Inappropriate polypharmacy has serious risks

The inappropriate polypharmacyunderstood as consuming more than five pills recurrently without actually needing several of them, can have serious health consequences of older people.

“The potentially inappropriate prescription (PPI) in Spanish multicenter studies reaches up to 33% in people over 64 years of age and is associated with a 91% increase in hospital admissions due to adverse events, 60%, in functional deterioration and, 26%, in adverse reactions, being more frequent in people who live in residences”, they explain to 65YMÁS from the Ministry of Health and detail that this type of consumption is associated with:

• Drug interactions: For example, the combination of anticoagulants and anti-inflammatories causes bleeding.
• Adverse effects: dizziness, drowsiness or kidney and liver impairment.
• Difficulty completing treatment correctly.
• Decreased adhesion.
• Medication errors.
• Functional and cognitive impairment in older people, increasing the risk of fragility.

Furthermore, in terms of public health, according to the study Use of chronic drugs in polymedicated people aged 65 and over and its relationship with morbidity, the prevalence of all health problems studied is higher in the polymedicated population compared to that which is not.

The differences are great in certain chronic pathologies: Yonheart sufficiency –7 times–, cischemic heart disease –5 times–, cerebrovascular disease and chronic renal failure –4 times– and diabetes mellitus –3 times–.

Dangerous combinations

And, specifically, as health sources explain to this medium, There are combinations that are more dangerous than others.which are related to these risks.

At European levelthese dangers are included in the tool designed for the older population called STOP/START.

It consists of a series of drugs to avoid in more advanced stages of life –STOP– and others, on the other hand, to consider using –START–, for the associated benefits.

Some criteria, which are being updated based on scientific evidence.

For example, according to version 3 of these criteriapublished in 2023, medications present possible unwanted effects mainly when they are prescribed without a clear clinical indication, for longer than necessary or in duplicate.

Among the groups with the highest risk, the cardiovascular drugs and analgesics: Prolonged use of non-steroidal anti-inflammatory drugs (NSAIDs) in people with vascular pathologies increases the risk of thrombosis, and if they are combined with anticoagulants, they drastically increase the risk of suffering serious gastrointestinal bleeding.

Likewise, the use of doses long-term aspirin highs or of anticoagulants In patients with uncontrolled hypertension, it presents a high risk of bleeding without demonstrating greater efficacy, while common medications such as diuretics can precipitate alterations in sodium and potassium levels or worsen incontinence if their need is not well evaluated.

On the other hand, there is a great risk associated with medications that affect the central nervous system and kidney function. Drugs like benzodiazepines and sleeping pills taken for more than two to four weeks carry a high risk of dependence, prolonged sedation, impaired balance and, consequently, a considerable increase in falls and fractures.

Likewise, first-generation antipsychotics and antihistamines can cause confusion, toxicity, and cognitive worsening in older people.

Finally, the document warns about the danger of toxicity due to accumulation: in patients with decreased kidney functioneveryday drugs such as metformin, NSAIDs, colchicine or digoxin are potentially inappropriate because they increase the risk of lactic acidosis, acute kidney injury or severe poisoning.

Reasons that explain polypharmacy

But how do you manage to ingest five, seven or even more than 10 pills a day without actually needing several of them? From Health they assure that there are six reasons:

• multimorbidity, see, that chronic diseases are suffered and treatments are required for each of them. This doesn’t have to be negative.
• Cascade prescription: To mitigate side effects of drugs, more are added, rather than removed.
• Lack of periodic review.
• Self-medication and use of alternative remedies.
• Fragmentation of care: little coordination between specialists.
• Lack of longitudinality –same professionals who care for the person– in Primary Care.

Therefore, the solution, according to the experts consulted, is to carry out a global assessment of What does the patient consume? see what you really need and why deprescribe what is not necessary.