The risks for the elderly

More and more older people consume five, ten or even fifteen medications a day. This phenomenon, known as Polymedicationimplies risks that go far beyond “Take an more pill”: It can cause serious interactions, falls, delirium episodes, memory loss and even increase mortality. Specialists in Geriatrics and Pharmacy insist on the importance of periodically reviewing the first aid kit to avoid this dangerous “recipe waterfall”.

According to statements a Europa Press Health Infosalusthe president of the Spanish Society of Geriatrics and Gerontology (SEGG)the doctor Paco Tarazonadefines polypharmacy as “that situation in which a patient takes five or more medications per day, continuously, and for more than six months.”

“This number of drugs includes both active ingredients prescribed by a doctor, and nutritional supplements, herbal products and the drugs that the patient takes motu propriowhat is known as self -medication “holds.

But it goes further pointing out that there is talk of severe polypharmacy when this number equals or exceeds ten drugs: “Polypharmacy definitions based on qualitative criteria have also been postulated, which include inappropriate prescriptions, and the absence of physical, psychic, social or clinical resources to properly manage the prescribed medication.”

For its part, José Manuel Parederopresident of the SEFAP, stands out in another interview with Europa Press Health Infosalus that the number of patients considered as “great polymedicated” – which every day take 15 or more active ingredients in their corresponding medications – It does not stop growing year after year: “This can become a problem when the patient is an elderly person And the medication it takes with a certain periodicity is not reviewed or in depth, which should be at least every 6 months. “

Polymedication risks

The geriatrician warns that polypharmacy entails numerous dangers, being The most serious the clear increase in the risk of mortalitymainly due to serious pharmacological interactions. In addition, it can cause An increase in geriatric syndromes as delirium, functional and cognitive deterioration, falls or constipation, among others.

“It can cause toxicity, which will also increase the risk of geriatric syndromes and greater mortality. Finally, one of the risks of polypharmacy is the so -called prescription waterfall, and that is characterized by treating the side effects of the medication prescribed with new drugs, which increases and aggravates the problem of polypharmacy. “

In this sense, the representative of Primary Care Pharmacists points out that “An important sign” that could show that a patient is polymedicated is his clinical situation and the pathologies he suffers: “There are very polymedicated patients who, despite this, have a poor quality of life, together with an increasingly low functionality. In these cases it is necessary to think if the patient’s polymedication is related to that quality of life. It is time to raise a structured and complete review of that medication and assess the gradual and/or suspension withdrawal of those medications that no longer fulfill their function properly. “

Are all the necessary medications?

On how many of those medications could be “too many”, the president of the SEFAP clarifies that “There is no universal answer to that question”because whenever a medication is taken that does not have a clearly defined therapeutic purpose for the patient we are facing a potential security problem. “This can happen in people who are not polymedicated, although logically, polymedicated are more risk,” he adds.

In the opinion of the wallro, it is almost certain that a person who takes 10 or more active ingredients every day, some of them are scheduled with the purpose of correcting or mitigating the side effects caused by others: “This can cause the “Therapeutic waterfalls”where medications are added to cushion the side effects of previously scheduled, in a loop that only increases yatrogenia. The fragility of older people makes them more vulnerable to these security problems “.

An integral geriatric assessment

To know if an older person really takes the medications he needs, the president of the SEGG explains that A broad multidimensional recognition is importantknown as integral geriatric assessment. This exam includes, among other sections, the complete review of the current medication of the elderly, both the prescribed and herbal products and those linked to the possible self -medication.

Meanwhile, the SEFAP representative acknowledges that it is normal for older people to need more and more medicines, although it warns that this fact “It doesn’t have to be a problem if those medications are well scheduled, For well -defined pathologies, with the appropriate dosage, the duration of stipulated treatment that provides value to the patient. “

If this is joined by periodic monitoring by its reference health professionals in primary care, nurse, Primary Care Pharmaceutical and even social workers, according to José Manuel Parederoof SEFAP, it is guaranteed that the patient uses the medications he needs, whether they are many or few. “What happens is that this ideal situation is less and less frequent due to multiple factors and causes”argues.

“From our work Primary Care Pharmacists we see more and more polymedicated patients, and increasingly with a greater load of medicines. There are many causes for this, for example, the fragmentation of healthcare, where there are many specialists who handle patients, the lack of conciliation of all that medication they pattern, the mobility of professionals and patients, which prevents in primary care for the same professional is the one that follows the patient for several years in a row. If we unite a tendency to the medicalization of life, increasingly present, the result is that increase in polymedicated and increasingly loaded with chronic medication that nobody reviews, “concludes this pharmacist.