Mini Review: Impact of Polypharmacy Treatment on Geriatric
Patients
Erlinda Surya Lita
and Julaeha
Master of Pharmacy, Universitas 17 Agustus 1945 Jakarta, Jl. Sunter Permai Raya, Jakarta 14350, Indonesia
Keywords: Polypharmacy, Geriatrics, Impact, Factors, Drug Use.
Abstract: Polypharmacy, the concurrent use of five or more drugs by a patient, is a common occurrence in elderly
individuals and is associated with potential hazards. Identifying and avoiding polypharmacy can lead to better
outcomes and improve the quality of life for elderly patients. The purpose of this paper is to describe the
impact of polypharmacy acceptance in geriatric patients. The method used to achieve this aim will be
described in the form of a questionnaire: The research method employed is a narrative review, conducted
using databases from PubMed and Google Scholar, covering the period from 2015 to 2023. The results
indicate that polypharmacy is associated with increased mortality rates, incidence of disability, combined
events, and hospitalizations. Furthermore, polypharmacy has a significant impact on the cost of health services
for patients and the healthcare system. It can lead to an increase in the dispensing of prescription drugs.
Geriatric patients who receive polypharmacy are susceptible to Adverse Drug Events (ADEs) due to drug
interactions. This can have a significant impact on their health, healthcare costs, and mortality rates. The use
of multiple drugs can lead to ADEs.
1 INTRODUCTION
Polypharmacy is the use of multiple drugs that
exceeds the clinically indicated amount.
Nonpolypharmacy refers to the use of 0-4 drugs,
while polypharmacy refers to the use of 5-9 drugs.
Polypharmacy overload is the use of 10 or more drugs
(Sahne BS, 2016).
Polypharmacy is a prevalent issue, particularly
among geriatric patients. A European study found
that 51% of home care patients take six or more
medications daily. In the UK, the average number of
drugs prescribed to individuals aged 65 and over has
nearly doubled from 21.2 to 40.8 types per year
(Johansson et al., 2016). Zulkarnaini and Martini
(2019) conducted research at the Polyclinic of RSUP
M. Djamil Padang and found that 64.72% of geriatric
patients experienced polypharmacy (Zulkarnaini &
Martini, 2019).
The global elderly population has been the subject
of extensive research, with over 260 million people
worldwide. According to the World Health
Organization (WHO), Indonesia's elderly population
is expected to reach 38 million by 2030 and 61 million
by 2050 (Faisal et al., 2023). This raises concerns
about the exponential increase in chronic and non-
communicable diseases, leading to geriatric patients
receiving polypharmacy treatment to manage their
conditions (Morin et al., 2018).
As individuals age, their body mass decreases and
they tend to have a higher proportion of body fat
compared to younger individuals. In the elderly, some
fat-soluble drugs have an increased distribution
volume, resulting in a relatively prolonged clearance
rate (Rochon et al., 2017). Therefore, polypharmacy
in geriatric patients may lead to unwanted effects and
is associated with a higher risk of harm compared to
non-polypharmacy (Almodovar AS & Nahata MC,
2019). Polypharmacy is associated with an increased
risk of potentially inappropriate drugs, medication
errors, side effects, hospitalization, and higher
medical costs, and can even lead to death (Whitney et
al., 2021).
This article review aims to examine the relative
impacts experienced by geriatric patients receiving
polypharmacy treatment. The goal is to identify the
best treatment practices to minimize negative impacts
on geriatric patients.
210
Lita, E. and Julaeha, .
Mini Review: Impact of Polypharmacy Treatment on Geriatric Patients.
DOI: 10.5220/0012642200003821
Paper published under CC license (CC BY-NC-ND 4.0)
In Proceedings of the 4th International Seminar and Call for Paper (ISCP UTA ’45 JAKARTA 2023), pages 210-213
ISBN: 978-989-758-691-0; ISSN: 2828-853X
Proceedings Copyright © 2024 by SCITEPRESS Science and Technology Publications, Lda.
2 METHODS
The writing method employed is narrative studies or
narrative reviews. This review uses articles obtained
from literature searches using databases derived from
PubMed and Google Scholar. The articles used were
published between 2015 and 2023. When writing
article reviews, data searches are conducted using the
keyword 'the impact of polypharmacy on geriatrics'.
The articles used are obtained from national and
international journals. The literature search aims to
increase knowledge related to research on
polypharmacy.
3 RESULTS AND DISCUSSION
Polypharmacy is the term used to describe the use of
multiple drugs. However, the literature provides
several different definitions of polypharmacy. Some
definitions refer to drug use that does not align with
the diagnosis, the simultaneous use of multiple drugs
to treat one or more diseases that occur together, the
simultaneous use of 5-9 drugs, or the improper use of
drugs that can increase the risk of adverse drug events
(Sahne BS, 2016).
Polypharmacy is a common occurrence in
geriatric patients and is often linked to adverse effects
and prolonged hospitalization. The administration of
medication to elderly patients is a challenging task
that necessitates careful consideration of the benefits
and potential harms. Any errors in prescribing
medication can have a significant impact on the
patient's health and well-being. The complexity of the
challenge arises from changes in age and body
functions, disease history, and the existence of
polypharmacy (Johansson et al., 2016).
