From the Guidelines
Polypharmacy in older adults is primarily caused by multiple chronic conditions requiring different medications, varied symptoms and complaints associated with these conditions, and factors such as multiple prescribers and pharmacies, which can lead to polyproviders and patient stockpiling of medications. The most recent and highest quality study, 1, highlights that advanced age, female sex, multiple chronic medical conditions, cognitive impairment, low body weight, creatinine clearance less than 50 mL/min, frailty, lack of medical knowledge, multiple prescribers and pharmacies, and the concurrent use of 9 or more medications can increase the risk of an adverse drug event (ADE) due to polypharmacy. Some of the key contributing causes of polypharmacy in older adults include:
- Varied symptoms and complaints associated with multiple chronic illnesses
- Polyproviders, which can lead to a lack of coordination in care and increased medication use
- Patient stockpiling of medications, which can occur due to a lack of understanding of their medication regimen or fear of running out of medications
- Self-prescribing over-the-counter medications by patients, not providers, which can also contribute to polypharmacy, although this is not directly addressed in the provided studies. It is essential to consider these factors when managing polypharmacy in older adults, as they can have a significant impact on the patient's quality of life, morbidity, and mortality, as noted in 1. The use of guidelines such as Beers and STOPP/START criteria, as mentioned in 1, can help recognize high-risk medications in older adults and avert adverse drug events. Overall, a comprehensive assessment and deprescribing plan are crucial in managing polypharmacy in older patients, as highlighted in 1 and 1.
From the Research
Contributing Causes of Polypharmacy in Older Adults
The following are contributing causes of polypharmacy in older adults:
- Varied symptoms and complaints associated with multiple chronic illnesses 2, 3, 4, 5, 6
- Patient-related factors, including having multiple medical conditions managed by multiple subspecialist physicians, having chronic mental health conditions, and residing in a long-term care facility 3
- Systems-level factors, including poorly updated medical records, automated refill services, and prescribing to meet disease-specific quality metrics 3
- Polyproviders, as individual physicians varied in their prescribing practices, even after adjusting for patient demographic and clinical characteristics 5
- Patient stockpiling of medications is not directly mentioned in the studies as a contributing cause, but patient factors such as female sex, higher BMI, having Medicaid insurance, current or former smoking status, comorbidities, and seeing a specialist were associated with the number of medications 5
- Self-prescribing over-the-counter medications by providers is not mentioned in the studies, but patients taking multiple medications, including over-the-counter medications, can increase the risk of adverse medical outcomes 3, 4, 6