Polypharmacy linked to poorer cognitive, physical capability

Polypharmacy is associated with poorer cognitive and physical capability even after adjustment for disease burden, according to a study published online March 24 in the Journal of the American Geriatrics Society.

10 april 2018--Mark James Rawle, M.B.Ch.B., from University College London, and colleagues conducted a prospective birth cohort study to examine longitudinal correlations between polypharmacy and cognitive and physical capability. An eligible sample of 2,122 men and women with medication data at age 69 years participated.
The researchers found that 18.2 percent of the participants had polypharmacy (five to eight prescribed medications) and 4.7 percent had excessive polypharmacy (nine or more medications) at age 69 years. In models adjusted for sex, education, and disease burden, both polypharmacy and excessive polypharmacy were correlated with poorer cognitive and physical capability, with stronger associations seen for excessive polypharmacy. Stronger negative associations with cognitive and physical capability were seen for participants with polypharmacy at both age 60 to 64 and at age 69 years.
"Future research aiming to improve cognitive and physical capability should consider interventions to reduce the duration and level of polypharmacy at younger ages, in addition to optimizing disease control with appropriate medications," the authors write.

More information: Abstract/Full Text

How to reduce medications in older generations

New research published today in the Journal of Gerontology has developed new ways to characterise older people who take multiple medicines and those who are open to "deprescribing", a process where medicines are reviewed in order to reduce or stop less effective medicines.

30 nov 2017--Lead researcher from the University of Sydney's School of Public Health, Kristie Weir, says; "Polypharmacy (multiple medications) in the older population is increasing and can be harmful. It can be safe to reduce or carefully cease medicines (deprescribing), but a collaborative approach between patient and doctor is required."
"Deprescribing isn't new, but there has been a recent explosion of research in this area showing how it can be done safely and in collaboration with patients. We provide a novel approach to describe these differences between older people who are happy to take multiple medicines, and those who are open to deprescribing.
"Ultimately, considering these variations in attitudes towards medicines and openness to deprescribing could improve communication between clinicians and their patients.
"We categorized three distinct types of people which could help guide the type of advice given by clinicians to older patients when discussing the issues around taking multiple medicines," she says. "Recognising these three types of patients can help clinicians tailor their communication approaches," she says.

Type one:

People who are resistant to deprescribing and are very attached to their medications as they are perceived as highly important to their wellbeing. This group like to be informed but ultimately preferred to leave decisions about medicines to their doctor.

Type two:

These people indicated they were open to deprescribing and preferred an active role in decision making to share responsibility with their doctor. They would consider deprescribing and said they didn't like the idea of completely relying on medications to stay healthy. This group have mixed attitudes towards medicines, valuing their benefit but disliking the side effects and hassle of taking them.

Type three:

People who were less engaged in decision making, most deferred decisions about medicines to their doctor or companion. The people in this group had chronic health conditions and as such were taking a large number of medicines. They often didn't give much thought to medicines and are commonly unaware deprescribing is an option but were open to deprescribing if their doctor recommended it.
"This research shows that doctors should tailor communication to individual older people who are taking multiple medicines in order to provide the best level of care," says Ms Weir.
"For some patients it might be that you need to help them think a bit more about their medicines and educate them more. Whereas for others, who were already aware of what medicines they were taking, identifying preferences and goals would be appropriate.
"We need to develop ways to support clinicians and patients to have these important but challenging conversations," she says.


Provided by University of Sydney

Older adults who take 5+ medications walk slower than those who take fewer medications

"Polypharmacy" is the term used when someone takes many (usually five or more) different medications. Experts suggest that, for most older adults, taking that many medications may not be medically necessary. Taking multiple medications also can be linked to problems such as falls, frailty, disability, and even death. 

