MANAGING POLYPHARMACY IN OLDER PEOPLE

Derek Stewart, PgCert, BSc , MSc, PhD, FRPharmS, FFRPS, Professor of Pharmacy Practice, School of Pharmacy and Life Sciences, Robert Gordon University.UK

 

Polypharmacy, the prescribing of multiple medicines, is considered to be ‘one of the greatest prescribing challenges’, increasing the likelihood of adverse drug events, drug interactions and contributing to non-adherence to medicines regimens. Furthermore, polypharmacy significantly impacts health outcomes and healthcare resources. While traditionally polypharmacy has been classified in terms of the number of medicines (usually defined as the use of five or more medicines), it is suggested that there should be a change in emphasis from ‘inappropriate polypharmacy’ (prescribing of multiple medicines which are either inappropriate or no longer indicated) to ‘appropriate’ or ‘optimal polypharmacy’ (appropriate prescribing of multiple medicines).

It is evident that inappropriate polypharmacy is a major concern, hence promoting appropriate polypharmacy at the point of medicines initiation or during medicines review is, therefore, of the utmost importance and deserves greater attention.

There are a number of tools which may assist in promoting appropriate prescribing in older people. A systematic review by Kaufmann et al. aimed to create a comprehensive and structured overview of existing tools to assess potentially inappropriate prescribing. The most widely used include Beers Criteria, STOPP-START and Laroche Criteria.

This workshop will focus on approaches to the management of polypharmacy in multimorbid, older people.

Objectives:

  • to define the terms ‘appropriate’ and ‘inappropriate’ polypharmacy
  • to describe the consequences of ‘inappropriate’ polypharmacy to describe a systematic approach to the management of ‘inappropriate’