Polypharmacy in elderly people: epidemiology, consequences and prevention strategies
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Abstract
Aging is a status often associated with multiple comorbidities which require pharmacologic intervention and complex medication regimens. Aging population results to the increase of chronic diseases and subsequent comorbidities that require concomitant multiple medications. It is reported that about 80 % of elderly have at least one chronic condition, and about half of them have at least two (such as heart disease, hypertension, diabetes mellitus, arthritis, and cancer). According the literature the worldwide polypharmacy prevalence has a wide range (between 5 to 78 %) due to different definitions on the number of medications taken (ranging between 2 and 9) and the different samples studied. In most studies polypharmacy was more common between women and in more elderly people. Many multicenter studies have been performed to define the term of polypharmacy and its prevalence in the elderly population. Polypharmacy is of growing concern for the older adults, because it can be very dangerous for this population due to altered absorption, distribution, metabolism and excretion of the drugs within their body reflecting unexpected pharmacokinetics and pharmacodynamics of various medications. This fact can lead to adverse drug reactions (ADR), drug interactions, noncompliance and reduced adherence, reduced functional status, geriatric syndromes, high risk of hospitalization and possible death. Over the last decade, there are several evaluation tools which can help the General Practitioner prevent the polypharmacy in the elderly. As prescribing for this group of individuals is a very challenging procedure, the General Practitioner should balance between under-treatment, over-treatment and risks and benefits. This review concluded that we need more cross-sectional clinical studies on practical preventive interventions to be applied not only on the population which is already exposed to polypharmacy, but also to the general population.
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