Polypharmacy in the elderly

In our series of recent posts, we’ve focused on the importance of early detection of modifiable risk factors associated with cognitive impairment. Conditions such as depression and anxiety are patient conditions that the physician can address with evidence-based treatments.

Another risk factor, polypharmacy, has significant impact on senior health.

What is polypharmacy?

Polypharmacy has been defined quantitatively (e.g., concurrent use of five or more medications) as well as qualitatively (e.g., use of multiple drugs whose interaction can cause adverse events).

However, unlike other risk factors, prescriptions are under the direct control of the patient’s physician(s). With detection and judicious review of medication choice, the physician has an opportunity to treat active medical conditions while reducing risks of medication-related harm.

The health burden in the elderly (treated with multiple medications) intersects with the physiological characteristics of aging (e.g., altered kidney and liver function, GI absorption) to increase the risks of polypharmacy compared to younger individuals.

Drug classes associated with polypharmacy

Anticholinergics, benzodiazepines, certain antidepressants, hypnotics, antipsychotics, and opioids are among drug classes that carry risk, alone or in combination, for falls, fractures, mental status changes, and/or cognitive decline in the elderly.

Tools and resources for physicians

Resources to assist the physician include app or web-based tools such as Epocrates® and Micromedex® as well as the American Geriatric Society’s Beers Criteria®.2

Physicians are encouraged to speak to their patients and recommend deprescribing as appropriate. A recent publication indicated that the vast majority of surveyed seniors would be willing to follow their doctor’s recommendation to stop one or more current medications.3

Medication review and reconciliation

With recognition of the impact of polypharmacy on cognitive health and life function, medication review and reconciliation is a required component in the recently approved cognitive care plan code, Current Procedural Terminology (CPT®) 99483.1

BrainCheck Care™ assists practitioners in gathering pertinent medical data, including current medications, necessary to compile an individualized cognitive care plan for individuals with cognitive impairment.

References

  1. Alzheimer’s Association. (2018). Cognitive impairment care planning toolkit. Retrieved from https://www.alz.org/careplanning/downloads/care-planning-toolkit.pdf
  2. 2019 American Geriatrics Society Beers Criteria® Update Expert Panel (2019). American Geriatrics Society 2019 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society, 67(4), 674-694. https://doi.org/10.1111/jgs.15767
  3. Reeve, E., Wolff, J.L., Skehan, M., Bayliss, E.A., Hilmer, S.N., Boyd, C.M., Reeve, E., & Wolff, J.L. (2018). Assessment of attitudes toward deprescribing in older Medicare beneficiaries in the United States. Journal of the American Medical Association Internal Medicine, 178(12), 1673-1680. https://doi.org/10.1001/jamainternmed.2018.4720