An article published recently in the Journal of the American Geriatrics Society titled Prevalence of Unplanned Hospitalizations Caused by Adverse Drug Reactions in Older Veterans; Zachary Marcum, et al, Jan. 2012, concluded that the number of medications a person takes is an independent risk factor for experiencing an adverse drug reaction (ADR). The calculated odds ratio for 5 to 8 medications was 2.85 and for >8 medications 3.90, which implies a high degree of correlation. The most common ADRs were bradycardia (slowed heart rate) from beta-blockers (atenolol, metoprolol, etc.) and digoxin; hypoglycemia (low blood sugar); falls associated with antidepressants and ACE inhibitors (lisinopril, enalapril, etc.); and mental status changes from anticonvulsants and benzodiazepines (lorazepam, alprazolam, etc.).
These findings are consistent with a large body of literature that the greater the number of medications we take, the greater the risk or likelihood we will experience an adverse drug reaction that causes us to seek medical attention. Using the number of medications a person takes as a screening tool should prompt all parties involved to review a persons medications to: ensure they are needed, that the doses are appropriate,that monitoring is in place, are free from significant drug interactions, and taken properly, since all of these contribute to the risk for an adverse drug reaction.
In the discussion section, the authors go on to talk about the concept of medication-minimization and how this approach might lead to a lower rate of adverse drug events, albeit how it can be a challenging task to pare down a complicated drug regimen. However, there is a growing body of evidence that suggests how we can pare down the drug regimens of an older adults without causing harm, and in many instances improve how they function. This is an area that will gain greater clarity in everyday practice and drastically change medication utilization in older adults, all for the greater good.