Polypharmacy is a term used when someone is taking four or more prescription drugs. Did you know over 40 percent of seniors who still live at home are subjects of Polypharmacy?

My clients range from ages 55 through 100. I very rarely meet someone who only takes an occasional aspirin. On the contrary, most attach a separate list of their medications to my client cover sheet. Just in the last three months alone, I have witnessed three of my clients who suffered the severe consequences of over-medicating. They were hospitalized for weeks, misdiagnosed, moved into ICU and once stabile discharged to rehab only to be readmitted to the hospital for further complications and unable to successfully complete their rehab therapy. It is a common problem in America and especially with our senior population.

So, what can we do about it? Who do we take our concerns to? Below are many facts on this subject but a couple simple steps you can do immediately are – work with only one pharmacy, make sure ALL your doctors have an updated list of all medications you are presently taking and discuss potential side effects. Do some research on the internet on your own and remember, you can question your doctors.

The American Society of Consultant Pharmacists is the international professional association representing consultant and senior care pharmacists, providing leadership, education, advocacy, and resources to advance the practice of senior care pharmacy. Consultant and senior care pharmacists are essential participants in the health care system, recognized and valued for the practice of pharmaceutical care for the senior population and people with chronic illness.

Here are some facts I am sure you will find interesting—or perhaps even bothersome:

Senior Care Facts

• Today there are over 43.1 million adults age 65 and older in the United States; by 2040, that
  number will rise to 79.7 million.
• Seniors represent 13.7 percent of the United States population, about 1 in 7 Americans.
• Nearly 92 percent of older adults have at least one chronic condition, and 77 percent have at
  least two.
• Some type of disability (e.g. difficulty in hearing, vision, cognition, ambulation, self-care, or independent living) was reported by 36 percent of adults aged 65 and over in 2012.

Senior Care Pharmacy

While medications are probably the single most important factor in improving the quality of life for older Americans, the nation’s seniors are especially at risk for medication- related problems due to physiological changes of aging, higher incidence of multiple chronic diseases and conditions, and greater consumption of prescription and over-the-counter medications.

“Any symptom in an elderly patient should be considered a drug side effect until proven otherwise.”
— J. Gurwitz et al. Brown University.

The economic impact of medication-related problems in persons over the age of 65 now rivals that of Alzheimer’s disease, cancer, cardiovascular disease, and diabetes. Medication-related problems are estimated to be one of the top five causes of death in that age group, and a major cause of confusion, depression, falls, disability and loss of independence.

Estimated Annual Cost of Medication Related Problems

• In the community population, medication-related problems cost $177.4 billion a year.
• Hospital admissions cost $121.5 billion.
• Long-term care admissions cost $32.8 billion.
• Physician visits cost $13.8 billion.
• Emergency department visits cost $5.8 billion.
• Additional treatments cost $3.5 billion.
• An additional $24 billion is spent on medication-related problems in other settings.
• $20 billion in acute care facilities, such as hospitals.
• $4 billion in nursing homes.

Senior Care Pharmacy Facts

• Adverse drug reactions are among the top five greatest threats to the health of seniors.
• Seniors have more chronic diseases and multiple conditions, so they use more prescription
  and over-the-counter drugs. More than 77 percent of seniors between the ages of 65 and 79 suffer from one or more chronic diseases. The number rises to 85% for those over age 80.
• Seniors represent just over 13 percent of the population, but consume 40 percent of prescription drugs and 35 percent of all over-the-counter drugs.
• On average, individuals 65 to 69 years old take nearly 14 prescriptions per year, individuals aged 80 to 84 take an average of 18 prescriptions per year.
• 15 to 25 percent of drug use in seniors is considered unnecessary or otherwise inappropriate.
• Adverse drug reactions and noncompliance are responsible for 28 percent of hospitalizations of the elderly.
• 36 percent of all reported adverse drug reactions involve an elderly individual.
• Each year 32,000 seniors suffer hip fractures caused by medication-related problems.

Pain Sufferers – Pain Killers – DID YOU KNOW?

The Centers for Disease Control and Prevention estimates that 12.5 million Americans take painkillers for unintended reasons, while the Institute of Medicine says some 100 million adults are dealing with chronic pain.

Christine Ritchie, a professor at the University of California at San Francisco, said: “We have this incredible tension that many of us feel, between worries about prescription misuse and the inadequate treatment of persistent pain.”

“Pseudoaddiction” is drug-seeking behavior among people whose pain has gone undertreated— is commonly mistaken for addiction or abuse, Ritchie said. With sparse evidence about what really works in older adults, she said, communication and close monitoring of painkiller use are a doctor’s best options.

“It’s very important to make sure they’re experiencing some benefit in terms of improved functions or quality of life, and that they know the risk factors for harm,” she said. “And patient agreement has to be done carefully with older adults. You might say, ‘Just in case you didn’t know, it’s actually a felony to share your pain medication with somebody else.’ ”

About 10 percent of adults 65 and older take opioids — narcotics like morphine or oxycodone. And 40 percent receive at least one prescription in a given year for NSAIDs — nonsteroidal anti-inflammatory drugs, such as ibuprofen, Aleve and Celebrex. (NSAIDs are also available over the counter, and can be dangerous for people with high blood pressure, heart failure or kidney disease.)

“I would submit that the longterm risks and benefits in older populations remain unknown,” M. Carrington Reid, a geriatrics professor at Weill Cornell Medical College, said on opioids for chronic pain. “We’re in an evidence-based era, and yet we don’t have sufficient data to warrant long-term use.”

Emphasis on assessing pain by using the 1-to-10 scale, he believes, has led to overtreatment. And studies show that opioids are a significant cause of falls and fractures for older adults.

“What I’ve come to, over 20 years of practice,” said Reid, “is that if an NSAID or opioid is not an option, it’s important to communicate the reason why.

“Not discussing it can be problematic. We need to elicit patients’ beliefs and attitudes about medication, and reinforce the tradeoff aspects of all analgesic prescriptions.”

Adverse reactions

For the typical 75-year-old taking more than 10 prescription drugs, the likelihood of at least one adverse reaction is close to 100 percent, said Michael W. Rich, a cardiology professor at Washington University.

The average number of adverse reactions is four.

Most people taking cardiac medications, he said, have other serious conditions that also need to be addressed.

“NSAIDs are bad for heart failure patients for multiple reasons; they promote water retention and they directly counteract many drugs,” he said. “And yet arthritis symptoms may be the most severe symptoms a person has. We don’t have great alternatives, to this day.”

Patients need to be in control of treatment decisions, Rich added; the most doctors can do is clearly explain possible benefits and risks. He cited a survey of chronic-heart failure patients, with an average age of 77, half of whom said they would not want to be resuscitated if their hearts stopped.

But when asked if they would be willing to trade the length of their time remaining for more comfort and a higher quality of life, about 70 percent said no.

“I think this is a very individualized issue,” Rich said. “The only way we’re going to know this is by asking the patient.”