(1/18/10)- Polypharmacy is a well known risk factor for adverse outcomes such as hospitalization and falls mainly because elderly persons are more prone to drug-drug interactions, adverse reactions and medical errors in dosing. In addition, polypharmacy may contribute to poor adherence, which has major clinical consequences. (See: Hajjar ER, Cafiero AC, Hanlon JF. Polypharmacy in Elderly Patients. Am J Geriatr Pharmacology 2007; 5:345-356.)
Researchers in Finland lead by Johanna Jyrkka studied an aged population in the city of KuopioFinland (See: Jyrkka J, Enlund H, Korhonen MJ, Sulkava R, Hartikainen S. Polypharmacy status as an indicator of mortality in the elderly population. Drug and Aging 2009; 21(12):1039-The study population consisted of 700 elderly persons 75 years or older selected randomly from a population of 4578 elderly residents of Finland
Eighty six percent of the 700 individuals consented to participate in the study. The research consisted of two five-year periods. The first was from 1998 to 2002 and the second was a follow up of the survivors of the first arm of the research.
In the second part of the study, the population were 80 years and older, a carry over of the survivors of the first part. Like the first group, this group was followed for 5 years (2003 to 2007). By the start of the second part of this study, out of 601 in the original, 233 had died and 29 refused to go on with the study or could not be counted, leaving a cohort of 339 participants in the second part of the study.
All study individuals underwent a structured clinical examination and interview. Medical records were reviewed and mortality rates were obtained from the careful records kept in Finland
The goal of the study was to assess whether polypharmacy (6 to 9 drugs) or excessive polypharmacy (10 or more drugs) could be indicators of mortality in elderly persons. The researchers concluded that excessive polypharmacy was an indicator of mortality in elderly persons. They also pointed out the limits of their study (generalize from one city to an entire population; did not control for comorbidities)
This study when read alongside the Hajjar et al* study and a host of other studies suggests that physicians be more careful in their prescription routine and that reduction of polypharmacy in the elderly may save lives instead of having an iatrogenic effect.
Hajjar reports that more then half of elderly persons using 5 or more different drugs were taking unnecessary drugs, including drugs without a clear indication, ineffective drugs and drugs that represent therapeutic duplications
Below the reader will find further references on the topic of polypharmacy
Flaherty JH, Perry HM, Lynchard GS et al. Polypharmacy and hospitalization among older home care patients.
Ziere G, Dieleman JP, Hoffman A et al. Polypharmacy and Falls in Middle Age and Elderly population
Aparasu RR, Fliginger SE. Inappropriate medication prescribing for the elderly by office-based physicians. Ann Pharmacotherapy 1997; 31:823-829
Rossi MI, Young A, Maher R. et al. Polypharmacy and health beliefs in older outpatients. Am J Geriatr Pharmacotherapy 2007; 5:317-323
Hajjar ER, Hanlon JT, Sloane RJ et al. Unnecessary drug use in frail elder older people at hospital discharge. J Am Ger Soc 2005; 53:1518-1523
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Harold Rubin, MS, ABD, CRC, Guest Lecturer
posted January 18, 2010