Polypharmacy:  A New Paradigm for Quality Drug Therapy in the Elderly?

There once was a time when polypharmacy was considered to be a bad thing in older patients.¹ It is well known that use of larger numbers of drugs is associated with an increased likelihood of inappropriate prescribing² and adverse drug events.³ Drug-induced symptoms can also produce prescribing cascades that develop when an adverse effect is misinterpreted as a new medical problem, leading to the prescription of additional drugs.⁴ Yet, the number of medications prescribed to elderly patients and the complexity of their drug regimens have continued to increase over time.^5- 6 Therapeutic regimens that include the use of 2 or more different medications to treat a single condition are increasingly promoted for the optimal management of conditions that are particularly prevalent in the older patient population, including hypertension,⁷ heart failure,⁸ ischemic heart disease,⁹ diabetes mellitus,¹⁰ and Alzheimer disease.¹¹ Promotion of prescription drugs directly to consumers may also factor into the increased levels of medication prescribing to older persons,¹² with advertising focusing heavily on conditions such as osteoporosis, osteoarthritis, hyperlipidemia, and dementia. A national survey of the US noninstitutionalized adult population indicated that more than 40% of persons 65 years or older use 5 or more different medications per week, and 12% use 10 or more different medications.¹³ Levels of medication use are even higher among elderly persons residing in assisted-living and nursing home settings.^3,14