Polypharmacy — taking five or more meds at a time — leads to side effects, unnecessary hospitalizations and premature deaths. Researchers and pharmacists are seeking solutions to this serious public health problem that disproportionately affects older adults.
When my grandmother Carol Mitchell was diagnosed with Parkinson’s disease in 2010 at the age of 72, she was prescribed a drug called carbidopa/levodopa. She swallowed the little oblong pill four times a day — 7 a.m., 11 a.m., 3 p.m. and 7 p.m.
In the years that followed, her doctors prescribed her a steroid cream for skin issues and drugs for depression, motion sickness, anxiety, acid reflux and early breast cancer. “I walked into her bedroom and there were vials everywhere,” says Elizabeth Mitchell, Carol’s daughter and my mother. “I was Googling each one to see what they were for.”
For Carol, who is now 82, taking all her drugs precisely when she’s meant to has been a tough goal. “I don’t want to take medications like that. It’s too much, I think,” she says. “You can’t leave the house because you’ve got all these medications to take.” Inevitably, she would find herself missing doses of her Parkinson’s drug — and when she did, her symptoms of tremors, stiffness and difficulty with speaking and walking would return or worsen. In the last four years, that has led to four emergency department visits, two of which involved extended hospital stays.
To make taking the essential Parkinson’s pill easier, Elizabeth suggested that her mom wean herself off as many meds as she could with her doctor’s help, and today, Mitchell takes only the Parkinson’s drug. “I feel much better being on less medicines,” she says. Elizabeth says that her mom is far more likely to take her carbidopa/levodopa at the correct time now, helping to keep her out of the hospital.
But for many other elderly patients who are on multiple medications, weaning is not so easy.
Polypharmacy, often defined as the regular use of five or more drugs by one patient, is on the rise and is expected to grow as life expectancy increases and the global population ages. Elderly people not only take more drugs but also face a greater risk of severe side effects because their livers tend to be less efficient at metabolizing and clearing medications from the bloodstream.
This risk is exacerbated by the fact that interactions between some drugs can be harmful and up to half of patients taking four or more drugs do not take them as prescribed, according to a 2020 analysis in the Annual Review of Pharmacology and Toxicology.