Polypharmacy can pose risks for elderly
individuals (Wauters et al., 2016). This is due to the
increased likelihood of drug interactions that can
occur with a greater number of medications.
Additionally, physiological changes associated with
aging, such as weight loss, liver and kidney damage,
decreased cardiac output, and body composition
changes, can make the elderly more susceptible to
adverse drug reactions (Santanasto et al., 2017).
Geriatric patients experience changes in
pharmacokinetics and pharmacodynamics. These
changes in pharmacokinetics are caused by a decrease
in absorption ability due to changes in the
gastrointestinal tract, changes in distribution
associated with decreased cardiac output and protein-
drug binding, metabolic changes due to decreased
liver and kidney function, and decreased excretion
rate due to decreased kidney function.
Pharmacodynamic changes can be influenced by the
degeneration of drug receptors in tissues, which can
result in altered receptor quality or a reduced number
of receptors (Supartondo, 2015).
The literature reviews conducted revealed that
polypharmacy can affect health, health service
utilization, and drug management. Polypharmacy in
the health sector can have a significant impact on
health, including drug side effects, adverse drug
reactions, anxiety, circulatory system diseases,
cognitive disorders, delirium, depression, disability,
decreased function, dizziness, dry mouth, metabolic
and endocrine system disorders, weakness,
gastrointestinal disorders, genitourinary disorders,
malnutrition, multimorbidity, weight loss, and even
death (Leelakanok et al., 2017).
Polypharmacy is concerned with the safe and
effective use of drugs by patients, encompassing
prescribing, dispensing, and administering. It is
associated with potential treatment errors resulting
from improper prescribing, non-adherence to
medication, drug interactions, and differences (Burt
et al., 2018).
Polypharmacy is associated with various
negative outcomes related to health service
utilization, such as hospitalization, unplanned
hospitalization, and an increase in the number of
prescriptions. These outcomes include ADR
hospitalization, emergency department visits, longer
hospital stays, higher medical costs, and unplanned
transfers (Leelakanok et al., 2017).
Geriatric populations are at risk of potentially
inappropriate drugs (PIMs) due to several comorbid
conditions and changes in pharmacokinetics and
pharmacodynamics, making them susceptible to
improper prescribing. Despite Indonesia having a
large geriatric population, information related to
PIMs is still limited, particularly in healthcare
facilities.
According to a review of research conducted in
Europe and America, the prevalence of potentially
inappropriate medication (PIM) is as high as 40%. In
Japan and Malaysia, the prevalence of PIM is 21.1%
and 32.7%, respectively (World Health Organization,
2018).
Polypharmacy can contribute to the occurrence
of Drug Related Problems (DRP) in geriatric patients,
in addition to PIM. DRP refers to undesirable events
or conditions that can affect health outcomes and are
often experienced by patients during actual or
potential treatment therapy.
Mini Review: Impact of Polypharmacy Treatment on Geriatric Patients
211
DRP can be classified into several categories
based on the nature of the difference, including
unnecessary drug therapy, the need for additional
drug therapy, ineffective drug therapy, incorrect
dosage (either too high or too low), and adverse drug
reactions (ADRs) resulting from patient non-
compliance (Ayele & Tesfaye, 2021).
Drug-related problems (DRP) in the elderly are
influenced by several factors, including
polypharmacy, inappropriate prescribing (IP),
underuse, and medication adherence. Inappropriate
prescribing (IP) refers to pharmacotherapy
prescribing that has potential risks of use greater than
the clinical benefits. This generally occurs in elderly
outpatients. According to a study that used explicit
criteria, 15% and 21% of seniors residing in
communities and taking one or more medications
experienced issues related to dosing, duration,
duplication, or drug interactions.
Underuse is defined as the omission of a
medication therapy indicated for the treatment or
prevention of a disease. The risk of underuse is
common in the aged population and increases with
age (Meid et al., 2015). Underuse has important
associations with negative health outcomes in older
adults, including functional disability, death and
healthcare use.
According to the World Health Organization
(WHO), medication adherence refers to the ability of
a person to use a drug in accordance with the agreed
recommendations from healthcare providers. Patient
compliance with drug usage is a crucial factor in
determining the success of therapy and avoiding
serious impacts. Non-adherence to medication among
the elderly is prevalent, with rates ranging from 40%
to 80% (averaging at about 50%). According to the
literature examined by McGrath (2017), older
patients may also be non-compliant due to possible
side effects, inability to read labels on products, or
even a lack of full understanding. To overcome these
possible impacts, prescribing can be used.
Prescription is the process of identifying and stopping
drugs that are unnecessary, ineffective, or
inappropriate to reduce polypharmacy and improve
the quality of health. The collaborative process
involves considering the benefits and harms of a drug
in relation to patient care goals, functional levels, life
expectancy, values, and preferences.
Fauziah's (2020) literature review suggests that
patient-specific prescribing interventions are linked
to improved survival rates. Discontinuing
prescriptions can lead to reduced healthcare costs,
fewer drug interactions and PIM, better medication
adherence, and increased patient satisfaction.
4 CONCLUSION
The use of large amounts of medication or
polypharmacy can have negative effects on health,
increase healthcare costs, and even lead to death. This
is especially concerning for geriatric patients who are
receiving multiple medications, as evidenced by 18
reviewed articles that establish a clear link between
the use of polypharmacy and negative health
outcomes, including an increased risk of death.
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