This indicator would enable us to quickly identify elderly people at risk of frequent emergency room visits and death
The number of medications taken by the elderly is constantly on the rise, and we shouldn’t wait until a person is taking twenty or so before questioning whether his or her medication is optimal. At what number should a warning light go on? Eight, suggests a study published in the Journal of Applied Gerontologyby a team from Université Laval’s Faculty of Pharmacy, VITAM - Centre de recherche en santé durable and the Institut national de santé publique du Québec.
"With the aging of the population and the rising prevalence of chronic diseases, there is a strong trend towards prescribing more and more drugs. People have more illnesses, so we come to think that it’s normal for them to take more medication. The truth is more nuanced, because there are health gains to be made when we ensure optimal therapy for each individual, and polymedication can be detrimental to this objective," points out the study’s leader, Caroline Sirois.
Polymedication, or polypharmacy, carries three types of risk, she continues. "On the one hand, as the number of drugs increases, so does the risk that some of them, which were appropriate at the time they were prescribed, may no longer be appropriate because the patient’s condition has changed. The greater the number of drugs, the greater the risk of harmful drug interactions. Finally, many drugs have a negative effect on an important neurotransmitter in the human body, acetylcholine. The additive effect of these drugs on this neurotransmitter can have significant health repercussions."
To explore the link between polymedication and certain health indicators, the research team led by Prof. Sirois used the Quebec Integrated Chronic Disease Surveillance System. This megabase of data contains, among other things, information on prescription drug claims, emergency room visits and deaths.
"We used this system to determine, among community-dwelling people over 65, which medication-related indicators best predicted frequent emergency room visits (3 or more visits per year) and deaths. Our analyses covered more than 1.4 million people," summarizes Professor Sirois.
The exercise determined that the number of medications was a better predictor of frequent emergency room visits and death than complex indicators based on inappropriate medication criteria.
"The threshold of eight medications is optimal. It provides a quick and easy way to identify seniors at risk of frequent emergency room visits and death. When healthcare professionals encounter patients taking eight medications, they should carefully review their medication to ensure that it is appropriate. This does not mean that there are no problems beyond this threshold. It’s an indication that it’s already time to review medication."
The authors of the study, published in the Journal of Applied Gerontology, are Alexandre Campeau Calfat, Justin Turner, Marc Simard, Marjolaine Dubé and Caroline Sirois.
