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Polypharmacy Demographics: Studying The Rise in Over Prescribing

By: Courtney Wright, PhamD

Polypharmacy is the utilization of multiple medications for one or more conditions generally regarded as treatment with five or more medications simultaneously. The elderly population is most susceptible to this practice, with nearly 40-50% of elderly patients being prescribed an array of medications to treat multiple conditions.

Swedish Study Shows Increases As Patients Age:

As humans age, comorbid conditions rise. A study in Sweden, conducted over the course of three years, observed the prevalence of polypharmacy in individuals aged 65 and older. During this time period, the prevalence of polypharmacy (5 medications) was 44% and excessive polypharmacy (10 medications) was ~11%. The incidence of polypharmacy increased as well. A one year follow-up to this study showed the risk of polypharmacy development was 20% for adults ages 65-74 and 34% for ages 95 and up. At the three year mark, the data showed the risk of polypharmacy having increased to 53% for patients ages 65-74 and up to 87% for patients 95 years and older.

British Study Found Patients With Higher Education Levels Less Susceptible:

A British study of elderly patients at age 70 reported the number of medications and use increased for most. However, polypharmacy was mostly prevalent in patients with cardiovascular medications. This study also concluded that patients with higher education levels were less likely to experience polypharmacy. Researchers suggested that people with higher education levels may be more inclined to research medications and their side effects, as well as explore alternative therapies.

U.S. Studies Show Population-Based Variations:

While the elderly are most often affected by polypharmacy, recent studies have shown population-based variation. A 2015 study done in the U.S., found differences in racial and geographic patterns in polypharmacy. The study looked at three different regions including: the stroke buckle (coastal plains of the Carolinas and Georgia), the stroke belt (eight Southern states: North Carolina, South Carolina, Georgia, Tennessee, Alabama, Mississippi, Arkansas, Louisiana) and the stroke non-belt (the rest of the continental United States). In this study, researchers looked at age differences as well as race (African Americans versus Caucasians) and sex (male versus female). The results showed female patients living in the southern region had a higher prevalence of polypharmacy than their opposite groups. Polypharmacy prevalence was similar between both ethnic populations; however, African American were less likely to be prone to polypharmacy. Also of note, most patients in the study were being treated for dyslipidemia, hypertension, and diabetes - diseases which often require at least 2-3 medications.

Polypharmacy More Prevalent For Certain Conditions:

Polypharmacy can also occur when patients are suffering from serious illnesses like HIV. There are several patients over the age of 50 years old living with HIV currently. For this group, comorbidities rise at a much higher rate than average. Although antiretroviral regimens have helped decrease the number of required medications, the existence of comorbidities with this illness continues to increase the likelihood for multiple drug treatments.

A retrospective cohort study was conducted between 2004-2006. This study looked at polypharmacy trends in HIV positive versus HIV negative men. The study found that polypharmacy increased in all patients despite age or HIV status; however, prevalence was higher for patients 50 years and older who were HIV positive and had medical insurance. The study also found that higher comorbidity index score equated to higher rates of polypharmacy.

Conclusions:

  • Polypharmacy has been shown to be a greater risk in the elderly population.

  • Studies have also shown the risk increases as people age.

  • Polypharmacy is not equally distributed between regions of the United State either with males or females.

  • Having HIV, or having multiple disease states, increased the likelihood of polypharmacy.

  • While polypharmacy is sometimes appropriate for the standard of care despite demographics, the practice should be avoided when necessary.

How We Can Help:

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References:

Rawle MJ, Richards M, Davis D, Kuh D. The prevalence and determinants of polypharmacy at age 69: a British birth cohort study. Rawle et al. BMC Geriatrics (2018) 18:118.

Morin L, Johnell K, Laroche ML, Fastbom J, Wastesson JW. The epidemiology of polypharmacy in older adults: register-based prospective cohort study. Clinical Epidemiology 2018:10 289–298.

Cashion W, McClellan W, Howard G, Goyal A, Kleinbaum D, Goodman M, Prince V, Muntner P, McClure LA, McClellan A, Judd S. Geographic Region and Racial Variations in Polypharmacy in the United States. Ann Epidemiol, 2015 June; 25(6): 433-438.

Ware D, Palella FJ, Chew KW, Friedman MR, D’Souza G, Ho K, Plankey M. Prevalence and trends of polypharmacy among HIV-positive and -negative men in the Multicenter AIDS Cohort Study from 2004 to 2016. PLoS ONE 13(9): e0203890.