Polypharmacy

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Top Contributors - Shwe Shwe U Marma, Lucinda hampton and Kim Jackson  

Introduction

Polypharmacy refers to the use of multiple medications in a patient, commonly an older adult. While the most commonly used definition of polypharmacy is being on five or more medicines, definitions are variable.

Catagories

There is no universally agreed definition of polypharmacy, however it can be described in 3 groups-

1. Excessive polypharmacy (EPP): concurrent use of ten or more different drugs.
2. Polypharmacy (PP): the use of five to nine drugs.
3. No polypharmacy: taking four or less drugs (included those taking no medicines)

Prevalence

• Individuals greater than 65 years old are the biggest consumers of medications; however, evidence shows that greater than 50% of elderly patients are taking at least one medication that is not medically necessary. Nearly 40% of elderly adults take more than five prescription medications and almost 20% take more than 10.
• Polypharmacy declines in patients older than 85 years of age secondary to poor drug tolerance with age and increasing deprescribing practices as medical providers fear serious adverse drug reactions that may be more common in the very elderly.

Associated Factors

Individual/Patient Factors	Physician Factors	Systems-Level Factors
Increasing age Female gender White ethnicity/race Lower socioeconomic status Poor self-reported health Multiple chronic conditions Declining nutrition/ability to function Decreased cognitive capacity Self-medication Use of over-the-counter medications Borrowing from friends/family Use of multiple pharmacies	Lack of education/competence High patient workload Prescribing habits Adherence to multiple medical guidelines Use of potentially inappropriate medications Improper medication reconciliation Poor physician-patient communication Multiple prescribers	Different electronic medical record systems Poor physician-physician communication Lack of continuity between multiple medical providers Ineffective transitions of care

Risks of Polypharmacy

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