Polypharmacy refers to the taking of multiple drugs by a single patient. As more and more drugs are introduced on the market that address the diseases and chronic conditions associated with aging, it is no surprise that it is the elderly who are most affected by polypharmacy. According to a Toronto Star article that appeared as part of their 2008 Atkinson Series, 23% of seniors over the age of 65 take at least five drugs, while 12% are taking 10 or more drugs. Generally, these individuals are seeing more than one specialist for more than one ailment and the issue is simply a lack of oversight in order to keep the ‘larger picture’ in view.
Delving deeper, however, USA Today cited a report by the Center for Substance Abuse Prevention that 17% of Americans over the age of 60 are abusing prescription drugs. In such instances of substance abuse, it is not unusual for the individual to visit numerous physicians (‘doctor shopping’) and process their prescriptions through a variety of pharmacies in order to hide the abuse. Particularly addictive drugs in the elderly population are the benzodiazepines (prescribed for anxiety and insomnia) and narcotic painkillers. Risk factors include a prior history of alcoholism or substance abuse. The effects of prescription abuse include confusion, memory impairment and an increased incidence of falls. In 1995, the Canadian Medical Association Journal reported that the doctors who wrote the most prescriptions also had the highest death rates amongst their patients.
So where does one draw the line between prescription use and prescription abuse? When a drug is used for a non-prescribed purpose or when use increases beyond the prescribed dose, then addiction is an issue. If you have a concern about an aging relative, stay connected and informed and periodically check for drug compliance (this is as simple as looking at the fill date and counting the number of pills thus far consumed). Assess alternatives (a pain management specialist, perhaps) and if necessary, express your concerns to the prescribing physician.
Jennifer Hartman, Guest Blogger
As a former manager at an assisted living facility, I was often (too often) witness to the devastating aftermath of falls in the elderly. As an administrator, the direct effects of a fall are obvious and measurable. According to the Centers for Disease Control and Prevention, over 1.8 million Americans over age 65 are injured annually in falls. A recent New York Times article indicated that 433,000 of those will be admitted to hospital and 15,800 will die as a direct result of the fall. In Canada, estimates suggest that 1 in 3 elderly people living in the community will experience at least one fall a year. The Canadian Institute for Health Information (2002) reports that 75% of in-hospital deaths were due to injuries from a fall.
What are far more difficult to track and quantify are the indirect consequences of a fall, from which many elderly also do not survive.
Post-fall, in the hospital environs, an aged person is subject to the complications of the fall. They are immobilized in bed, usually catheterized, and are prone to infection, muscle atrophy and pneumonia, which extends the length of their stay in the hospital (generally 11-14 days according to Health Canada). When they are eventually discharged, whether to their own home or to a care facility, they are terrified of falling again. A downward spiral of loss of confidence, social isolation, nutritional risk, psychological fragility, and a depressing awareness of their vulnerability often ensues. Any underlying co-morbid health conditions (diabetes, respiratory illness or cardiac conditions) will dramatically accelerate this downward spiral.
By the year 2031, one in five Canadians will be over the age of 65, compared with one in eight in 2001, and the number of people over the age of 80 will double over the same time frame (The Demographic Time Bomb). The increasing number of falls in the elderly is an emerging public health crisis and thus fall prevention initiatives and more facilitative access to community-based supports for the elderly must be critical components of provincial and nationwide health care planning.
Jennifer Hartman (Guest blogger)