Polypharmacy in the elderly from the clinical toxicologist perspective

Abstract

Polypharmacy is closely associated with multimorbidity in the elderly and can lead to problems and drug interactions. This study assessed polypharmacy in the elderly, tracking inquiries to the Poison Information Centre Nuremberg (PICN) and patients needing toxicological intensive care therapy. From 2006-2009, all PICN inquiries involving individuals > 70years were tracked, as were cases at the Toxicological Intensive Care Unit (T-ICU) regarding adverse drug reactions (ADRs) and drug poisoning. Of 11,683 PICN calls about pharmaceuticals, 175 (1.5%) were from people > 70years; 156 (4.8%) of 3,272 T-ICU patients were > 70years. Calls about psychopharmaceuticals (46.9%) and analgesics (25.7%) were most frequent. Among the T-ICU patients, psychopharmaceuticals like sedatives and hypnotics were frequently involved (20.5%), as were tricyclic antidepressants (17.9%) and analgesics (29.5%). Ethanol was co-ingested by 18.3%. Population-specific poison prevention strategies are needed to reduce toxic exposures. Such strategies could include pharmacist intervention, improved prescriber communication and education regarding the geriatric population, and computerized drug databases.