Skip to main content
Log in

Polypharmacy in the Aged

Practical Solutions

  • Review Article
  • Drug Therapy
  • Published:
Drugs & Aging Aims and scope Submit manuscript

Summary

Elderly patients use more medications than younger patients and the trend of increasing drug use continues through 80 years of age. Studies conducted in a variety of settings have shown that patients over 65 years of age use an average of 2 to 6 prescribed medications and 1 to 3.4 nonprescribed medications.

Success of pharmaceutical and medical research has resulted in an abundance of effective drugs to treat acute and chronic conditions. Most research resulting in the development and marketing of these medications has been directed at proving the efficacy and safety of single drug products. Little research has been directed to determine the safety and efficacy of combining multiple medications to treat concurrent conditions in a single patient. It is known that the use of multiple medications increases the risks of adverse drug reactions, drug-drug interactions, and makes compliance with medication regimens more difficult.

Numerous studies have been conducted to better understand factors that are associated with increased drug use in elderly people. Studies also have been conducted to identify interventions that can improve drug treatment for the elderly, and reduce polypharmacy.

Multiple drug use is common in older people, and may give rise to drug related problems. Methods to reduce the risks of polypharmacy include patient education, physician education, such as education and feedback systems, and regulatory intervention. Continual drug and disease monitoring is essential.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  • Aging America, Trends and Projections, 1991 ed., Department of Health and Human Services Publication No. (FCoA) 91-28001, Washington DC, p 113, 1991

  • Andrews GR. Gerontological education in Australia. Nippon Ronen Igakkai Zasshi 29: 375–377, 1992

    Article  PubMed  CAS  Google Scholar 

  • Avorn J, Soumerai S. Improving drug-therapy decisions through educational outreach: a randomized controlled trial of academically based ‘detailing’. New England Journal of Medicine 308: 1457–1463, 1983

    Article  PubMed  CAS  Google Scholar 

  • Avorn J, Soumerai SB, Everitt DE, et al. A randomized trial of a program to reduce the use of psychoactive drugs in nursing homes. New England Journal of Medicine 327: 168–173, 1992

    Article  PubMed  CAS  Google Scholar 

  • Beattie BL. International comparison in gerontological education — Canada. Nippon Ronen Igakkai Zasshi 29: 372–374, 1992

    Article  PubMed  CAS  Google Scholar 

  • Beers MH, Avorn J, Soumerai SB, et al. Psychoactive medication use in intermediate-care facility residents. Journal of the American Medical Association 260: 3016–3020, 1988

    Article  PubMed  CAS  Google Scholar 

  • Beers MH, Fingold SF, Ouslander JG, et al. Characteristics and quality of prescribing by doctors practicing in nursing homes. Journal of the American Geriatrics Society 41: 802–807, 1993

    PubMed  CAS  Google Scholar 

  • Beers MH, Ouslander JG. Risk factors in geriatric drug prescribing: a practical guide to avoiding problems. Drugs 37: 105–112, 1989

    Article  PubMed  CAS  Google Scholar 

  • Beers MH, Ouslander JG, Fingold SF, et al. Inappropriate medication prescribing in skilled-nursing facilities. Annals of Internal Medicine 117: 684–689, 1992

    PubMed  CAS  Google Scholar 

  • Bernstein LR, Folkman S, Lazarus RS. Characterization of the use and misuse of medications by an elderly, ambulatory population. Medical Care 27: 654–663, 1989

    Article  PubMed  CAS  Google Scholar 

  • Brawn LA, Castleden CM. Adverse drug reactions: an overview of special considerations in the management of the elderly patient. Drug Safety 5: 421–435, 1990

    Article  PubMed  CAS  Google Scholar 

  • Cadigan DA, Magaziner J, Fedder DO. Polymedicine use among community resident older women: how much of a problem? American Journal of Public Health 79: 1537–1540, 1989

    Article  PubMed  CAS  Google Scholar 

  • Carbonin P, Pahor M, Bernabei R, et al. Is age an independent risk factor of adverse drug reactions in hospitalized medical patients? Journal of the American Geriatrics Society 39: 1093–1099, 1991

    PubMed  CAS  Google Scholar 

  • Chrischilles EA, Segar ET, Wallace RB. Self-reported adverse drug reactions and related resource use. Annals of Internal Medicine 117: 634–640, 1992

    PubMed  CAS  Google Scholar 

  • Colley CA, Lucas LM. Polypharmacy: the cure becomes the disease. Journal of General Internal Medicine 8: 278–283, 1993

    Article  PubMed  CAS  Google Scholar 

  • Colt HG, Shapiro AP. Drug-induced illness as a cause for admission to a community hospital. Journal of the American Geriatrics Society 37: 323–326, 1989

