Advancements in Life Sciences Research Aims to Mitigate Risks Associated With Polypharmacy in Older Adults

If you take numerous prescriptions for your condition, your care may fall under polypharmacy. Some have negative experiences during this process, so how can polypharmacy be prevented in older adults? Here’s what life science research shows about this medication use.

What Is Polypharmacy?

Polypharmacy includes taking five or more medications to treat a condition. This care strategy is more prevalent when you age, considering your risk for chronic illnesses increases. A 2023 Global Health Research and Policy study found polypharmacy doubled between 1999 and 2018, rising from 8.2% to 17.1%.¹

“The polypharmacy was especially higher … in patients with heart disease, and in patients with diabetes,” the researchers said. “The high prevalence urges the healthcare providers and health policymakers to develop and implement measures targeted at polypharmacy among specific population groups, which might be of great potential significance to the delivery of appropriate and safe medication.”

You might not sign up to take that many medications for your condition, but your healthcare provider may deem it necessary. If your ailment presents varying symptoms, you may need multiple prescriptions to target these issues. For instance, your condition could include inflammation, mood changes, and pain needing treatment.

What Are the Risks of Polypharmacy for Older Adults?

Some healthcare providers may say multiple medications are necessary for their patients. However, the risks involved make life science researchers wonder how polypharmacy can be prevented in older adults. Here are five potential consequences of this healthcare approach.

1. Adverse Drug Reactions

One of the primary risks of polypharmacy is adverse drug reactions. The likelihood of a poor interaction increases with the number of prescriptions. Two or more medications could interact and cause severe side effects, thus making the approach less productive. Therefore, healthcare providers must be careful when prescribing.

With polypharmacy, you only need two incompatible medications to cause adverse effects. For example, your healthcare provider may prescribe a blood thinner like warfarin. If you take it with a pain reliever like aspirin, a 2022 investigation found the two caused higher bleeding rates in patients.²

2. Reduced Efficacy

One pill could reduce the absorption of another, leading to ineffectiveness. Therefore, you’re less able to combat your condition and get the necessary care.

If you have hypertension, your healthcare provider may prescribe lisinopril. Combining this angiotensin-converting enzyme inhibitor with ibuprofen is less effective. Ibuprofen is a non-steroid anti-inflammatory drug that may increase the risk of kidney damage when taken with lisinopril. You may also experience higher blood pressure.³

3. Fall Risks

Falling is a significant risk for older adults. One incident could cause broken bones, fractures, or fatalities. Experts say your fall risk increases with polypharmacy because of various side effects.

A 2022 BMC Geriatrics study examined the relationship between polypharmacy and falls among older adults in Saudi Arabia. The researchers followed 387 outpatients and the use of potentially inappropriate medications (PIMs). Five months of data showed that 55% of patients had a high risk of falling, so the researchers concluded a significant association was present.⁴

For instance, your medication could increase dizziness and lightheadedness. Other interactions could impair your balance or adversely affect cognitive function.

4. Increased Expenses

Pharmaceutical expenses can be cumbersome for older adults. If you’re retired or have a disability, you may have less income, so affording medications may be more expensive. Seniors may need help to afford medications with polypharmacy, leading to medical debt and conflict with living expenses.

The costs for five or more medications can add up quickly. A 2022 report from the Washington Office of Financial Management found older adults paid $17,733 more for polypharmacy than those without.⁵ Other costs originate with hospitalizations, emergency care, and adverse drug events. You may also have more doctor visits, lab testing, and other healthcare costs.

5. Complex Management

When you have five or more medications, keeping track can be challenging. Older adults may need help with their routine, especially if they have cognitive issues. You may miss one of your doses, leading to unwanted health issues. Alternatively, seniors may become confused and take one too many pills due to a complex schedule.

A complicated medication regimen could also hinder healthcare providers. With five or more prescriptions, you increase the risk of oversight and errors. It’s also essential to consider the consequences on a healthcare facility’s resources. Polypharmacy requires extra side effects and efficacy monitoring, thus consuming more of the staff’s time.

How Can Polypharmacy Be Prevented in Older Adults?

Healthcare providers must determine whether their patients should take five or more medications. Some may benefit from alternative strategies due to the health risks, but how can polypharmacy be prevented in older adults? Here are five modern methods.

1. Detailed Medication Reviews

One of the first steps should be a comprehensive medication review. Healthcare providers should regularly examine your prescriptions and ensure all are necessary and effective for your condition. Otherwise, they should consider deprescribing the medication. Extra scrutiny is warranted if the medication causes adverse side effects.

Regular medication reviews are essential if you see multiple specialists. Tell your healthcare provider about the other prescribed medications to avoid increasing risks. They should also discuss medication schedules with you, as they can influence outcomes.

2. Strong Healthcare Guidelines

The Beers Criteria have been essential in treating older adults. Mark H. Beers — a California geriatrician — developed this process to determine whether medications are necessary in 1991. The criteria have improved over the past three decades, so healthcare professionals could use it to combat polypharmacy’s risks.

This evidence-based approach warns which medication interactions to avoid and which require reduced dosages. You also get critical information regarding the side effects of each medication, helping you weigh the drawbacks. Updated Beers Criteria provide recommendations on drugs and the quality of evidence.⁶

3. Advanced Technologies

Humans are prone to mistakes, so it helps to have technology by your side. Advanced algorithms and analytics help healthcare providers understand individual patients and their needs. Therefore, you know in real time whether there’s an adverse interaction risk or duplicate medications. Some providers use medication management systems to track these medications.

