Polypharmacy Definition and overview The use of multiple medications by a patient, with a minimum threshold ranging from five to 10 medications. Metabolic differences to younger people: Decreased drug clearance -> multiple drugs -> heavier metabolic load. Prescribing cascades: adverse drug events -> wrongly viewed as new medical condition -> new prescription -> further adverse drug event. Risk Factors Non-concordance Interaction effects Falls Delirium Organ toxicities Nutritional issues/malabsorption Costs to the healthcare systems Treatment and Management Identify what is important to the patient at this stage of their life to guide what is necessary and unnecessary: Clarity of thought? Good sleep? Mobility? Being pain free? Identify the important medical issues and how they may be medicated. Is cholesterol lowering medication that important in a 90-year-old man? Is tight glycaemic control that critical for your patient Beer’s criteria for management A list of medications that are deemed inappropriate for elderly persons should be reviewed for their necessity on a case-by-case basis. MAKE SURE TO ENSURE THAT THE PATIENT IS NOT IN PAIN, DISOCMOFRT OR DE-FUNCTIONED WITHOUT THEIR MEDICATION. SHAAAAGD: Sleeping medications Heart medications e.g. beta blockers, anti-hypertensives, diuretics. Antihistamines Antidepressants Anxiolytics Analgesics Gastrointestinal medications Diabetic medications