Polypharmacy in the elderly

Background: Individuals >65 years (seniors) use more drugs than younger people. Polypharmacy, often defined as using >5 drugs, is often necessary but increases risks of adverse outcomes related to non-adherence and adverse drug events. Our objective was to assess polypharmacy prevalence and potential complications among local seniors. Hypotheses were: 1) polypharmacy affects >=20% of seniors , 2) seniors with polypharmacy are more likely to miss doses and have duplicate prescribed drugs and inappropriate drug combinations.

Methods: This cross-sectional study used a convenience sample of seniors recruited 10/1/2010-1/30/11 from county senior day programs. Enrolled seniors reviewed their prescribed drugs with a pharmacist consultant. Primary outcomes were 1) the percentage of seniors with polypharmacy, 2) self-reported frequent missed doses, 3) at least 1 duplicate drug, and 4) at least 1 inappropriate drug combination.

Results: 59 seniors enrolled (25.4% male) from 3 centers. Mean age was 76.9 yr (range 65-90); 35.6% had polypharmacy. 22% frequently missed doses, 19%, had duplicate drugs, and 20% had inappropriate combinations. 40% had prescriptions from multiple pharmacies. 57% of seniors with polypharmacy, and none without polypharmacy had inappropriate combinations. Polypharmacy was associated with duplication when models adjusted for race and education (OR 10.7, 95% c.i. 1.5-76.7, p=0.02). Polypharmacy was not associated with frequent missed doses (p=0.29).

Conclusions: Polypharmacy was common among senior center participants and was associated with drug duplications and inappropriate drug combinations. Many seniors used multiple pharmacies. As we promote the medical home, we need to improve coordination and communication between seniors, physicians, and pharmacists.