27 jun 2017--Polypharmacy also is a problem for older adults due to side effects or interactions resulting from the use of different medications. Older adults may have difficulties taking the medications properly, and the medications may interfere with a person's ability to function well.
The ability to walk well is a sign of independence and good health for older adults, for example, and it may be affected by the use of multiple medications. Although healthcare providers know that some treatments can slow or hamper an older person's ability to walk, little is known about the effects of polypharmacy on walking while performing other tasks, like talking. In a new study, researchers examined how polypharmacy affected walking while talking. They published their study in the Journal of the American Geriatrics Society.
The researchers examined information from 482 people age 65 and older who were enrolled in the "Central Control of Mobility in Aging" study. That study's main purpose was to determine how changes to the brain and our central nervous system occur during aging, and how they might impact an older person's ability to walk.
Researchers confirmed the medications (prescriptions as well as herbal and other over-the-counter supplements) study participants were taking. The researchers defined "polypharmacy" as using five or more of these treatments.
Participants took detailed exams assessing physical health, mental well-being, and mobility at the start of the study and at yearly follow-up appointments. Among other evaluations, the researchers measured the participants' walking speed. None of the participants used walking aides (such as canes or walkers) or monitors. The participants were asked to walk at their normal pace on a special 20-foot long walkway, and to walk while talking. The research team also interviewed the participants to learn about their medical conditions, ability to think and make decisions, and brain function.
Among the 482 participants in the study, 34 percent used five or more medications during the study period (June 2011-February 2016); 10 percent used more than eight medications. The participants were mostly in their late 70s.
People in the polypharmacy group were more likely to have high blood pressure, congestive heart failure, diabetes, and a history of heart attacks. They were also more likely to have had a fall within the last year and were more overweight than people in the non-polypharmacy group.
After accounting for chronic health problems, a history of falls, and other issues, the people in the polypharmacy group had a slower walking speed (or gait) than the people in the non-polypharmacy group. Those who took 8 or more medications had slower walking speed when walking while talking. The researchers concluded that there was a link between polypharmacy and walking speed, and that more studies would be needed to follow-up on their findings and the effect specific medications might have on overall well-being.
The researchers also noted that at their check-ups, older adults should be asked about all the medications they take, including herbal and other over-the-counter supplements. They also suggested that healthcare professionals measure walking speed during regular check-ups.

More information: Claudene George et al, Polypharmacy and Gait Performance in Community-dwelling Older Adults, Journal of the American Geriatrics Society (2017). DOI: 10.1111/jgs.14957


Provided by American Geriatrics Society

Older adults in home health care at elevated risk for unsafe meds

Older adults receiving home health care may be taking a drug that is unsafe or ineffective for someone their age. In fact, nearly 40 percent of seniors receiving medical care from a home health agency are taking at least one prescription medication that is considered potentially inappropriate to seniors, a new study in the Journal of General Internal Medicine has revealed.

22 nov 2011--The study's researchers, led by Dr. Yuhua Bao, assistant professor of public health at Weill Cornell Medical College, found that home health care patients aged 65 and over are prescribed Potentially Inappropriate Medications, or PIMs, at rates three times higher than patients who visit a medical office. The researchers' data shows that home health care patients are taking 11 medications on average, and that the concurrent use of multiple medications is a strong indicator of the presence of PIMs.

"Elderly patients receiving home health care are usually prescribed medications by a variety of physicians, and it's a great challenge for home health care nurses to deal with prescriptions from many sources," says Dr. Bao.

Still, she sees the home health care model offering potential for improving this situation. "Having a medical professional enter an elderly patient's home is an opportunity to do a proper medication review and reconciliation," Dr. Bao explains.

The study used data from the National Home and Hospice Care Survey, conducted in 2007 by the Centers for Disease Control and Prevention (CDC), which is the most recent nationally representative epidemiological survey of home health patients. The 2002 Beers Criteria, an expert-panel-generated list that itemizes 77 medications or groups of medications considered inappropriate for elderly people, was the basis for the PIMs chosen.

In a review of data of 3,124 home health patients 65 years of age or older, the researchers found 38 percent were taking at least one PIM. Senior patients taking 15 or more medications were five to six times as likely to be prescribed PIMs as patients taking seven or fewer medications. Of those seniors taking at least one PIM, 21 percent were taking 15 or more medications.

According to Dr. Bao, the study, if anything, underestimates the prevalence of PIMs taken by home health patients: The researchers were not able to look at potentially problematic drug-to-drug interactions or drug-and-disease interactions because data were not available.

