Need to Know
Issue No. 3: Words from the Wise
Words - Aarti Patel
Illustration - STEPFANIE AGUILAR + HANNAH CANDELARIA

Polypharmacy is the use of multiple medications, usually 5-10, at the same time.  This can include vitamins, over-the-counter (OTC) pills, prescriptions, and supplements. Polypharmacy is of particular concern for older adults who tend to have more chronic ailments, making them more likely to be prescribed an increased number of medicines. Nearly 50% of older adults take one or more medicines that are not medically necessary. There is a strong relationship between polypharmacy and negative health consequences due to some of the following factors:

• Slowing Metabolism
  As a person ages, the body processes medications differently. Kidney and liver function decreases with age, which impairs the body’s ability to break down and excrete medicines, leaving them in the body longer. Some commonly prescribed medications, including certain antibiotics and nonsteroidal anti inflammatory drugs (NSAIDs) like ibuprofen, can cause kidney failure, especially in older adults.

• Drug interactions
  Sometimes two medicines that are safe to take separately are unsafe to take together, potentially causing life threatening side effects. For example, someone may be on a blood thinner medicine called warfarin. If they recently also started taking ibuprofen for back pain, the combination of the warfarin and an NSAID increases the risk of gastrointestinal bleeding, which can be deadly.

• Prescribing Cascades  
  Polypharmacy increases the risk of “prescribing cascades.” This usually occurs when an adverse drug reaction (ADR) is misinterpreted as a new condition, resulting in a new medication being prescribed. For example, an older adult may be prescribed Reglan to treat nausea, and then develop issues with movement resembling Parkinson’s disease. They see a provider for the new symptoms, which are actually a reaction to the original medication. Instead of discontinuing Reglan, extra medications are added, contributing to the cascade.