Polymedicated seniors: pharmacotherapeutic advice

He draft of the new Law on medicines and health productspromoted by the Ministry of Health and approved in April 2025 in the first round, includes several measures that could help limit polypharmacy among older people and, in particular, inappropriate one.

And it is a real public health problem. with serious health risks. According to the report Use of chronic drugs in polymedicated people aged 65 and over and its relationship with morbiditynearly three out of 10 people over 65 years old consumes five or more pills on a recurring basis.

This phenomenon is explained, in part, by the prevalence of chronic diseases in this population group, but it is also related to failures in the health system such as: cascade prescription, the Fperiodic review discharge, the toself-medication and use of alternative remedies, the Fattention ragmentation wave Fhigh longitudinality.

“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 state to 65AND MORE from the Ministry of Health and list the potential dangers: drug interactions, andadverse effects, ddifficulty in complying with treatment correctly, disdecreased adhesion, andmedication errors and dfunctional and cognitive deterioration in older people, increasing the risk of fragility.

Pharmacotherapeutic Coordination Councils

In this sense, to bet on rationality and avoid errors, the draft Law proposes creating, at the level of the Basic Health Zones (ZBS), a key tool: the Pharmacotherapeutic Coordination Councils.

According to the textthis tool will be managed by a primary care pharmacist and will be composed “by a representation of the primary care medicine professionalsthe primary care nursing professionals, the pharmaceutical professionals who own the pharmacy offices located in said ZBS, the socio-health centers and the hospital pharmacy service belonging to the most directly linked hospital.

“Likewise, it will be possible to open the participation of members of civil society linked to the use of medications, if considered appropriate, if they request it from the Council coordinator,” adds the draft.

Thus, as the document literally stipulates, the functions of the councils, which will meet with, “at least quarterly”, they will be:

• Address failures coordination in prescription, dispensing and monitoring of the medications observed by the participating groups.
• Set the effective, efficient and relevant communication channels, between the different agents related to medication management in the field of ZBS.
• Work, within the scope of the ZBS, on adaptation to supply problems or supply difficulties that may arise with any medication or any presentation thereof.
• Detect unique needs training to improve medication management in the area of ​​ZBS and propose training interventions in this regard.

It should be noted that these bodies, if they end up being included in the final rule, should be managed by the autonomous communities and be established by them, once the regulations are applied. in its regional organization.

Savings of 500 million euros

This improvement in the prescription is also expected to translate in lower spending for public coffers and the citizen’s pocket.

As stipulated in the draft law itself, the rationalization measures, among which is the improvement of recipes, can be translated in savings of 500 million euros.

It is worth remembering that two decades ago it was estimated that around 70% of the pharmaceutical expenditure of the National Health System –13,855,066,160 euros in 2025– It was done by the elders. A percentage that will increasingly be higher – people over 65 years old are already more than 20% of the population – and that translates into estimates such as, according to AIREF calculationsthe percentage of GDP allocated to Health could go from 6% to exceed 8% in 2050 due to population aging.

In the draft itself it is explained that one of the objectives of this standard is to seek measures to address the costs who will come accompanied with the demographic transition.

The document explains that the pharmacist is the main health expense from the age of 55 and that its weight increases with age, exceeding the 60% of total spending from 75 years of age.

Likewise, it is said that greater longevity is associated with a higher rate of chronic disease and to greater consumption of resources, which explains much of the growth in this disbursement.

In this way, the reform seeks to adapt the system to “demographic challenges” addressing the medicine cycle in a “holistic” way to ensure that the health needs of the population are met in a sustainable way.

Other key aspects of the draft

These are other key points of the draft:

• Price regulation: establishes mechanisms to control drug prices, preventing them from being excessively high and guaranteeing their accessibility to the population.
• Generic promotion: encourages the use of generic medications, which are usually cheaper and have the same effectiveness as brand-name drugs, which helps reduce costs.
• Education and training: includes training programs for health professionals and patients, in order to improve knowledge about the proper use of medications and avoid irresponsible self-medication.
• Advertising control: regulates the advertising of medicines to avoid misleading messages that could lead to inappropriate use.
• Pharmacovigilance: implements tracking and monitoring systems for the side effects of medications, ensuring that potential health risks are detected and managed.
• Equitable access: seeks to ensure that all people, regardless of their economic situation, have access to essential medicines.

What is done to avoid inappropriate polypharmacy?

It is worth remembering that the public health problem posed by polypharmacy It has been on the agenda of the communities and of the Ministry of Health itself for several years.

All autonomies and even certain councils have programs or initiatives in favor of greater polymedication and rationalization and therapeutic adherence.

As announced in a Health statement, “between 2021 and 2024”, the actions implemented would have achieved a reduction in drug consumption of 8% in people over 65 years of age. Likewise, “it would have been registered a 15% improvement in therapeutic adherencewhich reflects advances in pharmacological monitoring, therapeutic conciliation and health education”.

“From the EAC (Strategy Attention to Chronicity) we have been working on the Optimization of pharmacological therapy in patients with chronic treatments, with special attention to polypharmacy patients, with the creation as a result of the new development document 2025-2028 of a working group for the development of a common structured review model in the SNS,” they say from Health.