Understanding Polypharmacy: Risks of Multiple Medications in Older Adults and Chronic Illness

Abstract

Polypharmacy — a term used to describe the concurrent use of multiple medications — is a growing global concern, particularly among older adults and individuals managing chronic health conditions. While intended to treat multiple ailments or complex health situations, polypharmacy often results in a cascade of problems, including harmful drug interactions, side effects, and avoidable hospitalizations. This research paper explores the phenomenon of polypharmacy through the lens of clinical trials, real-world patient stories, and pathophysiological insights. Tailored to an international audience using simple African English, this article aims to increase public awareness, enhance patient safety, and offer practical strategies for safer medicine use across all healthcare settings.

Introduction

In many parts of the world, especially among older people and those living with chronic conditions like diabetes, high blood pressure, heart disease, arthritis, or kidney failure, it is very common to find patients taking five, ten, or even more medications daily. This situation, known in medicine as polypharmacy, is often necessary but can easily turn dangerous when not properly managed. It is like trying to cook with too many ingredients—sometimes the mixture spoils the whole meal.

The World Health Organization (WHO, 2019) has warned that unsafe medication practices and errors are among the leading causes of injury and avoidable harm in healthcare systems worldwide. In fact, the elderly population — especially those aged 65 and above — are at the highest risk because of reduced organ function and multiple medical issues requiring treatment. According to the U.S. Centers for Disease Control and Prevention (CDC, 2022), adverse drug events (ADEs) cause over 1.3 million emergency department visits annually in the United States alone, with many linked directly to polypharmacy.

This article seeks to explain polypharmacy in a way anyone can understand — through relatable stories, science made simple, and practical solutions for patients, caregivers, and healthcare providers.

Understanding Polypharmacy: A Global Health Concern

Polypharmacy is generally defined as the use of five or more medications concurrently (Masnoon et al., 2017). While some medications are vital for managing complex illnesses, combining too many drugs increases the likelihood of negative outcomes.

Globally, the burden of polypharmacy is increasing due to aging populations and the growing prevalence of non-communicable diseases (NCDs). In Europe, nearly 40% of people over 65 take more than five medicines daily (Onder et al., 2014). In countries like Nigeria, Kenya, India, and Brazil, the rise in both formal and informal medicine use, including traditional herbs and supplements, makes the situation even more complex.

A Real-Life Example from Kenya:

Mrs. Atieno, a 72-year-old retired teacher from Kisumu, lives with diabetes, high blood pressure, and arthritis. Her daily medication includes insulin, two antihypertensives, a pain reliever, a blood thinner, and a multivitamin. She also takes a herbal tea recommended by a neighbor for her joints. One day, she fainted and was rushed to the hospital. Doctors found that her blood pressure had dropped dangerously low, possibly due to interactions between her antihypertensives and the herbal remedy.

The Pathophysiology Behind Drug Interactions and Adverse Events

To truly understand why polypharmacy can be dangerous, we must explore what happens inside the body when multiple drugs are introduced — especially in older adults.

1. Reduced Kidney and Liver Function

The liver and kidneys are the main organs responsible for breaking down and eliminating drugs. As we grow older, these organs lose some of their strength. According to Linnebur et al. (2020), renal clearance can decrease by up to 50% in elderly adults. This means drugs stay longer in the body, increasing the risk of toxicity.

For example, if an older patient takes digoxin (for heart failure) and also takes a diuretic (like furosemide), reduced kidney function may cause dangerous levels of digoxin in the blood, leading to heart rhythm problems.

2. Changes in Body Fat and Muscle

Older people tend to have more fat and less muscle. Many drugs are stored in fat (especially sedatives like diazepam), which can make the drugs act longer than expected, causing drowsiness, confusion, and falls.

3. Pharmacodynamic and Pharmacokinetic Changes

• Pharmacodynamics refers to how drugs affect the body.
• Pharmacokinetics refers to how the body processes drugs.

In the elderly, these mechanisms change significantly. As a result, drug effects become more unpredictable. For instance, benzodiazepines, commonly used for sleep or anxiety, can cause confusion, dizziness, and falls in older adults even at normal doses.

The Risks of Polypharmacy

Some of the most serious risks associated with polypharmacy include:

1. Harmful Drug Interactions

Some drugs, when taken together, can interfere with each other. A common example is using aspirin (a blood thinner) along with ibuprofen (a pain reliever). Both can increase the risk of stomach bleeding.

