Addressing polypharmacy in older people

A major challenge in healthcare, particularly for older people, is that patients are ending up on many medicines, termed ‘polypharmacy’. Polypharmacy can be either ‘appropriate’ or ‘problematic.’ With the latter, prescribing professions are traditionally better at starting medicines than stopping them (for a variety of reasons), which means that patients are too often left with problematic polypharmacy that can lead to side effects, interactions, and an inability to manage to take them all.

The NIHR Collaboration for Leadership in Applied Health Research and Care for Northwest London (CLAHRC NWL) have an active Medicines Optimisation work stream. A lot of work has been done around the need for medication review and stopping unnecessary medicines when problematic polypharmacy occurs. The term ‘deprescribing’ has emerged strongly in the literature and CLAHRC NWL have put together what we think is the first journal issue devoted to the topic of deprescribing.

The themed issue is particularly noteworthy due to the international contributorship, including key thinkers on this topic from Australia, Ireland, Israel, and UK. Barry Jubraj, Honorary Pharmacist for Medicines Optimisation at CLAHRC NWL, co-edited this themed issue and the CLAHRC NWL team contributed to several papers, including outlining a strategy for educating students and junior clinicians about the need to undertake medication reviews. This is a novel piece of work covering an issue close to the working practice of healthcare professionals in Imperial and beyond; the web version is currently available and the print version is forthcoming.

Perspectives on the management of polypharmacy

A paper published in the journal BMC Family Practice discusses the management of polypharmacy (the concurrent use of multiple medications by one individual). Because of ageing populations, the growth in the number of people with multi-morbidity and greater compliance with disease-specific guidelines, polypharmacy is becoming increasingly common.

Although the correct drug treatment in patients with complex medical problems can improve clinical outcomes, quality of life and life expectancy, polypharmacy is also associated with an increased risk of adverse drug events, some severe enough to result in hospital admission and even death. Hence, having systems in place to ensure that medications are started only when there is a suitable indication, ensuring patients are fully aware of the benefits and complications that may arise from their treatment, and reviewing patients regularly to ensure their medication regime remains appropriate, are essential.

The development and rapid uptake of electronic patient records – particularly in primary care settings where the majority of prescribing takes place – makes monitoring of patients more straightforward than in the past; and allows identification of sub-groups of patients at particularly high risk of adverse drug events and complications. It also facilitates ‘deprescribing’ the process by which medications are reviewed and stopped if not clinically beneficial.

In recent years, we have also seen the development of smartphone ‘apps’ to improve communication between patients and healthcare professionals, improve people’s understanding of their conditions and their treatment, and maintain a record of changes made to patient’s medication. In the longer term, developments such as the introduction of artificial intelligence and clinical decision support systems also have the potential to improve prescribing and minimise the risks from polypharmacy. Finally, there is considerable scope to improve the quality of prescribing and reduce risks from poly-pharmacy using non-medical groups such as pharmacists, specialist nurses and physician assistants.

https://doi.org/10.1186/s12875-017-0642-0