As we get older, we are more likely to develop different chronic illnesses that require us to take several medications. Photo / 123RF
OPINION
In the majority of cases, medications help patients. But even when treatment of individual illnesses is effective, treatment as a whole can become problematic.
When we see an older family member handling a bulky box of medications sorted by day of the week, we might stop and wonder, is it too much? How do all those pills interact?
The fact is, as we get older we are more likely to develop different chronic illnesses that require us to take several different medications. This is known as polypharmacy. The concept applies to people taking five or more medications, but there are all sorts of definitions with different thresholds (for example, four, 10 or 15 medicines).
I’m a pharmacist and pharmacoepidemiologist interested in polypharmacy and its impact on the population. The research I carry out with my team at the Faculty of Pharmacy at Université Laval focuses on the appropriate use of medication by older family members.
We have published this study on the perceptions of older adults, family carers and clinicians on the use of medication among persons over 65.
Polypharmacy is very common among older adults. In 2021, a quarter of persons over 65 in Canada were prescribed more than 10 different classes of medication. In Québec, persons over 65 used an average of 8.7 different drugs in 2016, the latest year available for statistics.
Is it a good idea to take so many drugs?
According to our study, the vast majority of seniors and family caregivers would be willing to stop taking one or more medications if the doctor said it was possible, even though most are satisfied with their treatments, have confidence in their doctors and feel that their doctors are taking care of them to the best of their ability.
In the majority of cases, medicine prescribers are helping the person they are treating. Medications have a positive impact on health and are essential in many cases. But while the treatment of individual illnesses is often adequate, the whole package can sometimes become problematic.
When we evaluate cases of polypharmacy, we find that the quality of treatment is often compromised when many medications are being taken.
Polypharmacy is also a combination of medicines. There are almost as many as there are people. The risks of these different combinations can vary. For example, the risks associated with a combination of five potentially inappropriate drugs would certainly be different from those associated with blood pressure medication and vitamin supplements.
Polypharmacy is therefore complex. Our studies attempt to use artificial intelligence to manage this complexity and identify combinations associated with negative impacts. There is still a lot to learn about polypharmacy and its impact on health.
What can we do as a patient, or as a caregiver?
Medications are very useful for staying healthy. It’s not uncommon for us to have to take more medications as we age, but this shouldn’t be seen as a foregone conclusion.
Every medication we take must have direct or future benefits that outweigh the risks associated with them. As with many other issues, when it comes to polypharmacy, the saying, “everything in moderation,” frequently applies.