Polypharmacy in the Elderly

Sirasa Ruangritchankul

doi:10.14456/rmj.2018.9

Authors

Sirasa Ruangritchankul Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

DOI:

https://doi.org/10.14456/rmj.2018.9

Keywords:

Polypharmacy, The elderly, Drug-related problems, Drug administration

Abstract

The prevalence of polypharmacy in the elderly has risen during the last 20 years. At present, Thailand is coming aged society which the number of older adults aged 60 or over increase to 16% of total population. Older patients usually present with multiple comorbidities related to advanced age, resulting in increased demand for medications. Furthermore, other risk factors of polypharmacy are age, education, the frequency of health care services and easily approachable medication. The prevalence of polypharmacy in Thailand has varied, ranging from 29% to 75%. Polypharmacy has negative impact on the elderly such as drug-drug interactions, drug-disease interactions, adverse drug reactions and events, duplicated drugs, nonadherence, morbidity as well as mortality. Moreover, polypharmacy has profoundly negative effect on health care systems including expenditure of human resources and medical resources. Prevention of polypharmacy should get cooperation by multidisciplinary team including physicians, nurses, pharmacists, the elderly and caregivers. In terms of health care personnel, comprehensive geriatric assessment and taking history of comorbidities and medications should be concerned before making decision for treatment. However, physicians should start treatment by non-pharmacological treatment. The strategies of pharmacological treatment in the elderly are consideration of risks and benefits of regimens, adjustment of doses for renal and hepatic impairment as well as start with a low dose and slow titration. Furthermore, physicians and pharmacists should be aware of drug-drug interactions, drug-disease interactions as well as adverse drug reactions and events during treatment. Finally, development of electronic prescription and medical reconciliation can help physicians and pharmacists monitor efficacy of drug usages and detect prescription problems.

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