pervasive are prescription drugs among older Americans? AARP conducted a survey of more than 1,200 people 50 and older earlier this year. Among the feedback the survey found for seniors who take prescription drugs on a regular basis:

• 98 percent said they take at least one prescription drug.

• 45 percent said they take four or more prescription drugs.

• 17 percent said they take six to 10 prescription drugs.

• 5 percent said they take 11 or more prescription drugs.

One solution offered by Sonnichsen is an independent, universal medication database that would track all prescription drugs, their interactions with other drugs and patient prescription records.

“This allows doctors to refer to databases that can analyze the full list of medication to identify potential interactions or prescribing errors,” he said. “The advantage of the computer is that it can display all known interactions, dosing errors and individual intolerances, even for a lot of simultaneously administered drugs, within a matter of seconds.”

For the University of Florida’s Benjamin A. Bensadon, the solution is an integrated approach to medications that combines psychiatry and geriatrics. “Many of the problems, issues and conditions that are medicated are not medical, especially with aging depression,” observed Bensadon, associate professor and director of the geriatric graduate programs at UF’s College of Medicine.

“Antidepressants are the largest selling medication we have,” he said. “Across all ages, but especially in the elderly, (there are) more and more prescriptions without diagnosis — just to make the patient ‘feel better.’ Not all medications go together.”

This is wrong thinking, Bensadon suggests. “There’s plenty of data that shows how old you feel is relevant, not how old you are. Out of 10 people who are in their 80s, all will be different in terms of healthy.”

For example, someone with insomnia doesn’t automatically need medication, he said. Cognitive behavior therapy might resolve the problem without prescription drugs.

The goal, Bensadon said, is “de-prescribing. Try and develop a medication regimen. Don’t get rid of all medications. Just use what’s necessary (and) not overmedicate.”

Side effects of a negative medication interaction could range from nausea or constipation to falls and cognitive decline, Bensadon said.

In the most dramatic incidents, when a powerful antipsychotic drug is prescribed to older people experiencing anxiety and depression, the side effects can involve permanent decline of motor control.

Some ways to avoid drug interactions seem to follow common sense.

“When you visit the doctor, tell him/her all the medication you are regularly taking, even including nonprescription drugs,” Sonnichsen advises. “Your (doctor) must be able to keep an overview.” It is important to be completely honest so that absolutely all drugs are recorded, he said.

Every so often, the current prescription list must be challenged by the physician, too. Is this precautionary painkiller really still necessary? Is a cholesterol-lowering drug still useful in very elderly patients?

Sonnichsen practices what he prescribes.

“The fewer medicines I take, the smaller the risk of potential side effects, thus increasing quality of life and saving money.”

Contact Fred W. Wright Jr. at travelword@aol.com.

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