When I was in pharmacy school I was taught about a concept called “Poly-Pharmacy”. It was loosely described as the situation where a person is taking multiple prescription and/or over-the-counter medicines. We were not taught to look at this as a bad thing… in fact, maybe even just the opposite. The inference was that if someone was prescribed a multitude of medicines, then it meant that the medical profession was actively doing its job and ultimately saving lives! And as a pharmacist I was playing my vital role. Today, my perspective is vastly different. Especially in regard to folks as they age – this is a terrible and costly (financially and in consideration of quality of life) practice - and I am making it my personal mission to put “Polly” out of business. An official definition for Poly-Pharmacy is “the concurrent use of more than 5 medications by an individual.” People over the age of 65 make up roughly 15% of the population but they use more than 30% of all prescription medicines written. Of course it seems obvious that older people are inclined to use more medicines – it is with aging that we tend to suffer from the conditions that supposedly require these medicines to control or manage. The problem with this scenario is that when potential medicines are being tested for safety and effectiveness, they are tested alone and they are tested in people who suffer from just the one condition that the medicine is designed to treat. And generally, the new drug is tested on subjects that are younger than the ultimate population that will end up using it. In other words – we have no way of knowing, or even accurately predicting, how multiple prescription medicines are going to act and react with each other in an individual person with multiple health challenges as he or she ages. One of the key facts that we seem to forget in medicine is that as we age our organ function and underlying biochemistry will likely change. It seems like common sense to realize that liver and kidney function in a 50 year old will change when that person is 70 and 80 and 90. If he is taking a drug that is removed through the body via one of those routes (nearly all prescriptions medicines do) then it is obvious that the amount of that medicine needed will also change. But we rarely see MDs alter the dosage of drugs as a person ages. Side effects and unwanted effects are more likely to happen. Often times, a “symptom” shows up and MDs are not looking towards the medicines that someone is already on as a potential cause… in fact, this “new” problem usually ends up being a reason to prescribe another medication! I need to introduce two terms here for my story to continue… Adverse Drug Reactions (ADRs) and Adverse Drug Events (ADEs). These two terms can be used interchangeably. An ADR is defined as, “a drug interaction that results in an undesirable or unexpected event that requires (if recognized) a change in the management of the patient.” This can happen with drugs interacting with each other, with other disease states, or with foods, and it can happen because of side effects or toxicities from the drugs. Statistics from a study done in 2003 show that in elderly people…
- 35% will experience an ADR,
- 29% will require some sort of medical intervention because of it,
- In nursing homes – 2 out of 3 people will suffer from an ADR, 15% of which will be hospitalized because of it, and
- Up to 30% of all elderly hospital admissions involve an ADR.