Potentially Inappropriate Medications and Polypharmacy

Abstract

One cross-sectional study conducted by Anrys and colleagues 1 Anrys P.M.S. Strauven G.C. Foulon V. et al. Potentially inappropriate prescribing in Belgian nursing homes: Prevalence and associated factors. J Am Med Dir Assoc. 2018; 19: 884-890 Abstract Full Text Full Text PDF PubMed Scopus (25) Google Scholar published in JAMDA has reported that the prevalence of potentially inappropriate medications was 88.3% among nursing home residents aged ≥65 years. The definition of potentially inappropriate medications is the use of a drug where a clinical indication does not exist or the use of an indicated drug in conditions where the risk outweighs the benefit. 2 Moriarty F. Bennett K. Fahey T. et al. Longitudinal prevalence of potentially inappropriate medicines and potential prescribing omissions in a cohort of community-dwelling older people. Eur J Clin Pharmacol. 2015; 71: 473-482 Google Scholar Anrys and colleagues also reported that polypharmacy (use of 5 or more drugs) was significantly associated with potentially inappropriate medications. 1 Anrys P.M.S. Strauven G.C. Foulon V. et al. Potentially inappropriate prescribing in Belgian nursing homes: Prevalence and associated factors. J Am Med Dir Assoc. 2018; 19: 884-890 Abstract Full Text Full Text PDF PubMed Scopus (25) Google Scholar Polypharmacy in older people has been found to be associated with increased risk of morbidities and mortalities. 3 Lai S.W. Liao K.F. Liao C.C. et al. Polypharmacy correlates with increased risk for hip fracture in the elderly: A population-based study. Medicine (Baltimore). 2010; 89: 295-299 Crossref PubMed Scopus (227) Google Scholar , 4 Saum K.U. Schottker B. Meid A.D. et al. Is polypharmacy associated with frailty in older people? Results from the ESTHER cohort study. J Am Geriatr Soc. 2017; 65: e27-e32 Crossref PubMed Scopus (126) Google Scholar , 5 Schoufour J.D. Oppewal A. van der Maarl H.J.K. et al. Multimorbidity and polypharmacy are independently associated with mortality in older people with intellectual disabilities: A 5-year follow-up from the HA-ID study. Am J Intellect Dev Disabil. 2018; 123: 72-82 Google Scholar To date, there is no definite cutoff number for defining polypharmacy. According to Masnoon and colleagues' review, the use of 5 or more drugs daily is the most commonly reported definition for polypharmacy in older people. 6 Masnoon N. Shakib S. Kalisch-Ellett L. et al. What is polypharmacy? A systematic review of definitions. BMC Geriatr. 2017; 17: 230 Crossref PubMed Scopus (1131) Google Scholar Anrys and colleagues emphasize that interventions for potentially inappropriate medications should target older people taking at least 10 drugs. In order to reduce polypharmacy and potentially inappropriate medications in older people, clinicians should review the indications for drugs prescribed among those people taking 5 or more drugs during every clinical visit. If the indication does not exist, this drug should not be prescribed again. Therefore, medication safety in older people can be improved.