Polypharmacy in Older Adults

The Impact of Polypharmacy

• Older patients taking five or more medications are 1.5 times more likely to become frail within a 3-year period than those who take less than five medications.
• Frail patients are twice as likely to be prescribed an inappropriate medication than patients who are not experiencing frailty.
• Polypharmacy can negatively impact patients and their families or carers.
• Frailty syndromes include falls, cognitive impairment, incontinence, immobility, and susceptibility to side-effects of medications.
• Medications can cause or contribute to all of these syndromes.

The 5Ms

• The 5Ms principles and actions are relevant to deprescribing.
• Mind: Mentation, dementia, delirium, depression.
• Mobility: Impaired gait and balance, fall injury prevention.
• Medications: Polypharmacy, deprescribing, adverse medication effects, medication burden.
• Multi-complexity: Multi-morbidity, complex bio-psychosocial situations.
• Matters most: Each patient has meaningful health outcome goals and care preferences.

Polypharmacy Research

• Determining cause and effect is difficult in polypharmacy research.
• Authors rely on identifying the strength of an association between an illness and a specific medication.
• Observational studies (e.g., cohorts) are typically used in polypharmacy research.
• Experimental studies are often unfeasible in this field.
• Observational research has identified risk factors for older persons taking multiple medications.