POLYPHARMACY
Polypharmacy and care homes
aS a rESULt of thE groWIng agEIng PoPULatIon, PoLYPharmacY IS noW rEcognISED aS a ‘nEcESSarY EVIL’, WhIch IS rEQUIrED for manY PatIEntS - PartIcULarLY thoSE In nUrSIng anD carE homES - In orDEr to ImProVE cLInIcaL oUtcomES.
P
olypharmacy – the concurrent use of multiple medication items taken by one individual – is
being increasingly driven by the growth of an ageing population and by the increasing prevalence of multi- morbidity, where patients may be living with several long-term conditions, often compounded by disability and/or frailty.
medical advances offer the hope of bringing benefits to patients, but also have the potential to do harm if used inappropriately.
appropriate polypharmacy describes the prescribing for an individual for complex conditions or for multiple conditions in circumstances where medicines use has been optimised.
Problematic polypharmacy is defined as the prescribing of multiple medications inappropriately, or in cases where the benefit of the medication is not realised.
needless to say, clinicians face mounting challenges posed by polypharmacy; one major challenge being the need to keep up to date
40 - PharmacY In focUS
with new drugs as they come on the market and of being aware of the interaction between them in patients, who are being treated for a number of medical conditions.
Why polypharmacy is challenging Polypharmacy is becoming increasingly common. By 2011, the average number of items prescribed for each person per year in northern Ireland increased to 20.2. there are several explanations for this rise; one being the fact that asymptomatic people are increasingly treated with preventive interventions to reduce their future risk of mortality and disease.
this is particularly true in relation to cardiovascular disease and medicines to reduce stroke and acute myocardial infarction events. as such, many asymptomatic or ‘well’ people are being put at risk of adverse events and harm from drug interaction. the ageing population is another important factor in the increase in polypharmacy, since the prevalence of chronic disease increases incrementally with age. If each
comorbidity is treated according to national guidelines, then it’s likely that patients could end up taking a complicated cocktail of drugs.
Problems caused by polypharmacy It is estimated that adverse reactions are implicated in up to 6.5 per cent of hospital admissions, with patients admitted with one drug side effect more than twice as likely to be admitted with another.
In addition, patients on multiple medications are more likely to suffer
drug side effects, although this is more likely to be related to the number of co-morbidities a patient has, than to their age.
Patients are often prescribed – and may remain on – drugs that cause adverse effects, often to the extent whereby the potential harm caused by the drug outweighs its benefits.
for many patients, of course, polypharmacy may be entirely appropriate, since there are many conditions in which the combined >
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