Polypharmacy risk factors

Polypharmacy is often a consequence of the cascade of problems. A literature review found that polypharmacy continues to increase and is a known risk factor for important morbidity and mortality (Hajjar et al. 2007). The reviewers states that many studies have found that various numbers of medications are associated with negative health outcomes, but more research is needed to further delineate the consequences associated with unnecessary drug use in elderly patients. Health care professionals should be aware of the risks and fully evaluate all medications at each patient visit to prevent polypharmacy from occurring . 

Nguyen JK, Fonts MM, Kotabe SE, Lo E. Polypharmacy as a risk factor for adverse drug reactions in geriatric nursing home residents. Am J Geriatr Pharmacother 2006 4(1) 36-41. 

Medications may cause, or at least exacerbate, delirium in many patients. Polypharmacy has been shown to be a risk factor for delirium. There are a number of different types of medications that may... 

Keywords Diabetes, cardiovascular disorder, micro-angiopathy, macroangiopathy, risk factors, health behaviour, polypharmacy, dmg concordance, patient, motivation, patient education. 

Other important factors for the increased risk of adverse drug reactions are polypharmacy and multimorbidity. Before adding a drug the physician should try to diagnose the condition and rule out drugs as the cause of the problem. When a drug is added the dose should be lower than in younger adults and then the dose can be titrated to a therapeutic response. 

A case-control study in 116 children born to epileptic women has suggested that for subjects without inherited factors the risk of developmental disorders is related to antenatal exposure to polypharmacy (OR=4.8, 95% CI=1.3, 18) and valproate monotherapy (OR = 9.4, 95% Cl = 1.7,50) (163). The findings were presented in abstract form, precluding close scrutiny of methodological aspects. 

A number of factors are believed to increase the risk of drug-related problems in the elderly, including suboptimal prescribing (e.g., overuse of medications or polypharmacy, inappropriate use, and underuse), medication errors (both dispensing and administration problems), and patient medication nonadherence (both intentional and unintentional). The following subsections address suboptimal prescribing and medication nonadherence, the most common problems. 

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