Polypharmacy
Polypharmacy is a major concern in geriatrics and often categorized as a geriatric syndrome. Polypharmacy is frequently seen in the elderly mainly due to the increased prevalence of chronic diseases and impaired health conditions, and thus multimorbidity.
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Definition and Significance Polypharmacy is a major concern in geriatrics and often categorized as a geriatric syndrome. Polypharmacy is frequently seen in the elderly mainly due to the increased prevalence of chronic diseases and impaired health conditions, and thus multimorbidity. Obviously, this is not an exclusively age-related problem but may also be seen in younger adults or even children and adolescents if multimorbidity is present. The unfavorable effects of polypharmacy are addressed in different chapters of this book. The main negative sequelae are summarized as follows: – Unfavorable adherence – Incalculable interactions – Accumulated adverse drug reaction (ADR) risk – Increased risk of hospitalization – Increased risk of medication errors – Increased costs. Therefore, polypharmacy is considered and generally accepted as an independent health risk indicator. This is particularly true for the elderly and has been implemented in recently developed screening tools to assess the general health risk (Stuck et al. 2007). In contrast to this, a remarkable
paucity of studies primarily addressing the problem of polypharmacy has to be stated. The neglect of this area is furthermore characterized by a stillmissing consent on the definition of polypharmacy. A recent review listed more than 15 different definitions of polypharmacy (Bushardt et al. 2008). As outlined in chapter “Adherence to Pharmacotherapy in the Elderly,” five or more simultaneously prescribed drugs are considered critical in this context. Thus, we recommend accepting this number as a threshold value to define critical polypharmacy, bearing in mind that aside from the mere number of drugs, interaction patterns and cumulated ADR risk may add to the problem. Polypharmacy—although significant and critical in every patient—is certainly more significant in the elderly due to their reduced resources and compensatory abilities. Therefore, increased occurrence of ADRs in this population is easily explained. A significant factor in this context is the total anticholinergic burden, mainly caused by several simultaneously administered centrally acting drugs (e.g., antipsychotics and antidepressants). Delirium and falls are common clinical problems that often result from increased anticholinergic burden (see related chapters “Dementia” and “Fall Risk and Pharmacotherapy”).
Epidemiology H. Burkhardt (*) IVth Department of Medicine, Geriatrics, University Medical Centre Mannheim, Theodor-Kutzer-Ufer 1-3, Mannheim 68167, Germany e-mail: [email protected]
Epidemiologic data are given in chapter “Epidemiologic Aspects” in more detail. For example, a population-based German survey analyzing
M. Wehling (ed.), Drug Therapy for the Elderly, DOI 10.1007/978-3-7091-0912-0_26, # Springer-Verlag Wien 2013
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Fig. 1 Prescribing cascade. ADR adverse drug reaction
prescription patterns in an urban elderly population (BASE, Berlin Aging Study) found the prescription of five and more drugs in 53.7% of elderly patients (Steinhagen-Thiessen and
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