There is no one reason why PIMs are prevalent in home health care settings. "Anecdotal evidence shows that many physicians are not aware of what is on the PIM list," says Dr. Bao. "In our fragmented health care system, we generally don't have an electronic reference for a patient that lists all medications from different physicians, and there isn't a readily available means for professionals to share essential information. Enhanced physician communication with home health care nurses may help to address the problem, as well as better communication among physicians."

Dr. Bao sees incentives for improvement in communication and care coordination in the implementation of the Patient Protection and Affordable Care Act passed by the U.S. Congress in 2010. "The current payment system doesn't provide incentives to optimize coordination of care," says Dr. Bao. "But when providers in different settings as a group are held responsible for outcomes and costs of care through, for example, an accountable care organization -- a concept promoted in the Affordable Care Act -- this could create an impetus to break the communication barriers that currently exist."

Provided by New York- Presbyterian Hospital

AANP: Polypharmacy Prevention Is Responsibility of All

INDIANAPOLIS, June 26 -- Polypharmacy represents a potential problem for patients of any age, but it can be managed safely through diligence on the part of caregivers and patients.
If it isn't monitored, said Thomas W. Barkley, Jr., D.S.N., APRN-RC, coordinator of the Acute Care Nurse Practitioner Program at California State University in Los Angeles, the result is likely to be overmedication, money wasted on drugs that may not be needed, drug interactions that can lead to over- or under-dosing, and even death.
Dr. Barkley told attendees at the American Academy of Nurse Practitioners meeting here that prevention of polypharmacy -- when a patient takes three or more drugs -- is the responsibility of all involved in healthcare, including the patient.
Polypharmacy sometimes appropriate, said Barkley, such as when a patient needs multi-drug treatment to handle comorbid conditions."
One contributing factor to polypharmacy is self-medication by the patient, said Dr. Barkley. Surveys show that 73% of Americans would rather treat themselves at home than see a doctor and 96% are confident about their ability to make their own healthcare decisions.
This decreases the ability of healthcare providers to properly monitor potentially dangerous interactions.
Patients' ability to start their own regimens without input from a healthcare provider is increasing as more medications make the switch to over-the-counter (OTC) status. There are more than 700 products available OTC today that were prescription-only less than 30 years ago, said Dr. Barkley.
Elderly patients are certainly at high risk for polypharmacy -- seniors consume 34% of all prescription drugs, 33% of all over the counter drugs and 6.5 million use 1 of 33 inappropriate prescription drugs. But, the possibility should not be discounted in other patients. Patients with co-morbidities, with multiple healthcare providers, and those who use fill prescriptions at more than one pharmacy are at increased risk.
"I spend 2 minutes at the end of every interaction going back over the patient's medications," said Barkley. "I ask about everything they have ever taken to include those medications they may take sporadically, those given by other providers, and OTC or herbal preparations. 'Ever' being the keyword here."
He suggests encouraging patients and their caregivers to:
Closely monitor the patient for any physiological or psychological changes after a change in dosage or medication.
Keep a list of all medications along with dosage, schedules, and dates of first use.
Never add any herbs, supplements (including vitamins), or OTC medications without first asking their healthcare provider.
Use only one pharmacy.
Always know the reason why each medication is needed.
Never use medications prescribed for others.
Responsibilities for those with prescriptive authority include such interventions as prompting the patient to report on what they are using, discontinuing unnecessary medications, closely monitoring the patient following changes is dose or medications, using single dose regimens and using one drug to treat multiple problems when possible, and avoiding the use of as-needed medications.
"Consider all new medications to be therapeutic trials," said Dr. Barkley. "Tell the patient that this isn't necessarily forever, and that you will evaluate together how well it is working in a few weeks."
"Overall polypharmacy is widespread and not limited to elderly patients," he said. "The risks can be substantially diminished by close monitoring and that is the collective responsibility of all involved."
Dr. Barkley reported no financial support.Primary source: American Academy of Nurse Practitioners Annual MeetingSource reference: "Polypharmacy: Pills, Potions, Problems, and Prevention"