Our 2016 Focus: Polypharmacy – America’s Other Drug Problem.
October 2016 marks the 31st Talk About Your Medicines Month. TAYMM is an annual opportunity to focus attention on the value that better medicine communication can play in promoting better medicine use and better health outcomes. Initially created by NCPIE and our health education stakeholders as “Talk About Prescriptions Month,” TAYMM has grown and expanded to stimulate conversations between consumers and their healthcare providers about all the types of medicines they may take, with a focus on what to know about a medication in terms of expected health outcomes, possible side effects, benefits and potential risks.
Our 2016 Focus: Polypharmacy – America’s Other Drug Problem.
This year, we are talking about the risks of polypharmacy – the use of multiple (5 or more) medications at the same time, putting patients at risk for drug interactions and side effects - and how patients and health professionals can work together to most effectively manage multiple medications.
- Our 2016 Focus
- What is polypharmacy?
- Why is it a problem?
- Are you at risk for harm by polypharmacy?
- Tips to prevent polypharmacy and manage multiple medicines – for consumers
- Tips to prevent polypharmacy and manage multiple medicines – for health care providers
- Additional NCPIE resources
- Plan a “Talk About Your Medicines” Event
- Previous “TAP” Observances (on-line)
What is polypharmacy?
Polypharmacy is generally defined as the concurrent use of a large number of prescription medicines, over-the-counter (OTC) medicines, vitamins and dietary supplements - generally 5 or more - by the same person, at the same time. This can result in confusing medication regimens and schedules, and a concerning accumulation of side effects (“adverse drug events”) or harmful drug interactions.
As polypharmacy is a common consequence of having several underlying medical conditions – often treated by several different clinicians - it is most common in older adult patients, who have higher rates of chronic illness. According to a recent study in the Journal of the American Medical Association tracking prescription drug use from 1999 to 2012, 39 percent of those over age 65 now use five or more medications — a 70 percent increase in polypharmacy over 12 years1.
What does polypharmacy look like in real life? “A cardiologist puts someone on good, evidence-based medications for his heart. An endocrinologist does the same for his bones. And let’s say the patient, like many older adults, also uses an over-the-counter reflux drug and takes a daily aspirin or a zinc supplement and fish oil capsules. Pretty soon, you have an 82-year-old man who’s on 14 medications.”
– Dr. Caleb Alexander, co-director of the Johns Hopkins Center for Drug Safety and Effectiveness.
Why is polypharmacy a problem?
Polypharmacy - the use of multiple medicines - can result in adverse drug events (side effects) and drug interactions. Adverse drug events account for nearly 700,000 emergency department visits and 100,000 hospitalizations each year2, and the likelihood of experiencing a medication adverse event or interaction increases with the more medicines you take. In fact, the estimated incidence of drug interactions rises from 6% in patients taking two medications a day to as high as 50% in patients taking five a day3.
Polypharmacy particularly increases the risk of adverse drug events in the older adult population such as falls, confusion and functional decline. Of additional concern, in older adults, polypharmacy-related side effects or drug interaction symptoms can sometimes be overlooked or misdiagnosed because they are often confused with the normal aging process4, such as
- Tiredness, sleepiness, or decreased alertness
- Constipation, diarrhea, or incontinence
- Loss of appetite
- Depression or lack of interest in your usual activities
- Visual or auditory hallucinations
- Anxiety or excitability
Many of these symptoms associated with aging can be an outcome of the use of multiple medicines, and can be managed or prevented. There are many ways that you and your team of healthcare providers can work together to reduce or avoid the risks of taking multiple medicines, and it begins with a conversation with your health care providers and pharmacist about the medicines you take, how they interact together, and what you can do to maximize the benefits and reduce the risks of your medicines.
Are YOU at risk for harm by polypharmacy?
As older Americans age 65+ tend to suffer from the most chronic conditions and see a broad number of medical specialists, they are at the highest risk for polypharmacy. It is also true that any patient with multiple medical conditions or being treated by multiple doctors may be at risk.
To assess your risk for harm from polypharmacy, answer these 9 questions. If you answer yes to any of the following, you should see your doctor or your pharmacist and ask for a complete medicine review of possible drug interactions and side effects:
- Do you take five or more prescription medicines?
- Do you take herbs, vitamins, other dietary supplements, or over-the-counter medicines?
- Do you get your prescription filled at more than one pharmacy?
- Is more than one doctor prescribing your medicines?
- Do you take your medicines more than once a day?
- Do you have trouble opening your medicine bottles?
- Do you have poor eyesight or hearing?
- Do you live alone?
- Do you have a hard time remembering to take your medicines?
— adapted from Henry Ford Allegiance Health’s “Aging Gracefully: Reducing the Risks of Polypharmacy”
“I was the picture of health when I was growing up – all I dealt with was an occasional cold or flu. But now my body is catching up with my age, and I’ve recently been diagnosed with hypertension, diabetes and arthritis. I have to take at least 10 pills a day – three to treat each condition and each medicine requires a different set of instructions – getting older is no picnic!”
– an older American
7 Tips for Reducing the Risks of Polypharmacy (for consumers)
- Make a list of every medication you are taking, its strength and dose. Be sure this list includes any supplements, vitamins, and over-the-counter medicines you take. For prescription medications, include the name and contact information of the prescriber so that your team of health care professionals can be in touch with each other as needed.
