Addressing the problems of polypharmacy in an aging world
Around the world, populations are growing older as people live longer. There is a tendency to view this as a problem, especially in population terms. However, for the individuals concerned, it should surely be seen as good — provided that people can maintain their quality of life as they age.
Increasingly, however, chronic health conditions are becoming more prevalent, especially among older people. More people have to use medication more often. There has also been an increase in the number of people who need to use several medications at the same time, known as polypharmacy. The combination of these events and situations can cause issues.
Setting the scene
Suppose we consider someone who has high blood pressure, diabetes and high cholesterol — all reasonably common health issues among older people. This person will need to take several different medications to manage those conditions. Each of those medications has its own set of potential side effects and complications. However, when they are used together, they may also interact, creating a whole new set of potential problems. Data from Cureatr suggest that an estimated 250,000 to 400,000 deaths each year in the US are caused by medical errors.
More practically, each medication will need to be taken in a specific dose, at a specific time or times. They may need to be taken with, without, before or after food. They must also be stored properly — some at room temperature, some colder — and of course should not be used if they are out of date.
Managing the use of all these medications would therefore be a challenge for anyone. However, you also have to add the fact that around 40% of the population aged over 65 is estimated to have age-associated memory impairment. This makes the situation even more difficult to manage, given that they may struggle to remember when to take — and whether they have taken — each of their many medications. This is a concern for those involved, and also for their families, doctors and pharmacists.
An ideal solution
What would be the ideal solution to all this? We need:
· A physical storage solution that will monitor the condition of medications, and flag up potential problems or concerns;
· A solution that will identify when medications are getting close to their expiry dates, and indicate that they should be removed and disposed of properly;
· A way to monitor and track medications, and remind patients what they should take when and how;
· A system that can identify any potential problems associated with prescriptions, such as potential interactions with other medications, or contra-indications. Both doctors and pharmacists should, of course, be looking out for these issues — but neither group is infallible, and a failsafe alternative is needed;
· A system that can provide information about potential side effects from individual medications and combinations of drugs, so that patients can identify whether they should be concerned about new symptoms, and discuss problems with their doctor;
· A system that has access to information about all licensed prescription and over-the-counter drugs, so that none are excluded;
· A way of ordering more medication either direct from the pharmacy or via prescription, either when a medicine is running low, or when a packet is getting close to its expiry date; and
· A way for patients or their carers to see immediately what medications they have in stock, and in what quantity, to enable forward planning, for example, for holiday periods.
A solution that offered all these elements would allow patients to take control of their own healthcare. They and their carers would be able to store, see and track all their medications relatively easily. Both groups could be more comfortable, knowing that nothing was out of date, and that they would be alerted when something was running out or nearing expiry. Patients could identify potential side effects and interactions, and reduce the risk of harmful adverse reactions. They would be more confident about taking their medication at the right time, and in the right way — and their carers and doctors would be happier that they were adhering to their medication regimen.
No single answer?
There are several apps currently available that already support medication management, and go some way to addressing some of these problems. However, there is no single solution that provides all of these elements. Our hope is that a solution can be developed that solves the issues of both the management and physical storage of medications — and empowers patients to take control of their health again.
