As people get older, they are more likely to develop chronic conditions like high blood pressure, diabetes and arthritis.
Commonly, an individual may develop multiple chronic conditions over a period of several years leading to more and more medications being prescribed. In Ireland, one-in-three people over the age of 65 take five or more daily medications.
This is referred to as polypharmacy. Polypharmacy is often appropriate and necessary to manage chronic diseases. However, in certain instances, polypharmacy can be harmful and may increase the risk of medication errors, drug interactions, and side effects.
Furthermore, the prescription of multiple medications may be burdensome and may result in people taking their medications in irregular patterns or not at all.
Researchers in Cork University Hospital and University College Cork, led by consultant geriatrician Prof Denis O’Mahony, have produced world-renowned research in the field of polypharmacy.
The research team developed the Screening Tool of Older Persons' Prescriptions (STOPP) and Screening Tool to Alert to Right Treatment (START) Criteria, tools designed to assist doctors with managing complex polypharmacy in older people with long term conditions.
STOPP/START criteria have been shown in clinical trials to reduce inappropriate prescribing and risk of medication-related adverse events in hospitalized older adults and the criteria have been endorsed by the organizations such as the National Institute of Clinical Excellence (NICE), the British Geriatrics Society, and the UK Royal College of General Practitioners.
When managing polypharmacy, the goal is to match the medication regimen to the condition, preferences and goals of care of the individual patient. This will involve the physician and patient working together to answer key questions:
- “Does each medication continue to serve a useful purpose?”
- “Do the benefits of each medication outweigh the potential risks?”
For complex, frail older people, the aim may be to find a “happy medium” – best possible control of the patient’s long-term conditions while minimizing the risk of drug-related problems.
Getting the balance right can be challenging, but a thoughtful, patient-centred approach to addressing the medication regimen can bring order to complexity and make meaningful differences to patients’ lives.