Polypathology, polypharmacy, medication regimen complexity and drug therapy appropriateness

Area of Science:

• Geriatrics
• Clinical Pharmacy
• Pharmacoeconomics

Background:

• Elderly patients often have multiple conditions (polypathology) and take numerous medications (polypharmacy), affecting 85% of this demographic.
• Polypharmacy is linked to adverse effects like weight loss, falls, cognitive decline, and hospitalizations, without improving survival.
• Therapeutic complexity, including drug formulation and administration, further complicates regimens and reduces patient adherence.

Purpose of the Study:

• To highlight the negative impacts of polypharmacy and therapeutic complexity in elderly patients.
• To emphasize the need for appropriate drug use, including deprescribing, to mitigate risks.
• To advocate for systematic medication reviews and the use of established criteria to improve prescribing practices.

Main Methods:

• Review of existing literature on polypharmacy, therapeutic complexity, and adherence in elderly patients.
• Discussion of proper prescribing principles and the role of periodic medication reviews.
• Highlighting the utility of the Beers and STOPP/START criteria for optimizing medication regimens.

Main Results:

• Polypharmacy does not correlate with increased survival in elderly individuals.
• Increased adverse drug events, functional decline, and hospitalizations are associated with polypharmacy.
• Both polypharmacy and complex drug regimens negatively impact patient adherence.

Conclusions:

• Appropriate drug use, including deprescribing, is essential for polymedicated, polypathological patients.
• Regular medication reviews, especially during healthcare transitions, are crucial for optimizing drug therapy.
• Utilizing tools like the Beers and STOPP/START criteria can improve medication appropriateness and patient outcomes.