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

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

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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.

REFERENCES

Almodóvar AS., Nahata MC. (2019). Associations

Between Chronic Disease, Polypharmacy, and

Medication-Related Problems Among Medicare

Beneficiaries. J Manag Care Spec Pharm.;25(5):573-

577.

Ayele, Y., & Tesfaye, Z. T. (2021). Drug-related problems

in Ethiopian public healthcare settings: Systematic

review and meta-analysis. SAGE Open Medicine, 9,

205031212110097.

https://doi.org/10.1177/20503121211009728

Burt J, Elmore N, Campbell SM. (2018). Developing a

measure of polypharmacy appropriateness in primary

care: Systematic review and expert consensus study.

BMC Med;16:91

Faisal S, Zairina E, Nathishuwan S, Khotib J, Kristina

SA, Nugraheni G. (2023). Prevalence and Predictors of

Excessive Polypharmacy in Geriatric Inpatients: A

Retrospective Cross-Sectional Study in Indonesia.

Journal of Primary Care & Community Health;14.

Fauziah, Husna M, Roza M, Rose. (2020). Polypharmacy

in Geriatric Patients. Human Care Journal. 5. 804.

10.32883/hcj.v5i3.796.

Johansson T, Abuzahra ME, Keller S, Mann E, Faller B,

Sommerauer C. (2016). Impact of strategies to reduce

polypharmacy on clinically relevant endpoints: a

systematic review and meta-analysis. Br J Clin

Pharmacol; (82): 532– 48.

Leelakanok N, Holcombe AL, Lund BC. (2017).

Association between polypharmacy and death: A

systematic review and meta-analysis. J Am Pharm

Assoc;57: 729e738.e10.

McGrath K, Hajjar ER, Kumar C, Hwang C, Salzman

B. (2017). Deprescribing: A simple method for

reducing polypharmacy. The Journal of Family

Practice; 66 (7): 435-45.

Meid AD, Quinzler R, Freigofas J, Saum K-U,

Schöttker B, Holleczek B. (2015) Medication

Underuse in Aging Outpatients with

Cardiovascular Disease: Prevalence, Determinants,

and Outcomes in a Prospective Cohort Study. PLoS

ONE 10(8): e0136339.

Morin L, Johnell K, Laroche ML, Fastbom J,

Wastesson JW. (2018). The epidemiology of

polypharmacy in older adults: register based

ISCP UTA ’45 JAKARTA 2023 - THE INTERNATIONAL SEMINAR AND CALL FOR PAPER (ISCP) UTA ’45 JAKARTA

212

prospective cohort study. Clin Epidemiol;10(10):

289-298.

Organization W. H. (2018) Health situation and trend

assessment. Elderly population. Geneva: World

Health Organization; http://www.searo.who.int/entity/

health_situationi_trends/data/chi/elderlypopulation/en

Rochon PA, Gill SS, Gurwitz JH. (2017). General

principles of pharmacology and appropriate

prescribing, in Hazzard’s Geriatric Medicine and

gerontology, seventh edition. McGraw-Hill

Education; 347-60.

Şahne BS. (2016) An overview of polypharmacy in

geriatric patients, in challenges in elder care. Intech

Open: 69-80.

Santanasto AJ, Goodpaster BH, Kritchevsky SB. (2017).

Body composition remodeling and death: aging health

and body composition studies. J Gerontol A Biol

SciMed Sci.;72(4):513–519.

Supartondo, Roosheroe AG. (2015). Guidelines for

giving drugs to geriatric patients and overcoming

polypharmacy problems, in: Setati S, Alwi I,

Sudoyono AW, Simadibrata KM, Setiyohadi B, Syam

AF. Textbook of internal medicine volume III Edition

VI. Interna Publishing; 3714-6 .

Wallace E, McDowell R, Bennett K, Fahey T, Smith

SM. (2017). Impact of potentially inappropriate

prescribing on adverse drug events, health related

quality of life and emergency hospital attendance

in older people attending general practice: a

prospective cohort study. J Gerontol A Biol Sci

Med Sci.;72(2):271–277.

Wauters M, Elseviers M, Vaes B. (2016). Too many, too

few, or too unsafe? Impact of inappropriate prescribing

on mortality, and hospitalization in a cohort of

community-dwelling oldest old. Br J Clin

Pharmacol;82(5):1382– 1392.

Whitney DG, Schmidt M, Haapala H. (2021).

Polypharmacy is a risk factor for mortality, severe

chronic kidney disease, and liver disease among

privately insured adults with cerebral palsy. J Manag

Care Spec Pharm.;27(1):51-63.

Zulkarnaini A, Martini RD. (2019). Polypharmacy

description of geriatric patients in several polyclinics of

Dr. M. Djamil Padang Hospital. Andalas Health

Journal; (8): 1-6.

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