2. Adverse Drug Events (ADEs)

This includes side effects like dizziness, nausea, confusion, bleeding, or even death. The more medicines one takes, the higher the chance of side effects. According to Maher et al. (2014), each additional drug increases the risk of an ADE by 10%.

3. Falls and Fractures

Many medications, especially those for sleep, anxiety, or blood pressure, can cause low alertness or balance problems. This puts older people at high risk of falls and fractures, which can be life-threatening.

4. Poor Treatment Adherence

Managing many pills is confusing. Patients may forget doses, take the wrong medicine, or stop treatment altogether, worsening their health outcomes.

Clinical Research and Global Data

Clinical studies have confirmed that polypharmacy increases hospitalization and mortality risk.

A 2020 study published in Drugs & Aging found that elderly patients on more than five medications had a 30% higher chance of hospitalization within a year (Tian et al., 2020). Another randomized controlled trial (RCT) in the UK known as the “SENATOR trial” attempted to reduce unnecessary prescriptions in elderly patients and showed promising results in minimizing ADEs (O’Mahony et al., 2018).

In India, a cross-sectional study conducted at a tertiary hospital found that over 60% of elderly patients admitted to the hospital were on polypharmacy, and nearly half experienced at least one ADE (Gautam & Aditya, 2018).

Practical Solutions for Patients, Families, and Healthcare Providers

1. Medication Review
   • Ask your doctor or pharmacist to review all your medications regularly, including over-the-counter drugs and herbal remedies.
2. Use One Pharmacy
   • When all prescriptions are filled at one place, it becomes easier to detect dangerous drug combinations.
3. Create a Medication List
   • Keep a written or digital list of all your medications, doses, and times. Share it with all your healthcare providers.
4. “Deprescribing” Strategy
   • This involves stopping medicines that are no longer necessary or may cause more harm than good (Scott et al., 2015). A healthcare provider should guide this process carefully.
5. Patient Education
   • Patients and caregivers should be taught how each medication works and what side effects to watch out for.

A Cautionary Tale: Mr. Joseph from Nigeria

Mr. Joseph, 68, suffered a mild stroke and was placed on multiple drugs, including a cholesterol-lowering statin, blood thinner, and antihypertensives. He also used herbal supplements for his blood sugar. After months of fatigue, he was diagnosed with liver injury due to an interaction between his statin and herbal product. After stopping the supplement, his liver tests improved.

Conclusion

Polypharmacy is not just about taking many medicines. It’s about making sure each medicine truly helps — and does not harm — the patient. In our quest to treat disease, we must also protect patients from medication overload. Especially in older adults and those with chronic illnesses, thoughtful prescribing, regular medication review, and patient education can make the difference between healing and harm.

Let us remember: more medicine is not always better medicine.

References

Centers for Disease Control and Prevention. (2022). Adverse Drug Events in Older Adults. https://www.cdc.gov

Gautam, C. S., & Aditya, S. (2018). Polypharmacy in elderly: A global concern. Journal of Pharmacology & Pharmacotherapeutics, 9(3), 145–150.

Linnebur, S. A., Vande Griend, J. P., & Fixen, D. R. (2020). Pharmacotherapy in older adults. Pharmacotherapy: A Pathophysiologic Approach, 11e.

Maher, R. L., Hanlon, J., & Hajjar, E. R. (2014). Clinical consequences of polypharmacy in elderly. Expert Opinion on Drug Safety, 13(1), 57–65.

Masnoon, N., Shakib, S., Kalisch-Ellett, L., & Caughey, G. E. (2017). What is polypharmacy? A systematic review of definitions. BMC Geriatrics, 17(1), 230.

O’Mahony, D., O’Sullivan, D., Byrne, S., O’Connor, M. N., Ryan, C., & Gallagher, P. (2018). STOPP/START criteria for potentially inappropriate prescribing in older people. Age and Ageing, 44(2), 213–218.

Onder, G., Liperoti, R., Fialova, D., Topinkova, E., Tosato, M., & Landi, F. (2014). Polypharmacy in nursing home in Europe: Results from the SHELTER study. The Journals of Gerontology: Series A, 69(5), 551–558.

Scott, I. A., Hilmer, S. N., Reeve, E., Potter, K., Le Couteur, D., & Rigby, D. (2015). Reducing inappropriate polypharmacy. JAMA Internal Medicine, 175(5), 827–834.

Tian, F., Qian, L., Zheng, Y., & Zhang, M. (2020). Polypharmacy and adverse health outcomes in elderly: A systematic review. Drugs & Aging, 37(10), 735–747.

World Health Organization. (2019). Medication Without Harm – Global Patient Safety Challenge. https://www.who.int