Health Literacy and PolyPharmacy
Polypharmacy is an umbrella term used to describe the simultaneous use of multiple medicines by a patient for their conditions. This can be two to five or more medications at once.
Polypharmacy is a growing public health concern. By age 70, three out of four people who are hospitalised take five or more medicines every day. The use of multiple medicines increases the risk of medicine-related harms, with the risk of harm continuing to increase with each additional medicine prescribed. Although the number of medicines alone predicts poor health outcomes, inappropriate medicine use is an even greater risk factor. It is also important to recognise polypharmacy is not just a problem of too many medicines. People using five or more medicines are, paradoxically, more likely to be under-treated with appropriate medicines (such as indicated preventive therapies) than people taking fewer medicines, and reduced medicine adherence (because of complex regimens and limited attention to patient priorities) can reduce the potential benefit of appropriate medicines. Many older people may benefit from taking fewer medicines. There is now substantial evidence showing some medicines can be withdrawn safely in older people, and reducing polypharmacy can improve health outcomes for older people. From - The Australian Team Approach to Polypharmacy Evaluation and Reduction (AusTAPER) hospital study: effect of a collaborative medication review on the number of current regular medicines for older hospital inpatients, Christopher Etherton-Beer et al, Aug 2024
The above article supplied by our resident Medical Librarian .
In the previous post on Health Literacy we introduced in detail what is Health Literacy (HL), how it benefits us and then used a detailed example to show how it helps us if we have a chronic health condition. We used OsteoArthritis (OA) as an example. In breaking down the components of Health Literacy, we indicated that prevention is perhaps the first and most important aspect to get familiar with. For instance - daily factors to nurture and be aware of including sleep, eating regime, body composition (muscle and body fat), mental & emotional wellbeing, movement/exercise/mobility, minimising stress and Self-Knowledge.
However, some of us develop chronic health conditions in spite of our best intentions and for multiple reasons. There are many useful strategies to help alleviate symptoms and manage chronic health conditions that are non-pharmacological. However, at this point in history, pharmaceutical drugs/medications are widely and heavily prescribed, often as the primary intervention for many chronic health conditions.
As we outlined in our previous article above, Health Literacy includes familiarising ourselves with the associated side effects of any medication and how to talk to a GP about symptoms associated with medication use. How long do I need to be on a medication and can the dose be reduced or the medication stopped down the track, especially if symptoms improve due to increased non- pharmacological interventions and preventatives. What is the required schedule and routine required for taking the medication.
All this becomes much more important if we are on two or more medications at once. The term polypharmacy is an umbrella term used to describe the simultaneous use of multiple medicines by a patient for their conditions. The term polypharmacy is often defined as regularly taking five or more medicines but there is no standard definition and the term has also been used in the context of when a person is prescribed two or more medications at the same time. Ref
Our resident Medical Librarian and team member recently discovered the following article that highlights some salient points concerning the increase in polypharmacy and the issues both patients and healthcare providers need to be aware of.
The article acknowledged that during Polypharmacy, the presence of adverse drug reactions (ADRs) and resultant prescribing cascades occur when, (and I really don’t like this term), Multimorbidity is present. Ref
Polypharmacy becomes problematic for an older adult when the medicines prescribed are not clinically indicated or when they cause more harm than benefit.
“Multimorbidity, also known as multiple long-term conditions (MLTC), means living with two or more chronic illnesses. For example, a person could have diabetes, heart disease and depression at the same time. Multimorbidity can have a significant impact on people's health and wellbeing. It also poses a complex challenge to healthcare systems which are traditionally focused on individual diseases. Multiple long-term conditions can affect people of any age, but they are more common in older age, affecting more than half of people over 65 years old!”
Prescribing cascades occur when a new medication is prescribed to treat or to prevent the symptoms of an adverse drug reactions (ADR) caused by another medication. Prescribing cascades can be intentional or unintentional.
Unintentional prescribing cascades occur when an ADR occurs; the adverse effect is misinterpreted as a new symptom that results in the initiation of a new medication.
Failure to recognise an ADR may result in an unintentional prescribing cascade, exposing a person to continuing risk of an ADR from the culprit medication and additional risk from the newly prescribed medication.
Health Literacy asks that, if you have one or more chronic health conditions, you become aware of the above possibilities and any new adverse drug reactions (ADR) and engage your health care provider in conversations that addresses these potential issues. And, without glossing it over, this process of identifying a prescribing cascade becomes even more complex in the context of polypharmacy in an older adult with multiple long-term conditions.
A recent qualitative study with healthcare professionals and patients on prescribing cascades found that an ability to identify a prescribing cascade, as distinct from a new symptom, was key to the prevention of prescribing cascades. Research to date has sought to identify lists of potential prescribing cascades. More recent research has systematically assessed the evidence supporting these potential prescribing cascades. Findings from these studies need to be translated into educational initiatives to raise awareness of potential prescribing cascades.
Chronic Health conditions are sometimes unavoidable. Constantly improving health literacy helps substantially in optimal management of these conditions. And of course tweaking and implementing as much as possible the daily pillars of health like sleep, eating regime, body composition (muscle and body fat), mental & emotional wellbeing, movement/exercise/mobility, minimising stress and Self-Knowledge, helps people who have a chronic condition AND those who are symptom free and wish to stay that way as long as possible.