Older Psychiatric Patients - Risk from Polypharmacy

A small study suggests that older psychiatric inpatients may be a “vulnerable target” for polypharmacy and are, in fact, frequently discharged with multiple medications that have potentially hazardous interactions, according to data reported at the European Psychiatric Association 18th European Congress of Psychiatry. Researchers presented the results of a study that assessed the extent of polypharmacy and potential drug interactions in 25 elderly psychiatric inpatients at the time they were discharged from the hospital to their home, a nursing home, or residential care. Eighty percent of individuals over age 75 years take at least 1 prescription medication, with 36% taking 4 or 5 medications,” according to the study director. Multiple Medications at Discharge For this study, the researchers identified potential interactions by entering information on the patient’s medication prescriptions as documented in their medical records on a UK Website known as www.BNF.org. The organization aims to provide UK health professionals with authoritative and practical information on the selection and clinical use of medicines in a clear, concise, and accessible manner. Overall, 8 patients (32%) had prescriptions for 4 or fewer medications at discharge, 10 (40%) had 5 to 8 prescriptions, and 7 (28%) had 9 or more prescriptions at discharge. The median number of prescriptions at discharge was 6.5. The median number of hazardous interactions was 3.1. A prescription for 6 or more medications was more likely to cause drug-drug interactions and hazardous drug-drug interactions. Preventing Polypharmacy To improve patient outcomes, Dr. Kumar the study author echoed prior published recommendations: including:
  • Know your patient well before starting treatment;
  • Order a treatment package, not just a prescription;
  • Educate the patient;
  • Choose the right medicine;
  • Ensure that the patient takes the medication;
  • Use as few drugs as possible;
  • Tailor the treatment to the patient’s needs;
  • Familiarize yourself with the drug;
  • Have a high index of suspicion; and
  • Consider the patient’s viewpoint.
The psychiatrist may need to work with nurses and social workers to ensure that these recommendations are implemented given that older patients may have difficulty in communicating. He also said that a dedicated in-house pharmacist may be pivotal in reducing the risk of polypharmacy in elderly psychiatric inpatients.