As people live longer, the use of multiple medications to treat conditions that may have started in middle age, combined with comorbidities related to aging, can put the elderly in a potentially precarious position. Although there is no concrete definition of polypharmacy, some have defined it as the use of multiple medications without clear indications (Fulton, 2005). Others have offered a numerical value to describe polypharmacy, that being five medications or more (Masoon, Shakib, Kalisch-Ellett et al., 2012).

Due to certain medical conditions, some medications are necessary for prevention, treatment, or maintenance. As comorbidities develop, multiple medications tend to get combined, both in short and long-term use. A thorough review of medication lists is necessary at each intervention with a health provider, to ascertain the best use of medications with the least potential problems developing.

In an effort to delineate an overuse of medication with appropriate use, scholars have supported the development of different criterion-based processes to aid in the avoidance of polypharmacy, particularly in the elderly. One of the most common forms of surveillance of medications for the elderly is the Beers Criteria® (Wastesson, Morin, Tan, & Johnell (2018).

The Beers Criteria® (AGS, 2015) was developed by Mark Beers and colleagues in 1991 as a way of identifying certain medications that may be problematic in older people. Although not exhaustive, the avoidance of medications within particular settings should be considered. These areas include avoidance in:

1. Many older people, outside of hospice and palliative care.
2. Specific health conditions in older people.
3. Combination with other medications, possible potentiating a drug-drug reaction.
4. Cautionary use due to possible harmful side effects.
5. Reduced kidney function, whereas the dosing may need to be avoided or changed in dosing.

There is a continuing need to reevaluate the necessity of multiple pharmacologic treatments especially in the elderly. As described in the Beers Criteria, there can be an increase in adverse events as a result of drug-drug reactions, harmful side effects, and a slower metabolism of medications through the kidneys. Some drugs, even over the counter ones, can cause serious consequences and/or complications. Older adults would benefit by bringing all their medications and supplements to each visit with their provider for review and reconciliation that they are on the most effective and least harmful medication regime.

References

American Geriatrics Society (AGS) Beers Criteria Update Expert Panel. American Geriatrics Society 2015 updated beers criteria for potentially inappropriate medication use in older adults. Journal of American Geriatric Society, 63(11): 2227–2246.

Fulton, M.M., Riley, A. E. (2005). Polypharmacy in the elderly: A literature review. Journal of American Academy of Nurse Practitioners, 17(4):123–132.

Masnoon, N., Shakib, S., Kalisch-Ellett, L., et al. (2017). What is polypharmacy? A systematic review of definitions. BMC Geriatrics. 17(1): 230.

Wastesson, J. W., Morin, L., Tan, E. C. T., & Johnell, K. (2018) An update on the clinical consequences of polypharmacy in older adults: A narrative review, Expert Opinion on Drug Safety, 17:12,1185-1196, DOI: 10.1080/14740338.2018.1546841