Factors impacting the aging population: Polypharmacy (3/4)

By: Vrati M. Mehra

Canadians aged 65 years and older make up approximately 20% of the population as of 2023 (Older Adults and Population Aging Statistics, n.d.).Older adults are part of the fastest-growing age group in Canada (Older Adults and Population Aging Statistics, n.d.). The COVID-19 pandemic brought attention to the low quality of care and attention provided to older individuals in our society. Insufficient focus on addressing the unique challenges facing older individuals led to distressing conditions in nursing homes and assisted living facilities. Many found themselves isolated in cramped quarters, devoid of meaningful human interaction, and tragically, some passed away without the comfort of seeing their loved ones, owing to stringent visitor regulations. Moreover, the pandemic underscored the vulnerability of older adults to instances of abuse and neglect, particularly within institutional settings characterized by insufficient oversight and accountability.

As longevity becomes increasingly common, the inevitability of aging becomes more apparent. It affects not only those we cherish but also stands as a shared future experience for most of us. Consequently, there arises a pressing need to invest in comprehensive, long-term strategies that prioritize the integration of older individuals within their communities, safeguarding their dignity and well-being.

Central to implementing such solutions is fostering awareness and understanding of the multifaceted challenges faced by older adults. As such, in the coming weeks, this series will identify one factor impacting this group each week and propose potential solutions for these issues.

What is polypharmacy?

Polypharmacy encompasses various definitions. While some research adopts a quantitative approach, defining it as the use of "5 or more medications by the same individual," others opt for a descriptive definition, emphasizing the concurrent use of multiple medications over an extended duration. The significance of polypharmacy lies in its potential to elevate the risk of adverse drug events and harm. Although a purely numerical definition aids in ease of use, it may oversimplify the critical concept of heightened adverse reactions when individuals consume more than one medication simultaneously (Masnoon et al., 2017).

With increasing age usually comes an increasing list of comorbidities accompanied by a long list of medications. Most health professionals are trained to check all medications being taken by their patients before adding new ones. This ensures that only important medications are added, and those that can negatively interact with the patient’s current medications are not added or added with caution. 

Prevalence of polypharmacy

Some studies report that as many as 27% of Canadian seniors take five or more medications regularly (Reason et al., 2012). Unfortunately, multimorbidity is common among Canadians. A study by St John et al. (2021)  found that among all Canadians aged 45–85, the mean number of chronic illnesses per person was 3.1. Notably, Canadian women had a higher number of chronic illnesses than men (St John et al., 2021), likely translating to a greater burden of polypharmacy. 

Polypharmacy among female patients

Studies have shown that polypharmacy is more common among female patients (32.7% in females vs. 15.2% in males) (Hosseini et al., 2018). One of the reasons for this is that they are more likely to have multiple comorbidities and be taking medications. They are also more likely to have continuous polypharmacy over an extended period than men (Thiruchelvam et al., 2021). Better education is needed, especially among older women, about the risks of polypharmacy and how to ensure they are safe when taking multiple drugs. Below are some suggestions that may help.

What can you do to ensure you and your loved ones are safe when taking multiple medications?

1. Ensure comprehensive tracking of all medications being used—this includes supplements! 

2. Always carry a comprehensive list of your medications to medical appointments, pharmacy visits, and emergency department visits, regardless of the reason for your visit.

3. Keep a wallet-sized medication list for easy access. Just as many people carry emergency contact or allergy information, it's vital for older adults, especially those on multiple medications, to have their medication list readily available.

4. Regularly review all medications with your primary healthcare provider every few months to assess their necessity and effectiveness. Discuss any symptoms and evaluate whether the current medications are beneficial.

5. Consult your pharmacist for guidance on medication scheduling, potential side effects, and necessary precautions. Pharmacists excel in identifying which medications can be taken together, with or without food, and which require specific timing. 

References

Hosseini, S., Zabihi, A., Jafarian Amiri, S., & Bijani, A. (2018). Polypharmacy among the elderly. Journal of Mid-Life Health, 9(2), 97–103. https://doi.org/10.4103/JMH.JMH_87_17

Masnoon, N., Shakib, S., Kalisch-Ellett, L., & Caughey, G. E. (2017). What is polypharmacy? A systematic review of definitions. BMC Geriatrics, 17(1), 1–10. https://doi.org/10.1186/S12877-017-0621-2/PEER-REVIEW

Reason, B., Terner, M., Moses McKeag, A., Tipper, B., & Webster, G. (2012). The impact of polypharmacy on the health of Canadian seniors. Family Practice, 29(4), 427–432. https://doi.org/10.1093/FAMPRA/CMR124

St John, P. D., Menec, V., Tyas, S. L., Tate, R., & Griffith, L. (2021). Multimorbidity in Canadians living in the community. Canadian Family Physician, 67(3), 187–197. https://doi.org/10.46747/CFP.6703187

Thiruchelvam, K., Byles, J., Hasan, S. S., Egan, N., & Kairuz, T. (2021). Prevalence and association of continuous polypharmacy and frailty among older women: A longitudinal analysis over 15 years. Maturitas, 146, 18–25. https://doi.org/10.1016/J.MATURITAS.2021.01.005