the World Health Organization (WHO) to establish their definition of polypharmacy as “the administration of many Polypharmacy Since the early 2000s there has been an increase in individual usage of pharmaceuticals, prescription drugs, over the counter drugs, and vitamins and other supplements. While there are some clinical guidelines that detail concurrent use of various medications for disease management, currently there is no standard definition
drugs at the same time or the administration of an excessive number of drugs, “ as quoted by Delara et al (2022).
for polypharmacy. As mentioned, a typically accepted description of polypharmacy is applied to patients who take five or more medications daily for an extended period; however, it should be noted that description can vary by provider, location, and healthcare setting (Table 2).
Table 2: Examples of Polypharmacy Definitions Varied Definitions of Polypharmacy Numerical Definitions of Polypharmacy in a Healthcare setting
Descriptive Language Definitions of Polypharmacy
Five or more medications
Five or more medications at hospital discharge
Necessary polypharmacy: “Necessary polypharmacy regimens should be considered additional medications that can optimize functional status and prevent disability in older adults. For older patients receiving NP regimens, the benefits outweigh the risks.” Qualitative polypharmacy: “prescription of five or more medications including at least one drug considered potentially inappropriate for older adults” Psychotropic polypharmacy: “the concurrent use of two or more psychotropic agents in one” patient
Six or more medications
Five to nine medications during a hospital visit
Ten + medications
Known as “excessive polypharmacy,” 10 or more medication
Seven or more medications
N/A
Appropriate polypharmacy: “optimization of medications for patients with complex and/or multiple conditions where medicine usage agrees with best evidence”
Five to nine medications
N/A
“Use of medications which are not clinically indicated”
(Pazan & Wehrling, 2021) In addition to the differentials relative to the number of medications comprising polypharmacy, there is a relative difference pertaining to actual prevalence, with some estimates reportedly impacting a range of 10% to 90% of adults that are affected. This differential is due to the numerous definitions of polypharmacy and varying demographic information including geography, age, type of health-related conditions, and types of medication. Clinicians who are working with patients managing their multimorbidity should differentiate between appropriate polypharmacy and the achievement of each specific therapeutic outcome or objective to minimize opportunities for adverse drug reactions (Verghese et al., 2023). Managing pharmacological therapy is of the utmost importance for patients managing multiple conditions; however, clinical pharmacists should review medications to limit redundancy and potential counterindication. Of note (Verghese et al., 2023): ● There are circumstances in which polypharmacy is not always harmful. ○ Proper evaluation has been conducted to curtail adverse outcomes. ○ Treatment is managed to achieve positive therapeutic outcomes. ● There are circumstances in which polypharmacy is inappropriate from the onset. ○ Prescribed medications are inappropriate and can result in adverse treatment results or outcomes. ○ Therapeutic objective will not be achieved. ● Clinical goals should always be that patients receive appropriate pharmacological therapy for disease management, in consideration of all chronic conditions receiving concurrent treatment.
○ Patient must be monitored and evaluated in a timely manner. ● All providers should make therapeutic judgements based on comprehensive and holistic treatment approach and planning. ○ Consulting available resources identifying potentially dangerous drugs for older adults, such as the Beers Criteria for Potentially Inappropriate Medication Use in Older Patients, will provide insight. According to Wang et al. (2023) there are population characteristics that impact and drive the demographic trends relative to polypharmacy, which has shown consistent increase in recent decades. From 1999 to 2018 Wang’s research shows a continuous uptick in polypharmacy from 8.2% to 17.1%. Notable observations include higher incidences of polypharmacy in the following groups: ● Females ● Older adults ● Non-Hispanic Whites ● Adults who have graduated high school but have not attended college ● Adults with cardiac disease ● Adults with diabetes Throughout the United States there has been an increased use of multiple medications simultaneously over the past two decades (Wang et at., 2023). Many Medicare Advantage health plans include an over-the-counter benefit that offers zero to no-cost medications, while simultaneously there are new prescription drugs introduced to the marketplace for easy consumer use, which may give the older adult the perception that more is better. The opportunity for more medication, either prescribed or over the counter, can be
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