Geropharmacology Strategies for Reducing Polypharmacy in Older Adults

Polypharmacy can occur in people of all ages but is typically more prevalent among older adults. This population often has multiple morbidities and is thus at high risk for polypharmacy and adverse drug events (Hajjar, Cafiero, & Hanlon, 2007; Hanlon et al., 1997). In addition to concerns about patient safety, the health costs of polypharmacy can quickly compound. Older adults account for more than $3 billion in annual prescription drug sales (Kaufman, Kelly, Rosenberg, Anderson, & Mitchell, 2002). Bootman, Harrison, and Cox (1997) found that for every $1 spent on medications in nursing homes, $1.33 was spent on treating the effects of adverse drug events. In another study, Field et al. (2004) found that adverse drug reactions are responsible for 5% to 28% of acute geriatric hospital admissions and occur in 35% of community-dwelling older adults. Polypharmacy is frequently identified by the use of multiple medications, multiple prescribers, several filling pharmacies, too many forms of medication, medications taken when there is no clinical indication, multiple dosing schedules, and appropriate medications for which the patient must take too many pills, resulting in “pill burden” (Fulton & Allen, 2005; Haque, 2009; Zarowitz, Stebelsky, Muma, Romain, & Peterson, 2005). Interestingly, Michocki (2001) made a distinction between polymedicine and polypharmacy. Polymedicine is the use of many medications to treat multiple health problems, whereas polypharmacy is described as the use of multiple medications, duplicative medications, high-dosage medications, and medications prescribed for too long a period of time. This array of definitions has left many prescribers still wondering if there is some arbitrary number of drugs that defines polypharmacy, but no such number is specified in the literature. Clearly, polypharmacy is problematic, unfortunately widely practiced, and often unnecessary (Michocki, 2001). The fact that many older individuals are on multiple medications to treat comorbid conditions is not by itself problematic. Polypharmacy occurs when there is inappropriate or unnecessary prescribing that results in negative outcomes (Hajjar et al., 2007). About the Authors Dr. Planton is Clinical Consultant Pharmacist, and Dr. Edlund is Professor and Coordinator, Gerontological and Palliative Care Nurse Practitioner Options, Medical University of South Carolina, College of Nursing, Charleston, South Carolina. The authors disclose that they have no significant financial interests in any product or class of products discussed directly or indirectly in this activity, including research support. Address correspondence to Barbara J. Edlund, PhD, RN, ANP, BC, Professor and Coordinator, Gerontological and Palliative Care Nurse Practitioner Options, Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas Street, PO Box 250160, Charleston, SC 29425; e-mail: edlundb@ musc.edu. Posted: December 22, 2009 doi:10.3928/00989134-20091204-03 AbstrAct