The problem of polypharmacy, or the prescribing of multiple potentially inappropriate medications to patients with multiple chronic illnesses, particularly the frail elderly, has been recognized for more than 40 years. The physiological changes of aging make elderly patients particularly vulnerable to the harms of polypharmacy, routine excess dosing, and side effects of drugs.
Between 25-45% of elderly Americans are on five or more prescription medications, and more than 20% are taking at least 10 drugs. In the past 20 years, the rate of polypharmacy has nearly doubled in the US and this pattern is mirrored in other developed nations.
While drugs can improve and lengthen patients’ lives, the hazards of adverse events, whether due to side effects or drug interactions, increases with every additional prescription. Adverse drug-drug reactions caused by polypharmacy can lead to frailty, falls, hospitalization, and even death.
While multiple tools exist to reduce polypharmacy, the barriers to change are high – lack of communication between prescribers, clinical guidelines that recommend additional medications, patients’ fear of medication cessation, lack of information on patients’ prescriptions, reluctance to stop another doctor’s prescription, and more.
We believe reducing polypharmacy—and promoting the practice of deprescribing—requires an “ecological” approach, which tackles the problem from several angles using a variety of means to increase awareness among clinicians, pharmacists, and patients, and to provide incentives for clinicians and pharmacists to change their behavior.
We are conducting research and convening a working group of experts to create a framing paper on polypharmacy – defining the problem, the effects, the barriers and drivers, and interventions. We will then create an action plan of policies and interventions aimed at clinicians, physician societies, pharmacists, patients, which will serve as a first step towards a national strategy for addressing polypharmacy and inappropriate prescribing in frail elderly patients.
This project is made possible through the generous support of the Gordon and Betty Moore Foundation.