Geriatric Poly-Pharmacy: A Growing Epidemic. How to Prevent It?

Abstract

Introduction: Geriatric poly-pharmacy is defined as the use of more drugs in older adults than are medically necessary. It is widely prevalent in clinical practice. The rationale for poly-pharmacy in the elderly is not clear. Objective: 1) Review the epidemiology, etiologic factors and potential consequences of geriatric poly-pharmacy; 2) Provide recommendations for prevention and reduction of geriatric poly-pharmacy. Methods: A review of literature for published articles in English language from online databases (Medline, EBSCO, Psychinfo, Google scholar) was conducted from 2000-2017. Results: With minor geographical variation, the prevalence of geriatric poly-pharmacy ranges from 15-80%. The trend is rising globally. Etiology is not clear. Associated factors include demographic factors (advanced age, education, geographic variation, socio-economic status, insurance), comorbidities, health status, severity of disease, treatment- refractoriness, healthcare setting (inpatient, out-patient or nursing home), cultural beliefs, physician prescribing pattern, etc. The concurrent administration and use of multiple medications increase the risk of drug interactions, potential adverse consequences, falls, fractures including morbidity and mortality in the elderly. Geriatric poly-pharmacy is also associated with cumulative toxicity, poor medication adherence and treatment non-compliance. Recommendations provided are targeted at preventing and reducing unnecessary geriatric poly-pharmacy in clinical practice. Conclusion: The growing epidemic of geriatric poly-pharmacy poses a significant public health problem. This article highlights on the strategies for preventing and reducing unnecessary prescribing of drugs in the elderly. A better understanding of physicians’ rationale for geriatric poly-pharmacy, patient tolerability and effectiveness of this strategy is needed to guide clinicians and to inform the development of evidence based treatment guidelines.