Polypharmacy is defined as the use of five or more medications per day by an individual patient. Studies have shown that nearly one-half of older adults take at least this many prescription drugs, and as many as one in five of these medications is inappropriate. Although taking multiple medications is sometimes necessary, it increases the potential risk of adverse reactions and negative side effects.
In a recent study published in JAMA Internal Medicine Ashwin Kotwal, MD, and colleagues at the University of California San Francisco found that older patients who scored higher on a loneliness questionnaire were more likely to be on multiple medications including antidepressants, sedatives, anti-anxiety meds, and nonsteroidal anti-inflammatory drugs. The study’s participants also reported a slight increase in opioid use.
“All of those drug classes come with substantial risks for older people, the researchers noted, including opioid dependence, gastrointestinal bleeds, falls, fractures, delirium or cognitive impairment, new functional disability, and death” (MedPage Today).
Dr. Kotwal’s group suggested that “clinicians should consider initiating social interventions for lonely older adults or ‘social prescribing’ to local community-based support programs rather than piling on medications to relieve symptoms.”
Another part of the equation is to consider deprescribing, defined as “adjusting medications down to the minimum effective dosage or stopping them when a patient’s health status changes in a way that medication burden or potential for harm outweighs the benefit of the medication” (aafp.org). Deprescribing is often an afterthought because the health care system is geared more toward starting medications, not reducing or discontinuing them.
The American Academy of Family Physicians urges physicians to become more aware of the possible benefits of deprescribing, especially when a patient is on multiple medications. Tapering dosages or stopping one or more drugs may be the solution to a patient’s new or persistent symptoms.
A simple way to start is by assessing one particular adverse effect across all medications the patient is taking to determine if there may be an additive effect from taking multiple drugs. Knowing when and how to deprescribe is simply good medicine.