Polypharmacy is a serious problem for many seniors. Here on AsOurParentsAge I’ve written multiple posts (links to a few at the bottom of this page) about the medications that our aging parents take for various chronic conditions. I’ve wondered, after considerable experience with my husband’s and my parents, why they have so many, and more importantly, why their physicians do not coordinate the medications. It seems like it would be prudent for primary care physicians to review a patient’s medications, perhaps once a year, comparing and contrasting the drugs with patient experiences and outcomes.
My musings led me to a terrific blog posting by Joanne Kenen, “Pill Popping–Or Pill Stopping? Polypharmacy’s Impact on Older Patients.” Kenen, a health policy writer, posted her December 11, 2010, piece on the Altarum Institute blog — Altarum focuses on improving health care delivery. She writes about a study, Feasibility Study of a Systematic Approach for Discontinuation of Multiple Medications (abstract), published in the October 11, 2010 Archives of Internal Medicine. The journal article is not free, but Kenen’s blog post provides a comprehensive, almost perfect and easy-to-understand summary of the research, and she has even communicated with the researcher. If you have aging parents who are on multiple medications, I strongly recommend that you read these two articles, though you may need to read the journal article at a hospital library.
The study, undertaken by Doran Garfinkel, MD, set out to discover what might happen if seniors’ medications were re-evaluated and where possible, discontinued. The author writes that “… improved medical technology in the last century has resulted in a notable increase in lifespan in general and in patients with chronic, life-shortening diseases in particular.” (p. 1652) Garfinkel points out this situation is unparalleled in human history and requires new treatment models rather than the single disease approach practiced by so many physicians today.
Mitchell H. Katz, MD, a Deputy Editor of the Archives of Internal Medicine wrote a note, posted right after the abstract, an exquisite summary of the research process and conclusions:
The investigators of this study have put the theory of “less is more” into practice. They used an established tool to discontinue medications taken by community-dwelling older persons. Remarkably, they discontinued 311 medications in 64 patients with no significant adverse reactions; 84% of patients reported an improvement in health. Clearly, outpatient medication use among older persons is a case where less is more. (p. 1648)
Polypharmacy is a huge issue for our older senior parents because the results of inappropriate medication use affects the quality of their lives. When a person visits multiple physicians for legitimate health needs, medications are usually prescribed to address specific conditions — but the larger picture is not examined. Unfortunately, it is far too easy for the medications to literally pile up on one another, and at some point it becomes extremely difficult to figure out whether, when a new health problem surfaces. Is a new problem a real problem or the result of drug interactions or side effects?
Near the end of his journal article, Dr. Garfinkel writes, “Polypharmacy itself should be conceptually perceived as “a disease, with potentially more serious complications than those of the diseases these different drugs have been prescribed for.” (p. 1653)
This subject has been on my mind a lot. Sad it took a study for them to realize that too many medications are often not a great thing for vulnerable people, but glad there’s movement toward a saner approach!
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