Polypharmacy and Geriatrics

The following is a literature review of the article “Can Polypharmacy Reduction Efforts in an Ambulatory Setting Be Successful?” by Rhonda L. Randall, DO and Stephen M. Bruno, PharmD. The article originally appeared in Clinical Geriatrics, volume 14 issue 7, in July 2006.

Polypharmacy, the use of one or more unnecessary medications, is becoming an area of greater concern in the field of geriatrics. The elderly population is responsible for consuming 34% of prescribed drugs and 40% of over-the-counter medications in the US. Polypharmacy results from two main factors. Many older adults take to self-medicating, causing them to take many unnecessary drugs. Additionally, a lack of coordinated care by physicians results in excessive or overlapping medication therapy.

The Study

A recent study focused on the impact of consultant pharmacist collaboration with prescribers in long-term care programs. Consultant pharmacists were brought in to collaborate with geriatrician medical directors to attend to potential drug-related problems (DRPs) within long-term care facilities. The study lasted for 18 months and included observations from three long-term care facilities. Over 900 medication records were reviewed for unnecessary drug use, duplication of therapy, compliance, dosage, therapy duration, and drug interaction. Prescriber recommendations were also tracked to see if they were followed accurately.

The Findings

• Duration of therapy (44%)
• Duplication of therapy (24%)
• Dosing (14%)
• Drug interaction (9%)
• Nonpreferred (5%)
• Patient compliance (1%)

The consultant pharmacists believed they prevented serious DPRs in 21 of the cases that they examined.

The Results

The study demonstrated the need for increased physician-physician and physician-pharmacist communication in the provision of geriatric care. Identifying medication errors such as those listed above can protect patients and provide them with better coordinated care as well as reduce medical costs. Consultant pharmacists proved to be effective in improving healthcare for the elderly, but these pharmacists were often limited in their ability to access up-to-date patient and prescribing information. Additionally, patients often forget to disclose self-medicating practices, and without this information from the physicians, the consulting pharmacists are unaware of other existing medication errors that could occur. Improved patient-physician communication and disclosure is, then, also important. Pharmacy tracking tools are just one improvement that can help to decrease medication errors and to improve communication between healthcare professionals providing coordinated care.