- Share your medication list with all of your health care professions at each visit. Ask your doctor or pharmacist to check your list for possible interactions.
- Inquire if you still need to take all the medications on the list, or if you can potentially reduce the dosages.
- Always read medicine labels. They may help you avoid a possible drug interaction and to know what potential side effects to be on the lookout for.
- Aim to get your prescriptions filled at the same pharmacy, this way the pharmacist has a complete record of all the medications you take and can monitor for possible interactions. Many pharmacies now over a “medication synchronization” program in which you can coordinate your refill schedules and arrange to pick up of all of your ongoing prescription refills at the pharmacy on a single, convenient day each month and speak with your pharmacist about any issues or questions at that time.
- Avoid combination medicines (products that contain multiple active ingredients, like cold remedies that may treat congestion, cough and achiness). Buy only medication that treats the specific symptoms you are experiencing.
- If you are already taking multiple medicines, don’t take start a new medicine without discussing possible side effects and interactions with your doctor, your pharmacist, or both. If a new medicine is prescribed or recommended, ask “Will this medicine work safely with all of the other medicines I am taking.”
Tips for Health Care Providers: Preventing & Managing Polypharmacy in Your Patients
- Prevent: Avoid prescribing for minor, non-specific or self-limiting complaints. Only prescribe when there is a strong need for the
- Conduct a regular medication review: An accurate and up-to-date drug history is essential for patients on multiple medicines and should include
and OTC medicines as well as vitamins and herbal supplements. Assess the appropriateness and ongoing need for therapy, adverse effects and interactions, the dosage regime and formulations, and also the patient’s compliance/adherence. Pharmacists, look into enrolling your patients on multiple medications in medication synchronization programs to coordinate refill pick-ups and have a dedicated monthly opportunity to provide counseling or answer questions.
- Adjust: Make medication adjustments as needed. Retain only those medicines for which there is an ongoing need. Decrease the dosing frequency and
titrate doses down where appropriate.
- Consider non-pharmacological approaches: Use lifestyle measures whenever possible either as an adjunct or instead of medications.
- Communicate: Talk with the patient about why you are prescribing the medicine, what the anticipated benefits are and what the risks and potential
side effects may be. Ensure they understand the dosage and directions. Speak to your patients about their concerns, expectations, difficulties in using the medications and their ability to follow the medication regimen. Discuss any suggested changes to the medication regimen with the patient’s other health care providers.
- Simplify: Reduce your patients’ regimen to essential drugs. Consider fewest possible dosage intervals and dose reduction where appropriate.
- “Start low and go slow:” Although requirements vary considerably from patient to patient, doses often may be reduced for elderly patients by
one-third to one-half of the recommended adult dose5. For patients on multiple medicines already, start any new medication as a trial and discontinue it if ineffective or if side effects are unacceptable. Check for drug interactions before writing any new prescription or recommending a new OTC medicine.
— adapted from National Prescribing Services Newsletter “What is Polypharmacy” (PDF) and Modern Medicine, “Polypharmacy: Keeping the Elderly Safe”
Additional NCPIE Resources
- Talk Before You Take: Talk to your healthcare provider and ask questions about the benefits and potential risks of medicines you take. Learn tips for maximizing the time you have to talk with you health professional to get the information you need about your health and medicines.
- 10 key questions (PDF): Download the “Talk Before You Take” list of 10 key questions to ask about the medicines you take.
- Your Medicines. Be Safe. Be Smart. (PDF) Safe medicine tips brochure.
- Safe Use. Safe Storage. Safe Disposal. Tips from Talk About Your Medicine Month 2015.
Credits and Footnotes
* Content on this page is adapted from Henry Ford Allegiance Health’s brochure Aging Gracefully: Reducing the Risks of Polypharmacy.
- Qato, D. Changes in Prescription and Over-the-Counter Medication and Dietary Supplement Use Among Older Adults in the United States, 2005 vs. 2011. JAMA Intern Med. 2016;176(4):473-482.
- Budnitz, D. Emergency hospitalizations for adverse drug events in older Americans. N Engl J Med. 2011;365:2002-2012.
- Lin, P. (2004). Drug interactions: A method to the madness. Perspectives In Cardiology, 20(10), 20.
- Henry Ford Allegiance Health’s Aging Gracefully: Reducing the Risks of Polypharmacy
- Beers, M. H. (Ed.) "The Merck manual of geriatrics (3rd ed.), Section 1, Basics of geriatric care, Chapter 6, Clinical pharmacology." 2005.
Plan a “Talk About Your Medicines” Event
Planning a “Talk About Your Medicines” event in your community? Contact NCPIE at firstname.lastname@example.org and request a
free toolkit. (It will be sent to you via email only.) The 2016 toolkit contains a newsletter article, Facebook and Twitter Posts and graphics that you can share.
One more thing: Follow @TweetNCPIE and “Like” us on Facebook to be part of the “Talk About Your Medicines” Month conversation!
Previous Talk About Your Medicines Month tools and resources
Note: All previous “Talk About Your Medicine” themes are “evergreen” - meaning the messages can be used throughout the year.