Medication management software provides automated solutions to understand your prescriptions. This system leverages algorithms to support clinical guidelines, thus determining your medication needs. For instance, you may need specific medicines based on your age and renal function. Recent advancements like  IoT sensors and blockchain technology have made medication management more effective.⁷

4. Simplified Medication Routines

Adherence is among the risks of polypharmacy, so how can these issues be prevented in older adults? Another critical step for healthcare providers is simplifying medication routines. Your doctor could reduce the number of prescriptions by combining therapies. For example, a fixed-dose combination incorporates two ingredients in one dosage.

A prominent example of a fixed-dose combination is Atripla, which contains emtricitabine, efavirenz, and tenofovir disoproxil fumarate. Combining these therapies improves convenience and optimizes the dosing. How does it compare to other polypharmacy treatments? A 2023 Frontiers in Pharmacology study found fixed-dose combinations increase adherence better than free-equivalent combination therapies.⁸

5. Behavioral Interventions

While polypharmacy risks focus on medications, there are also human issues to consider. Behavioral interventions may be necessary to address how people approach their prescriptions. Your healthcare provider could implement this strategy to ensure the appropriate use of medications. It’s also beneficial if patients have cognitive issues regarding their prescriptions.

Healthcare providers may use behavioral intervention to improve medication adherence and limit the risks of drug interactions. A 2022 International Journal of Environmental Research and Public Health study focused on people in Thailand with schizophrenia. The researchers found that cognitive-behavioral therapy and motivational interviewing helped patients with adherence over time.⁹

What Signs Indicate Polypharmacy Has Negative Effects?

Polypharmacy may negatively affect your health, especially as you age. Therefore, understanding the signs of harm is essential. Here are a few signs your medications have adversely affected your health:

• Appearance changes: Your medicine could cause changes in your appearance. For example, you could experience weight gain, fluid retention, or changes in skin tone.¹⁰
• Loss of appetite: Taking numerous medications could lead to a suppressed appetite. You could endure malnutrition and decreased protein absorption due to polypharmacy medications.¹¹
• Depression: Polypharmacy could lead to depression in older adults¹², emphasizing the need for personalized care.

Why Does Polypharmacy Pose Challenges for Seniors?

As you age, your water content and muscle mass decrease while your body fat may increase. Therefore, your body’s ability to break down and excrete drugs may be inhibited. Seniors with five or more medications may encounter slower absorption rates, leading to lower peak serum concentrations.¹³

Polypharmacy may affect the entire pharmacokinetic process in your body. For example, multiple medications could influence distribution by displacing each other from protein binding sites. This occurrence could minimize the drug’s effects in older adults, causing further issues. The ramifications also hinder excretion by harming kidney function and renal toxicity.¹⁴

Polypharmacy also affects pharmacodynamics in older adults. This branch of pharmacology focuses on what a drug does to your body on physiological, biochemical, and molecular levels. Older adults may experience pharmacodynamic changes in their bodies through adverse drug reactions or reduced efficacy. You may be more sensitive to specific medications because of your receptor function as you age.

Discovering How Polypharmacy Can Be Prevented in Older Adults

Polypharmacy’s prevalence is increasing worldwide. Therefore, older adults and their healthcare providers must scrutinize medications and ensure they’re essential. How can you prevent polypharmacy if it might be unnecessary in older adults?

Recent research has demonstrated success with behavioral therapies and advanced algorithms. While medicine is necessary, healthcare professionals must personalize treatment and notice the warning signs.

Citations

1. Wang X, et al. Prevalence and trends of polypharmacy in U.S. adults, 1999–2018. Glob Health Res Policy. 2023;12(8):25. doi: 10.1186/s41256-023-00311-4
2. Schaefer J, et al. Assessment of an Intervention to Reduce Aspirin Prescribing for Patients Receiving Warfarin for Anticoagulation. JAMA Netw Open. 2022;5(9):e2231973. doi:10.1001/jamanetworkopen.2022.31973
3. Brewer, Alex, PharmD. Lisinopril oral tablet. Medical News Today, 2024.
4. AlHarkan K, et al. Associations between polypharmacy and potentially inappropriate medications with risk of falls among the elderly in Saudi Arabia. 2023;23(1):222. doi: 10.1186/s12877-023-03852-y
5. Office of Financial Management. Health outcomes and costs associated with polypharmacy in Washington state, 2022.
6. Journal of the American Geriatrics Society. American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults.
7. Junaid S, et al. Recent Advancements in Emerging Technologies for Healthcare Management Systems: A Survey. Healthcare. 2022; 10(10):1940. https://doi.org/10.3390/healthcare10101940
8. Wei Q, et al. Medication adherence with fixed-dose versus free-equivalent combination therapies: Systematic review and meta-analysis. Front Pharmacol. 2023 Mar 22;14:1156081. doi: 10.3389
9. Inwanna S, Duangchan C, Matthews A. Effectiveness of Interventions to Promote Medication Adherence in Schizophrenic Populations in Thailand: A Systematic Review. Int J Environ Res Public Health. 2022;19(5):2887. doi: 10.3390, 2025.
10.  Nakamura T, et al. Polypharmacy is associated with malnutrition and activities of daily living disability among daycare facility users. Medicine (Baltimore). 2021;100(34):e27073. doi: 10.1097.
11. Cheng C, Bai J. Association Between Polypharmacy, Anxiety, and Depression Among Chinese Older Adults: Evidence from the Chinese Longitudinal Healthy Longevity Survey. Clin Interv Aging. 2022;17:235-244. doi: 10.2147
12. StatPearls. Polypharmacy.

Zhang B, et al.  Association between polypharmacy and chronic kidney disease among community-dwelling older people: a longitudinal study in southern China. BMC Nephrol. 2024;25(169).