There is a common misconception that there is a pill to fix virtually any health issue. I’ve written about this before (‘A pill for everything?’) in relation to medications for dementia (most notably prescribed for people with Alzheimer’s Disease), but for this blog post I want to concentrate on a topic I’m seeing with alarming frequency in my consultancy work – Poly pharmacy.
What is poly pharmacy?
Poly pharmacy is when a person, often an older person, is taking 4 or more medications. It’s often related to older people because as our bodies age, more can start to go wrong that requires medication (or that it’s perceived requires medication). Poly pharmacy is also more dangerous as we age because our bodies often can’t cope with multiple medications as well, putting strain on vital organs and potentially affecting the person both physically and mentally.
How does poly pharmacy happen?
Very easily! Common medications that occur frequently in cases of poly pharmacy include drugs to treat high blood pressure, digestive problems, pain, diabetes, thyroid problems, sleeping problems, and medications for depression/mood/behaviour. Indeed, many times in my dad’s life with vascular dementia he was prescribed more than 4 medications, making him the subject of poly pharmacy (although we had never heard of this at the time).
There is a well worn joke that as you age you ‘rattle’ from all the pills you swallow, but poly pharmacy is no laughing matter, nor should it be ignored or considered ‘the norm’.
Why is poly pharmacy a problem?
Once a person is taking more than 4 different medications, pharmaceutical companies cannot reliably tell you what the side-effects might be. Of course there might be none, but there could also be serious underlying problems developing that the person either is or isn’t aware of. Unchecked, at best these can impact on the person’s quality of life, and at worse could lead to serious illness or injury (for example falls if the person experiences sleepiness as a side-effect).
How does poly pharmacy impact upon a person with dementia?
Many people with dementia also live with other long-term conditions that require medication, or they are given medication to prevent certain conditions from developing (for example a statin because it’s believed they lower cholesterol, although opinions are divided). Given the nature of the cognitive problems that characterise dementia, the person may be more vulnerable to being given medication because unlike someone who isn’t living with dementia, a person with dementia may not have the communication ability, or confidence, to question a prescription effectively.
The tipping point
The tipping point into poly pharmacy will vary from person to person, entirely dependent upon whether the individual has historically been a person who has lived with multiple long-term conditions for a long time prior to their dementia and is used to managing some or all of those conditions with medications.
However, the prescription of anti-dementia medication upon a diagnosis of dementia might take a person into the realms of poly pharmacy, as might the prescription of sleeping medication or anti-depressants, both of which are common pharmacological ways of ‘managing’ problems a person with dementia is perceived to have with ‘behaviour’.
Questioning the prescription of such medication to manage ‘Challenging behaviour’ (a phrase I dislike – read this blog for the reasons why) is particularly important because these medications are often used instead of the more controversial antipsychotics. Antipsychotics have been the subject of a target to reduce their prescriptions since they were linked with serious side effects and even the premature deaths of people with dementia.
Replacing one ‘chemical cosh’ with another one, albeit potentially a milder type of medication, is still dangerous in my opinion, especially in a person already taking other medications who is then at risk of poly pharmacy.
Standing up against poly pharmacy
I feel strongly that everyone needs to understand the risks of poly pharmacy. That’s not to say that every medication given is wrong, or that anyone should suddenly stop taking medications that may be absolutely essential to them. But awareness of poly pharmacy, the confidence to try and guard against becoming the subject of poly pharmacy, and regular reviews for anyone taking multiple medications is absolutely vital.
Doctors who understand poly pharmacy would always be very supportive of trying to avoid it, and only prescribing absolutely essential medications that are then regularly reviewed.
Supporting a person with dementia who may be at risk of poly pharmacy
Ideally, a person with dementia would be supported at medical appointments by a family member, friend or advocate, but that won’t be the case for everyone. If the person is alone, or the individual with them doesn’t feel confident in speaking up or questioning a medication, then often the medication will just be prescribed.
Even social care professionals accompanying a person from a care home to a GP or hospital appointment may not feel they have the skills to question a prescription. For this reason, it is vital that training in poly pharmacy and empowering staff confidence is given by all social care providers, as they are often unofficial advocates for a person with dementia.
Until next time…