The elderly rebel against polypharmacy

Polypharmacy has become a real public health problem of the age of longevity. And medical advances – treatments, vaccines and hygiene – have caused life expectancy to increase substantially, reaching 84 years. But those decades gained are often lived carrying chronic diseases, such as diabetes, heart disease, arthritis or even certain types of cancer.

And this causes the consumption of treatments to increase substantially as we age. A recent report from the Ministry of Healthcarried out based on data provided by primary care, puts figures on this phenomenon typical of our time: nearly three out of every 10 people over 65 years of age live on polypharmacy – taking more than five active ingredients a day –, a percentage that increases, in the age group of 85 to 94, up to 44.7%.

However, in many cases, older people take more pills than they really need, as experts have reported 65AND MORE. And this happens for many different reasons: treatments to deal with the side effects of other drugs, little communication between professionals from different specialties, lack of global vision of the patient, lack of knowledge and self-medication.

For this reason, the country’s main senior associations themselvesdemand that institutions take this issue very seriously, since it has consequences for the health of seniors, since many medications are not safe.

Active patient

Jose Manuel Freiredoctor, former counselor of the Basque Government and president of the Health Commission of the Platform for Seniors and Pensioners (PMP), which assures that controlled polypharmacy can be a “blessing”, also recognizes that this phenomenon is negative when the drugs “are not necessary” and “incompatibilities exist.”

On the one hand, the president of the Health Commission assures that the administration has a role to play in preventing these situations, betting on ‘conciliation’, in other words, reviewing everything a patient takes.

And in parallel, he maintains, it is crucial that the elderly themselves be empowered. “Important and fundamental also the active role of patients in the rational use of medications; “They must inform themselves, ask about their treatment – what it is for, dosage, when to take it -, follow the instructions to the letter, not self-medicate, report adverse effects, thereby ensuring effective treatments, reducing risks, preventing resistance and, importantly, also saving costs – in health and economic terms – for the entire society,” he comments.

“Less pills and more sneakers”

The president of the Spanish Confederation of Seniors’ Organizations (CEOMA), José Luis Fernández Santillanaadvocates a change of mentality that is summarized in the following expression: “Less pills and more sneakers”.

For this reason, he vindicates the figure of geriatrician as the key specialist. The CEOMA representative defends that this figure has a “comprehensive view of the person, their age and clinical status.”

“A periodic review of the medication would be advisable to see if it is still necessary, whether or not the dosage needs to be changed, its suppression or a change to a more current drug,” he proposes.

And although since the confederation They assume that chronicity implies treatmentthey also ask to promote avoid self-medication and promote healthy lifestyle habits.

Medicalization of non-health problems

Anatolio Diez, general secretary of the Union of Retirees and Pensioners of UGT (UJP-UGT), warns that a “medicalization of problems that are not exclusively health”treating issues such as loneliness, grief or lack of social support with psychotropic drugs and anxiolytics.

And he warns that excess medication increases the “risk of falls, cognitive impairment, hospital admissions and loss of personal autonomy”.

For this reason, Diez firmly defends that “It is not about removing medications, but about reviewing them” to ensure that treatments are appropriate.

In short, Diez emphasizes that older people “they don’t need more medications; they need more attention, more listening and more comprehensive care”, concluding that “true good health practice does not consist of prescribing more, but rather caring better”.

Annual review

For his part, the president of the Federation of Associations of the Elderly of Catalonia (FATEC), Josep Carné, believes that “many older people are taking medications that they do not need or that do not provide them with any benefit.”

and criticize the “prescription by inertia”, with an erroneous medical and social culture where it seems that a visit that does not end with the prescription of a medication “is not really a visit.”

Its main requirement is organizational: the elders must be assigned a “reference healthcare professional” – whether it is the doctor or the pharmacist – who is responsible for your overall therapeutic plan. Likewise, it suggests that a medication review process be carried out “at least once a year.”

Tolerance towards polypharmacy

From the State Confederation of Active Seniors (CONFEMAC), its secretary general, Vicente Pérez, warns that the population has dangerously normalized this phenomenon: “Our society does not frown upon excess medication and makes little use of other non-pharmacological actions.”

And they warn of a direct and often ignored relationship: the increased risk of falls. In older people, drugs such as anxiolytics or sedatives (which 30% of polymedicated patients consume) are often the culprits of hip or femur fractures that end the person’s autonomy.

Therefore, they ask that doctors systematically apply the deprescribing criteria – such as the STOP/START– to withdraw medications that “stopped making sense” a long time ago.

More resources

Finally, Manel Ferrana volunteer from Nagusilan, warns about the lack of coordination between specialists who prescribe drugs “without taking into account those prescribed by the family doctor” or other professionals, which leads to consuming preventive medications that “from a certain age are neither useful nor necessary and can even be harmful.”

To solve this problem, Ferran emphasizes that “The problem is not the quantity itself,” but periodically evaluate whether the pills are still truly necessary. To achieve this, it is considered essential a “good coordination between the family doctor and the pharmacist.”

However, the Nagusilan volunteer warns that for this initiative to work “resources are needed”. In this sense, it demands that the means be provided to reinforce primary care.