All articles tagged with #polypharmacy
A large study in Ontario found that 24 common drug combinations in older adults often result from side effects being mistaken for new conditions, leading to unnecessary and potentially harmful prescriptions. Researchers recommend better documentation and automated alerts to prevent these chains.
A large cohort study in Ontario identified 24 common and potentially inappropriate prescribing cascades in older adults, where side effects of one drug are misinterpreted as new conditions, leading to unnecessary additional medications. The findings highlight the need for better medication reviews and automated alerts to prevent harm.
A study of 7,828 adults aged 65+ followed for about 8.5 years found that taking five or more prescription medications (polypharmacy) is associated with a 38% higher overall mortality risk, with each additional medication linked to roughly a 7% increase. The findings suggest considering deprescribing, but limitations include a single 30-day medication snapshot and the observational nature of the study; patients should review all meds with their clinician.
A University of Michigan study of 7,828 adults aged 65+ (1999–2016) found that taking five or more prescription meds—polypharmacy—was linked to a 38% higher overall mortality risk over ~8.5 years, with each additional drug adding about 7% risk. More than half the participants fell into at least one high-risk category (40% on 5+ meds, 37.6% on meds risky for older adults, 11.4% with major drug interactions). The total number of medications was the strongest predictor of death after accounting for health conditions. The findings could guide deprescribing, but limitations include observational design and a single 30-day medication snapshot, so causation can’t be proven.
A Japanese study found that seniors discharged on six or more medications, especially those over 80 or recovering from stroke, are less likely to regain independence during rehabilitation, highlighting the risks of polypharmacy and the importance of reviewing and reducing unnecessary medications to improve recovery outcomes.
De-prescribing psychiatric drugs is an important consideration, as many psychiatric illnesses can be intermittent and highly variable. For those with a history of only one episode of depression, it may be safe to consider stopping treatment after a period of recovery, typically six months to a year. De-prescribing is also crucial for popular anti-anxiety medications like benzodiazepines, which can be habit forming and have serious potential adverse effects over time. Additionally, rational de-prescribing is essential in cases of polypharmacy, where multiple medications are used simultaneously, to avoid a "psychotropic drug soup" and simplify complex treatments without loss of benefit.
A study in Maryland found that an increasing number of children and adolescents enrolled in Medicaid are being prescribed multiple psychiatric drugs simultaneously, despite the lack of safety testing and research on the impact of these combinations on the developing brain. The prevalence of "polypharmacy" among this group, defined as taking three or more different classes of psychiatric medications, has risen by 9.5 percent from 2015 to 2020. Concerns have been raised about the long-term effects of simultaneous use of multiple psychotropic medications, especially among vulnerable populations such as youths with disabilities or in foster care.
A study led by researchers at the Beth Israel Deaconess Medical Center reveals that efforts to deprescribe medications for dementia patients are failing, as there is an increase in overall medication use following a dementia diagnosis. Despite the importance of simplifying medication regimens and reducing adverse drug events, deprescribing guidelines and efforts are not effectively implemented. The study highlights a potential gap in clinical practice and raises concerns about the increased use of central nervous system-active medications, which can adversely affect cognitive function. The findings suggest missed opportunities to reduce burdensome polypharmacy and deprescribe medications with high safety risks or limited likelihood of benefit.
Many older adults may be on too many medications and could benefit from a medication review with their primary care doctor. About 57% of people age 65 years or older take five or more medications regularly – a concept known as polypharmacy. Patients and caregivers can ask for an honest conversation with their doctor. By reevaluating their medications, older adults can actually lower their chances of potentially harmful side effects, and avoid the spiral of being prescribed even more medications.
The Beers criteria is a guideline to help guide safe prescribing practices in the geriatric population. Adverse events and drug interactions should almost always be on our differential diagnosis with elderly patients. Emergency physicians should be familiar with the Beers criteria, which includes recommendations to avoid certain medications due to potential harm, such as antipsychotics, benzodiazepines, and nonselective NSAIDs. However, the guidelines lack clear citations and discussion of absolute risk, making it difficult to incorporate into evidence-based practice.