Economics / Chapter 14 the Elderly Population

Economics / Chapter 14

The elderly population is prone to polypharmacy, or being prescribed multiple medications to treat one or several medical conditions. Although the prescribing provider(s) have good intentions, the practice of polypharmacy can lead to dangerous or even deadly consequences, particularly in the elderly. This trend is becoming more and more common, leading to questions about at what point does prescribing multiple medications more of a hazard than of any help? And perhaps most importantly, how do we as providers effectively intervene in order to address this concern?

Recent figures have shown that 6.5% of in-patient hospital admissions stem from adverse drug reactions. Of those adverse reactions, 72% are identified as ones that could definitely or possibly have been avoided (Anguita, 2011). This is of particular concern in the elderly, who are a patient population with higher incidence of multiple health problems, more prone to drug-drug interactions, errors in dosing of their medications, and are at higher risk for falls (Jykka, Enlund, Korhonen, Sulkava & Hartikainen, 2009). With new prescription drugs constantly flooding the market, there is a plethora of pharmaceutical options available to providers for treating their patients. This can lead to a trend of providers relying more on medications to treat patients rather than first exploring alternative treatment options. Jykka (2009) reports that recent studies have indicated that of elderly patients taking five or more drugs daily, half were taking drugs that were either unnecessary, ineffective, without a clear indication, and even drugs that represent therapeutic duplication. In addition, the more drugs that are added to a patient's regimen, the more likely that unwanted side effects from these drugs will occur. This can lead to more medications being prescribed to treat these symptoms or even to a drug side effect being misdiagnosed as a separate illness, and this cycle can continue to perpetuate itself.

So just how much of a contributing factor is polypharmacy to an increase in morbidity and mortality in the elderly? This can be difficult to quantify, and there are a very limited number of studies with concrete data to give a clear and supported answer to this question. However, Jykka (2009) did a study that attempted to address this problem. The study was a prospective population-based cohort study that involved subjects who were the age of seventy five and older. The participants all had a baseline clinical assessment that included reviewing and recording all of their current medications, as well as an interview at the beginning of the study. Results from the study were measured in two phases and measured outcomes of patients in the excessive pharmacy group (those taking ten or more daily medications), the polypharmacy group (those taking six to nine drugs), and the non-pharmacy group (those taking zero to five drugs). The results showed that in the first phase the mortality rate was 37%, and in the second phase was 40%. In terms of how the mortality rates differed among the three groups, Jykka (2009) reports that the survival curves in both phases represented a "significant difference in all-cause mortality between the three polypharmacy groups." In particular, "in the first phase, the univariate model showed an association between excessive polypharmacy and mortality." This study represents concrete evidence that points to the conclusion that polypharmacy does in fact have a significant contribution to morbidity rates.

Although Jykka's (2009) study showed the correlation between polypharmacy and mortality, the question of what to do about it still remains. The article written by Anguita (2011) does offer some suggestions as well as recommendations by national organizations. One intervention is for providers (particularly those in primary care) to more vigilantly review a patient's medications. An annual systematic review of a patient's medications can help to ensure that unnecessary, ineffective, and duplicate treatment drugs are eliminated from their regimen. By having a system that closely monitors medications and how they contribute to a patient's medical needs, it helps ensure that patients are receiving appropriate treatments and are not subjected to taking medications that are no longer indicated or have been ineffective. In addition, better communication between hospitals, specialists, primary care providers, and nursing or assisted living homes can facilitate this process and likely lead to improved outcomes for patients. As is often not done, giving patients explanation and reason for the medications that they are prescribed can go a long way in helping patients become more involved and informed about their own healthcare. This is significant for many reasons, but one important reason is the fact that if patients are more aware of their medications and why they are taking them can facilitate in a patient's ability to take a proactive approach to their healthcare. This certainly includes patients being able better address their questions or concerns about the need and/or effect of the medications they are prescribed.

Another key factor in addressing the polypharmacy problem lies within providers' and prescribers' decision making on treatment plans. Resisting the urge or temptation to prescribe at any opportunity that arises. Considering the potential risks and benefits of prescribing medications needs to be carefully considered. Taking a few moments to consider whether a medical concern can be resolved by means other than drug therapy can make a big difference in a patient's morbidity and mortality.