Too Few Medications May Be Just As Harmful As Too Many for Seniors

Older patients who take too few medications for their health conditions may face equal risks as those who take too many medications.

Although the dangers of polypharmacy among seniors have garnered media attention in recent months, some researchers are arguing that too few medications may be equally as harmful for older patients.

A recent study published in the British Journal of Clinical Pharmacology investigated possible links among prescription, hospitalization, and mortality rates for 503 patients aged 80 years or older who resided at home in Belgium.

Unlike most studies involving older patients and prescription medications, the Belgian study honed in on medication underuse and misuse—defined as not having a prescription to treat a proven medical condition and receiving an inappropriate medication, respectively.

Although more than half of the study participants took more than 5 medications, two-thirds weren’t receiving prescriptions they should have, 56% were misusing medications, and 40% were both underusing and misusing medications. Just 9% of participants had no evidence of polypharmacy, underuse, or misuse.

Mortality risk increased by 39% for each additional medication an individual needed but didn’t have. Meanwhile, hospitalization risk increased by 26% for each misused prescription medication.

During the 18-month study period, 9% of participants died and 31% were hospitalized.

The prescription medications most commonly misused were benzodiazepines, followed by duplicated drugs, such as 2 similar prescription pain drugs, 2 blood-thinners, or 2 antidepressants.

Meanwhile, the most commonly underused drugs included angiotensin-converting enzyme inhibitors for patients with heart failure, blood thinners, and statins for patients with heart disease. Inhalers for patients with asthma or chronic obstructive pulmonary disease and vitamin D or calcium for those with osteoporosis were also among the most often misused drugs.

Because current health care practices focus primarily on diagnosing and prescribing drugs, the need to taper, reduce, or discontinue inappropriate therapy receives relatively little attention. In fact, few clinical guidelines cover drug deprescribing, and this lack of evidence-based direction contributes to prescribers’ hesitancy or reluctance to touch treatment regimens that may have originated from a different practice setting.

The resultant polypharmacy may disproportionately affect older patients, who take 5 medications by age 65 and 7 by age 85, on average—often to treat several different chronic conditions.

Nevertheless, the goal of prescribing should never be based on the quantity of drugs taken by a patient, but rather the appropriateness and comprehensiveness of the regimen based on a patient’s complete health profile.

“Absence of polypharmacy is not a simple indicator of quality of care,” study author Maarten Wauters of Ghent University told Reuters Health. “Patients with just a few medications could be at risk of missing essential and beneficial medications.”

The results support a clear mandate for pharmacists to collaborate with physicians and patients in order to develop the most accurate and appropriate medication regimen for patients with individualized care needs.