The Mismanagement of Multiple Medications in the Older Adult Population

Abstract

Mismanagement of medications in older people is associated with an increased risk of adverse drug reactions, healthcare utilization, and mortality. Potentially inappropriate prescribing includes medications given when the risk outweighs the benefit and/or omission of drugs when medically indicated. How a drug or drug-drug interaction harms or benefits an older person is dependent upon how each person handles that drug (pharmacokinetics) and how that drug affects the body (pharmacodynamics). Physiological changes result in a reduction in physiologic reserve which reduces the ability to cope with stressors. The main changes occur in a reduction in renal and hepatic clearance. Absorption, distribution, protein binding, metabolism, and elimination of drugs are affected. Pharmacokinetic changes with aging are expressed clinically as an unpredictable response to drug therapy leading to adverse drug reactions. Polypharmacy is common in the elderly due to multiple reasons. It is defined both as the concurrent use of multiple drugs and the administration of more medications than are clinically indicated. Consequences include drug-drug interaction, drug-disease interaction, reduction in functional capacity, medication nonadherence, increase in geriatric syndromes, and increased mortality. Tools have been developed to guide clinicians in starting and stopping medications as indicated. Utilization of these tools can reduce polypharmacy and adverse drug reactions. Clinicians need to be aware of these factors when prescribing medications for the elderly.