Polypharmacy
=The use of 5+ medications by the same patient.
Ireland, l in 5 of those over 50, and I in 3 of those over 65, regularly take 5 or more medications.
30% of hospitalisations in over 65s are due to ADRs or failing to take the drug as prescribed.
What’s the risk?
- Increased cost.
- Pill burden. Hard for pt to remember . order, collect etc.
- Increased risk of medication / dispensing prescribing errors. Risk of omission esp.
- Increased risk of non-compliance.
- Increased risk of drug-drug interactions.
- Risk of prescribing cascade.
- More meds, more potential adverse effects.
- Renal and hepatic function decline with age.
Who at risk – MLTC, those older, chronic mental health issues, intellectual delay, nursing home residents, those with no GP.
How to manage?
- Not always bad.
- Always review meds – needs time!
- Deprescribing tools - Beers Criteria, STOPP / START, PROMPT. Let pt know deprescribing is active care.
Drs very good at starting meds, not such much at stopping, example
- PPIs.
- Z meds.
- NSAIDs.
Multiple long Term conditions / Multimorbidity.
> 2 long term chronic illnesses.
More likely to cause difficulties if
- Female
- Older
- Lower socio-economic groups.
- Addiction
- Chronic pain syndromes
- Enduring mental health
Problems
- Synergistic loss in Quality of life.
- Inc risk of death.
- Cost to pt / carer / health service / state.
- Burden to above.
- Risk of duplication esp with vertical care ( hospital / silo).
- Polypharmacy
- Complicated drug regimes
- Reduced social functioning
- Poor self-perception / mood.
To manage
- Horizontal integration – GP. Centrally held records.
- Regular reviews.
- Deprescribing.
- Social Prescriptions.