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On 12 August, 2023, Seniors Today hosted their Weekly Health Live webinar with Dr Rajiva Gupta who spoke on and answered questions about Medication Overload: Impact of Polypharmacy
About Dr Rajiva Gupta:
Dr Rajiva Gupta is a Senior Consultant in Internal Medicine and Diabetes with an experience spanning over 40 years. He did his MBBS from Maulana Azad Medical College, New Delhi and MD from Dr. Ram Manohar Lohia Hospital, New Delhi (now called PGIMER – Post Graduate Institute of Medical Education & Research, University of Delhi). He has also done a Post Graduate Program in Diabetology from the Johns Hopkins University School of Medicine, USA and a Specialist Certificate Course from the International School of Diabetes (IDF).
Dr Gupta currently has consultation practice at his personal clinic Upchaar Wellness in Gurugram as well as affiliated with C K Birla Hospitals at Gurugram and Punjabi Bagh, Delhi.
He has been practising earlier at his clinic in Ashok Vihar , Delhi and has been affiliated with major hospitals like Fortis Hospital, Shalimar Bagh, Max Super Speciality Hospital Shalimar Bagh, Delhi Heart and Lung Institute New Delhi etc.
Dr Gupta has conducted CME (continuing medical education) programmes in the fields of internal medicine with special focus on diabetes, clinical cardiology, and geriatrics and given lectures and conducted certified courses on various topics in diabetology, cardiology, critical care , geriatrics and Covid-19.
He has attended several national and international symposia, conferences and workshops under the auspices of leading organisations and institutions like Harvard University, American College of Cardiology, Cleveland Clinic, European Society of Hypertension , Indian Thyroid Society, American Diabetes Association, American Society of Hypertension etc.
Dr Rajiva Gupta has been an active researcher having participated in several national and global clinical trials in the fields of diabetes and cardiology. He is a member of several prestigious professional organizations like the Endocrine Society, American Diabetes Association, American Association of Clinical Endocrinologists, American College of Physicians.
American College of Cardiology, Research Society for the Study of Diabetes in India , Geriatric Society of India etc. He has contributed articles in the fields of Vitamin D , Insulin therapy, Geriatrics in reputed journals.
Dr Rajiva Gupta has written a book titled ‘Stress & Diabetes: The Underappreciated Connection’ published by the Pendown Press, New Delhi which was released at the New Delhi World Book Fair on February 25, 2023.
Polypharmacy is defined as a concurrent use of multiple medications, usually five or more.
For the seniors these can be the prescribed medications for specific illnesses and comorbidities in addition to over the counter medications which include supplements and ayurvedic medications, herbs and treatment for certain other reasons.
This is why seniors are at an increased risk for polypharmacy.
A survey in the US revealed that at least 57% of the population is taking 5 or more medications and about 20% is taking 10 or more medications.
38% of the population is taking over the counter drugs
63% of the people consume herbal medicines
When a patient is discharged from the hospital, he is on an average of 14 medications which he has to take after the discharge from the hospital.
The concept of poly pharmacy and its adverse effects, especially on the older age group emerged when patients on multiple medications presented to the hospital with complaints which were reduced by simply reducing and removing certain medications from their prescription.
In patients with chronic kidney disease, the tendency to bleed rises, and an upper GI bleed is a common side effect seen with polypharmacy, which poses a significant challenge and harm to the individual’s life.
Multiple medications lead to interactions amongst the medicines itself as well as the disease. Adverse effects, complications and deterioration of the quality of life can be seen when multiple medications are prescribed, leading to polypharmacy.
Safe and effective drug therapy is an essential part of caring for the seniors.
What can be done is- an updated medication list of the patient should be easily accessible to the treating physician and all the healthcare workers tending to the patient at all times. This
- Enables identification of drug related cases of new symptoms
- Eliminated duplication of medication
- Allows reduction in drug interactions
- Allows easier planning of a regimen best suited for the patient for easier and more compliant adherence
All adults on multiple medications should have an annual drug review which gives the physician an opportunity to
- Discontinue unnecessary or duplicated medications
- Addition of necessary drugs which are not currently prescribed
All drugs prescribed to seniors should have a clearly defined indication for the medication.
All patients should receive appropriate information regarding the indication and need for the prescription of any and all drugs in their prescription. They should also be educated about the possible associated side effects of the medications that the patient is on, and sufficiently warned.
When a patient is put on any medication, the patient’s response to therapy should be monitored and even charted/ documented. This will help us understand if the patient and the medication is meeting the desired therapeutic goal. And this can also provide the basis for alteration, continuation or discontinuation of the medication.
Risks of polypharmacy are increased in the elderly because of the change in their metabolism which are age related such as reduced drug clearance by the kidneys, which can be compounded by increased use of drugs (in quantity).
Polypharmacy can also lead to an increase in the possibility of prescription cascade- a phenomenon which has been appreciated recently- a process whereby the side effects of the medication are misdiagnosed as symptoms of another medical condition leading to addition of more medications.
Poly pharmacy over a long period of time increases the risk of adverse health outcomes such as falls and hospitalisation.
If a person is on 2 medications, the chances of such adverse events are around 13%
If a person is on 5 medications, the chances of such adverse events are around 58%
If a person is on more than 7 medications, the chances of such adverse events are as high as 82%