    PubMed  CAS  Google Scholar 

  • Cooper JW. Effect of initiation, termination and reinitiation of consultant clinical pharmacist services in a geriatric long term care facility. Medical Care 23: 84–86, 1985

    Article  PubMed  CAS  Google Scholar 

  • Cooper JW. Drug-related problems in geriatric long term care facility patients, p 3, Haworth Press, Binghamton, 1991

    Google Scholar 

  • D’Arcy PF, Griffen JP. Iatrogenic diseases 3rd Edition, Oxford University Press, Oxford, 1986

    Google Scholar 

  • Darnell JC, Murray MD, Martz BL, et al. Medication use by ambulatory elderly: an in-home survey. Journal of the American Geriatrics Society 34: 1–4, 1986

    PubMed  CAS  Google Scholar 

  • Editorial. Need we poison the elderly so often? Lancet 2: 20–22, 1988

  • Editorial. Fifth report on the joint national committee on detection, evaluation, and treatment of high blood pressure (JNCV). Archives of Internal Medicine 153: 154–183, 1993

  • Elon R, Pawlson G. The impact of OBRA on medical practice within nursing facilities. Journal of the American Geriatrics Society 40: 958–963, 1992

    PubMed  CAS  Google Scholar 

  • Federal Register (17 Jan 74) 39: 2238, 1974

  • Fukuchi Y. Gerontological education in Japan — geriatric education and training. Nippon Ronen Igakkai Zasshi 29: 368–371, 1992

    Article  PubMed  CAS  Google Scholar 

  • Gehlbach SH, Wilkinson WE, Hammond WE, et al. Improving drug prescribing in a primary care practice. Medical Care 22: 193–201, 1984

    Article  PubMed  CAS  Google Scholar 

  • Gillin JC, Byerly WF. The diagnosis and management of insomnia. New England Journal of Medicine 322: 239–248, 1990

    Article  PubMed  CAS  Google Scholar 

  • Gurwitz JH, Avorn J. The ambiguous relation between aging and adverse drug reactions. Annals of Internal Medicine 114: 956–966, 1991

    PubMed  CAS  Google Scholar 

  • Hale WE, May FE, Marks RG, et al. Drug use in an ambulatory elderly population: a five year update. Drug Intelligence and Clinical Pharmacy 21: 530–535, 1987

    PubMed  CAS  Google Scholar 

  • Hale WE, May FE, Marks RG, et al. Drug-drug and drug-disease interactions in the elderly: a report from the Dunedin Program. Journal of Geriatric Drug Therapy 3: 67–86, 1989

    Google Scholar 

  • Hale WE, Perkins LL, May FE, et al. Symptom prevalence in the elderly: an evaluation of age, sex, disease and medication use. Journal of the American Geriatrics Society 34: 333–340, 1986

    PubMed  CAS  Google Scholar 

  • Hanlon JT, Fillenbaum GG, Burchett B, et al. Drug use patterns among black and nonblack community-dwelling elderly. Annals of Pharmacotherapy 26: 679–685, 1992

    PubMed  CAS  Google Scholar 

  • Hansten PD, Horn JR. Drug Interactions 7th ed., Lea and Febiger, Philadelphia, 1993

    Google Scholar 

  • Health and Public Policy Committee. Improving medical education in therapeutics: American College of Physicians. Annals of Internal Medicine 108: 145–147, 1988

    Google Scholar 

  • Healthy People 2000: National health promotion and disease prevention objectives, US Department of Health and Human Services 91-50212, p 67, Washington, DC, 1990

    Google Scholar 

  • Helling DK, Lemke JH, Semla TP, et al. Medication use characteristics in the elderly: the Iowa 65+ rural health study. Journal of the American Geriatrics Society 35: 4–12, 1987

    PubMed  CAS  Google Scholar 

  • Hendricks J, Johnson TP, Sheahan SL, et al. Medication use among older persons in congregate living facilities. Journal of Geriatric Drug Therapy 6: 47–61, 1991

    Google Scholar 

  • Hirshfield JS. Positive patient outcomes from interdisciplinary assessments of psychoactive drug use. The Consultant Pharmacist 8: 532–534, 1993

    Google Scholar 

  • Hoehn-Saric R, McLeod DR. Generalized anxiety disorder. Psychiatric Clinics of North America 8: 73–88, 1985

    PubMed  CAS  Google Scholar 

  • Hulka BS, Kupper LL, Cassee JC, et al. Medication use and misuse: physician-patient discrepancies. Journal of Chronic Disease 28: 7, 1975

    Article  CAS  Google Scholar 

  • Jörgensen TM, Isacson DGL, Thorslund M. Prescription drug use among ambulatory elderly in a Swedish municipality. Annals of Pharmacotherapy 27: 1120–1125, 1993

