Polypharmacy Is Rising Among Older Americans, But There’s Some Good News

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<p>A growing number of Americans ages 62 and older are taking five or more prescription medications, according to a new study published in <em>JAMA</em>.</p>
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<p><a href="https://jamanetwork.com/journals/jama/article-abstract/2854478#google_vignette">Researchers compared</a> medication and dietary supplement use in 2015-2016 with use in 2021-2023. They found that <a href="https://medshadow.org/drug-updates-recalls/drug-safety/medication-safety-for-older-adults-strategies-to-reduce-risk-and-improve-care/">polypharmacy</a> — defined as taking five or more medications or supplements at the same time — increased over that period. The percentage of people taking five or more prescription medications rose from 31% to 36%, while the percentage taking five or more supplements increased from 13% to 17%.</p>
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<p>Pharmacists and doctors often worry about polypharmacy because it can raise the risk of a dangerous drug interaction.</p>
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<h2 class="wp-block-heading">Fewer Drug Interactions, But Concerns About Muscle Relaxants</h2>
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<p>Despite this rise, potentially dangerous medication combinations became less common. The share of people taking interacting regimens fell from 26% in 2015-2016 to 22% in 2021-2023. One possible explanation is a growing awareness of polypharmacy among clinicians, including “deprescribing” initiatives aimed at streamlining treatment regimens when possible.</p>
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<p>Still, the study’s key takeaway is that polypharmacy remains prevalent, and older adults should be aware of potentially dangerous drug interactions, says lead author <a href="https://mann.usc.edu/faculty/dima-m-qato-pharmd-mph-phd/">Dima M. Qato, PharmD, MPH, PhD</a>, of the University of Southern California in Los Angeles.</p>
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<p>“About 1 in 5 are taking a drug combo that is potentially life-threatening,” Dr. Qato said, who urges consumers to be aware of the risks of their prescription medications, including supplements.</p>
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<p>The study used data from the National Social Life, Health, and Aging Project, a nationally representative sample of community-dwelling Americans ages 62 to 85. Researchers counted a medication or supplement as in use if a person took it daily or weekly, then used a database called Cerner-Multum Lexicon Plus to identify potentially dangerous drug-drug interactions.</p>
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<p>Unlike prescription drugs and supplements, the use of over-the-counter medication declined from 60% in 2015-2016 to 55% in 2021-2023.</p>
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<p>Among the medications involved in these interactions, antidepressants, <a href="https://medshadow.org/conditions-treatments/statins/rethinking-statins-inside-the-fierce-debate-over-cholesterol-and-heart-health/">statins</a>, and antiplatelet therapy remained the most common. Meanwhile, regimens involving opioid analgesics and benzodiazepines declined — possibly due to efforts to limit and monitor prescriptions with addiction potential.</p>
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<p>“Despite declines in the use of opioid analgesics and benzodiazepines in interacting regimens, increases in the use of muscle relaxants in interacting regimens may be contributing to increases in unintentional overdose deaths in older U.S. adults. Therefore, efforts to identify and manage interacting regimens involving muscle relaxants among older adults are needed,” the researchers wrote.</p>
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<h2 class="wp-block-heading">Older Adults Are Using Supplements Differently</h2>
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<p>Supplement use is shifting too, notes Dr. Qato. Multivitamins used to be more popular, but increasingly, older adults are taking more single-ingredient supplements to target specific needs, such as <a href="https://medshadow.org/drug-updates-recalls/can-i-take-this-with-that/can-i-take-melatonin-with-ambien/">melatonin</a>, zinc, or Omega-3s, she adds.</p>
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<p>Older adults are often in the care of multiple specialists, while also self-treating with supplements, meaning no single clinician may have the full picture. One way older adults can mitigate issues, says Dr. Qato, is to “communicate that with [their] primary care doctor, [and their] pharmacists.”</p>
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<p>It’s important that all adults know “what they are taking, why they are taking it, and whether or not there are any interactions,” she adds.</p>
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<p>The study was funded through the National Social Life, Health, and Aging Project (NSHAP), which is supported by the National Institutes of Health's National Institute on Aging. One of the key limitations of the study is that it did not identify actual adverse events from drug-drug interactions, only the potential for dangerous combinations.</p>
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