Polypharmacy in old age - how too much medicine harms well-being

The average age of the population continues to skyrocket from year to year. Life has become more comfortable than it was just a few decades ago, and it is precisely this high standard of living that is causing people's age to skyrocket. The demographic change is in full swing and this can also be observed realistically on the basis of everyday situations. The fact of being able to grow older and older also partly holds hurdles that family doctor practices are increasingly confronted with. The largest of these hurdles addressed is polypharmacy. There are a number of things to keep in mind when taking multiple medications at the same time as one ages, as this procedure is often treacherous in nature.

If we start purely from the meaning of the word "medicament", we end up in Latin: Medicamentum means remedy translated into German. From the sound of it, this is to be seen as positive. However, especially in old age, it becomes apparent what a double-edged sword medications are. Interactions that bring dangers such as dizziness and falls are not uncommon among the older generation; just as domestic pharmacies with seven to ten medications occur now and then. The NDR documentaryMedikamente im Alter - Die unterschätzte Gefahr (Medications in old age - the underestimated danger ) uses real life stories to bring home just how far-reaching the effects of taking more medication can be in patients. This is also the case with the story of Mrs. Ellen Engelken:

She takes seven medications a day. She also has diabetes, a type of diabetes. That's why she relies on insulin injections. To treat her painful bone disease rheumatism, she is prescribed cortisone. The problem is that cortisone is the antagonist of insulin. If the goal of insulin is to lower blood sugar levels, cortisone raises them in turn. This leads to fluctuations in blood sugar. This is also the case with Ellen Engelken, who takes the cortisone without any warning. Since then, she finds it more difficult to regulate her blood sugar, she gains weight and feels more unwell. After stopping the cortisone, she has to cope with the pain caused by the rheumatism, but overall feels much better than before.

More real-life stories about the sense and nonsense of taking medication in old age can be found in the NDR documentary Medikamente im Alter - Die unterschätzte Gefahr (2018):

The fact that the consequences of the simultaneous and high intake of medication usually cannot be ignored makes the situation really dangerous. Instead of achieving a positive effect, those affected are maneuvered into a health disaster by the regular mixed intake. It is not uncommon for four drugs in combination to cause severe side effects and for a fifth to be used to treat the side effects. So instead of taking a more defensive approach, people prefer to fight evil with evil. A change in thinking must take place here, and the assessment of the disease must also be more individual, time-intensive and detailed on the part of the physician. But the patients themselves can also help to change the situation. In particular, caution is required when changing doctors frequently, as this is where most mistakes are made in the administration of medication. In such cases, the past medication plan should always be passed on to the new doctor.

In order to ensure excellent quality across the board and, above all, consistently, people are increasingly relying on the use of standards. Only when rules, sequences, contents and approaches are practiced and executed identically everywhere can one speak of comprehensive quality. These standards can be seen everywhere - whether in protective clothing, traffic regulations or even our laws. Accordingly, it is hardly surprising that in medicine, too, decisions are made on the basis of guidelines that contain and focus precisely on this equality of quality. The case of Mrs. Meyer, who wishes to remain anonymous, shows that despite these standardizations, one should sometimes still think for oneself:

She was discharged from the hospital after treatment at the age of 78 and then went to see her family doctor. In order to ensure goal-oriented follow-up treatment, the family doctor compiled the prescribed medication plan and meanwhile had to make an unbelievable observation. Based on the hospital report, Ms. Meyer had to take around 21 pills every day - a total of 14 different medications. Although it was also clear from this hospitalization history that all of these prescribed agents had a purpose and were also appropriate according to the guideline, this condition should by no means be simply accepted.

It may be that polypharmacy in old age is also caused by the guidelines imposed on physicians. But the problem with the guidelines is that they are not sufficiently scrutinized. They are based on fixed parameters that do not allow for "reading between the lines". No guideline and no computer algorithm can tell what the simultaneous combination of 14 different agents does to the body. There is simply still too little known about the interaction of so many drugs to simply wave this through. Here, too, a more critical and individualized view must be the order of the day. Around 25,000 deaths in Germany are attributed to drug reaction and interaction. Take care of yourself...