    PubMed  Google Scholar 

  • Kidder SW. The cost-benefit of pharmacist-conducted drug-regimen reviews. The Consultant Pharmacist 2: 394–398, 1987

    Google Scholar 

  • Kitchin LI, Castell DO. Rationale and efficacy of conservative therapy for gastroesophageal reflux disease. Archives of Internal Medicine 151: 448–454, 1991

    Article  PubMed  CAS  Google Scholar 

  • Kovar M. Health of the elderly and use of health services. Public Health Reports 92: 9–19, 1977

    PubMed  CAS  Google Scholar 

  • Kroenke K, Pinholt EM. Reducing polypharmacy in the elderly: a controlled trial of physician feedback. Journal of the American Geriatrics Society 38: 31–36, 1990

    PubMed  CAS  Google Scholar 

  • Kruse W, Rampmaier J, Frauenrath-Volkers C, et al. Drug-prescribing patterns in old age. A study of the impact of hospitalization on drug prescriptions and follow-up survey in patients 75 years and older. European Journal of Clinical Pharmacology 41: 441–447, 1991

    Article  PubMed  CAS  Google Scholar 

  • Landahl S. Drug treatment in 70–82 year-old persons: a longitudinal study. Acta Medica Scandinavica 221: 179–184, 1987

    Article  PubMed  CAS  Google Scholar 

  • Lapierre G, Pevonka MP, Stewart RB, et al. Evaluation of hypertensive therapy in a skilled nursing facility. Drug Intelligence and Clinical Pharmacy 17: 39–44, 1983

    PubMed  CAS  Google Scholar 

  • Larson EB, Kukull WA, Buchner D, et al. Adverse drug reactions associated with global cognitive impairment in elderly persons. Annals of Internal Medicine 107: 169–173, 1987

    PubMed  CAS  Google Scholar 

  • Laukkanen P, Heikkinen E, Kauppinin M, et al. Use of drugs by non-institutionalized urban Finns born in 1904–1923 and the association of drug use with mood and self-rated health. Age and Ageing 21: 343–352, 1992

    Article  PubMed  CAS  Google Scholar 

  • Lindley CM, Tully MP, Paramsothy V, et al. Inappropriate medication is a major cause of adverse drug reactions in elderly patients. Age and Ageing 21: 294–300, 1992

    Article  PubMed  CAS  Google Scholar 

  • Lipton HL, Bero LA, Bird JA, et al. The impact of clinical pharmacists’ consultations on physicians geriatric drug prescribing. Medical Care 30: 646–658, 1992

    Article  PubMed  CAS  Google Scholar 

  • Loewe S. The problem of synergism and antagonism of combined drugs. Arzneimittel Forschung 3: 285–290, 1953

    PubMed  CAS  Google Scholar 

  • Magaziner J, Cadigan DA, Fedder DO, et al. Medication use and functional decline among community-dwelling older women. Journal of Aging and Health 1: 470–485, 1989

    Article  Google Scholar 

  • Martin S. What you need to know about OBRA’ 90. American Pharmacy NS33: 26–28, 1993

    PubMed  CAS  Google Scholar 

  • May FE, Stewart RB, Cluff LE. Drug interactions and multiple drug administration. Clinical Pharmacology and Therapeutics 22: 322–328, 1977

    PubMed  CAS  Google Scholar 

  • Miller SW, Warnock R, Marshall L, et al. Cost-savings and reduction of medication-related problems as a result of consultant pharmacy intervention. The Consultant Pharmacist 8: 1265–1268, 1993

    Google Scholar 

  • Montamat SC, Cusack B. Overcoming problems with polypharmacy and drug misuse in the elderly. Clinics in Geriatric Medicine 8: 143–158, 1992

    PubMed  CAS  Google Scholar 

  • Montamat SC, Cusack BJ, Vestal RE. Management of drug therapy in the elderly. New England Journal of Medicine 321: 303–309, 1989

    Article  PubMed  CAS  Google Scholar 

  • Neel AB, Pittman JC, Marasco RA, et al. Psychoactive drug use in Georgia nursing homes: effects of aggressive intervention. The Consultant Pharmacist 8: 245–248, 1993

    Google Scholar 

  • Nolan L, O’Malley K. The need for a more rational approach to drug prescribing for elderly people in nursing homes. Age and Ageing 18: 52–56, 1989a

    Article  PubMed  CAS  Google Scholar 

  • Nolan L, O’Malley K. Adverse drug reactions in the elderly. British Journal of Hospital Medicine 41: 452–457, 1989b

