Polypharmacy in Older Patients

Question 1

What is the cost of polypharmacy?

Answer 1

> £1 billion per year in Scotland on prescribed drugs

Direct harm due to side effects = impact on quality of life, 15% of elderly admissions to hospital

Question 2

What are some important side effects to consider?

Answer 2

Cognition and consciousness = increased delirium risk
Bowel function = especially constipation
Dizziness and balance = risk of falls/immobility

Question 3

What are some anticholinergic side effects?

Answer 3

Confusion, hallucinations, tachycardia, blurred vision, urinary retention, constipation, dizziness, falls

Question 4

What do anticholinergic side effects increase the risk of?

Answer 4

Increase risk of developing dementia

Question 5

What are some drugs associated with anticholinergic side effects?

Answer 5

Parkinson’s drugs, antidepressants, anti-emetics, opiates, antipsychotics, antihistamines

Question 6

Why has polypharmacy become a problem?

Answer 6

Patient expectations = want drugs to fix issues
Accumulation = good at starting but bad at stopping drugs, prescriptions should be time limited for some
Side effect spiral = start drug to treat side effect

Question 7

What are some interventions for medications causing harm?

Answer 7

Stop NSAID if bleeding ulcer, stop ACEi if kidney failure, stop antidepressants if hyponatraemia

Question 8

What are some side effects and uses of gabapentin?

Answer 8

Treats chronic lower back pain = causes dizziness, fatigue, visual disturbances, confusion

Question 9

How can polypharmacy be managed?

Answer 9

Stop prescribing drugs that have no benefit

Risk-benefit balance = number needed to treat and number needed to harm, and risks and benefits of this

Question 10

How can polypharmacy be prevented?

Answer 10

Thoughtful prescribing = does benefit outweigh risk?

Time limited prescription = especially symptom relief