    Google Scholar 

  • Owens NJ, Sherburne NJ, Silliman RA, et al. The senior care study: the optimal use of medications in acutely ill older patients. Journal of the American Geriatrics Society 38: 1087–1090, 1990

    Google Scholar 

  • Physicians’ Drug Prescribing Patterns in Skilled Nursing Facilities. Department of Health Education and Welfare publ. no. OS 76-50050. Public Health Service Office of Long-Term Care, US Department of Health, Education and Welfare, Washington, DC, 1976

  • Ray WA, Fink R, Schaffner W, et al. Improving antibiotic prescribing in outpatient practice: non-association of outcome with prescriber characteristics and measures of receptivity. Medical Care 23: 1307–1313, 1985

    Article  PubMed  CAS  Google Scholar 

  • Ray WA, Taylor JA, Meador KG, et al. Reducing antipsychotic drug use in nursing homes: a controlled trial of provider education. Archives of Internal Medicine 153: 713–721, 1993

    Article  PubMed  CAS  Google Scholar 

  • Reuben DB, Bradley TB, Zwanziger J, et al. The critical shortage of geriatrics faculty. Journal of the American Geriatrics Society 41: 560–569, 1993

    PubMed  CAS  Google Scholar 

  • Robers PA. Extent of medication use in U.S. long-term-care facilities. American Journal of Hospital Pharmacy 45: 93–100, 1988

    PubMed  CAS  Google Scholar 

  • Sackett DL, Haynes RB (Eds). Compliance with therapeutic regimens. Johns Hopkins University Press, Baltimore, 1976

    Google Scholar 

  • Schaffner W, Ray WA, Federspiel CF, et al. Improving antibiotic prescribing in office practice: a controlled trial of three educational methods. Journal of the American Medical Association 250: 1728–1732, 1983

    Article  PubMed  CAS  Google Scholar 

  • Scharlach AE, Mor-Barak ME, Katz A, et al. Generation: a corporate-sponsored retiree health care program. Gerontologist 32: 265–269, 1992

    Article  PubMed  CAS  Google Scholar 

  • Schneider JK, Mion LC, Frengley JD. Adverse drug reactions in an elderly outpatient population. American Journal of Hospital Pharmacy 49: 90–96, 1992

    PubMed  CAS  Google Scholar 

  • Schwartz RK, Soumerai SB, Avorn J. Physician motivations for nonscientific drug prescribing. Social Science and Medicine 28: 577–582, 1989

    Article  PubMed  CAS  Google Scholar 

  • Sherman DS, Avorn J, Campion EW. Cimetidine use in nursing homes: prolonged therapy and excessive doses. Journal of the American Geriatrics Society 35: 1023–1027, 1987

    PubMed  CAS  Google Scholar 

  • Skoll SL, August RJ, Johnson GE. Drug prescribing for the elderly in Saskatchewan during 1976. Canadian Medical Association Journal 121: 1074–1081, 1979

    PubMed  CAS  Google Scholar 

  • Soumerai SB, Avorn J. Economic and policy analysis of university-based drug detailing. Medical Care 24: 313–331, 1986

    Article  PubMed  CAS  Google Scholar 

  • Soumerai SB, McLaughlin TJ, Avorn J. Improving drug prescribing in primary care: a critical analysis of the experimental literature. Milbank Quarterly 67: 268–317, 1989

    Article  PubMed  CAS  Google Scholar 

  • Stewart RB. Polypharmacy in the elderly: a fait accompli? DICP: Annals of Pharmacotherapy 24: 321–323, 1990

    PubMed  CAS  Google Scholar 

  • Stewart RB. Noncompliance in the elderly: is there a cure? Drugs & Aging 1: 163–167, 1991

    Article  CAS  Google Scholar 

  • Stewart RB, Cluff LE. Studies on the epidemiology of adverse drug reactions VI: utilization and interactions of prescription and nonprescription drugs in outpatients. Johns Hopkins Medical Journal 129: 319–333, 1971

    PubMed  CAS  Google Scholar 

  • Stewart RB, Yedinak KC, Ware MR. Polypharmacy in psychiatry: three case studies and methods for prevention. DICP: Annals of Pharmacotherapy 26: 529–533, 1992

    CAS  Google Scholar 

  • Teeling-Smith. The economics of drug development and use. British Journal of Clinical Pharmacology 22: 45S–48S, 1986

    Article  PubMed  Google Scholar 

  • Williamson J, Chopin JM. Adverse reactions to prescribed drugs in the elderly: a multicenter investigation. Age and Ageing 9: 73–80, 1980

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Stewart, R.B., Cooper, J.W. Polypharmacy in the Aged. Drugs & Aging 4, 449–461 (1994). https://doi.org/10.2165/00002512-199404060-00002

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00002512-199404060-00002

Keywords

Navigation