In a recent report released by the Hong Kong Pharmaceutical Services Fund, it was highlighted that a significant portion of elderly individuals in Hong Kong are facing the issue of “polypharmacy,” which refers to the simultaneous use of five or more medications. Shockingly, over 30% of the elderly are prescribed 10 or more medications, with some even receiving prescriptions for up to 32 different drugs. Unfortunately, many elderly individuals lack the ability to effectively manage their medication regimen, leading to potential misuse of medications and emphasizing the need for government intervention.
The “Elderly Medication Support and Education Program” team conducted a study to assess the situation of “polypharmacy” among community-dwelling elderly individuals. In addition to providing services to the elderly, the team collected background information and recorded medication usage for analysis with the consent of the service users.
Project manager Li-na Choi analyzed the survey results and expressed concern over the severe prevalence of “polypharmacy” among community-dwelling elderly in Hong Kong. She revealed that more than 30% of service users were prescribed 10 or more medications, with over 90% of these medications obtained from public hospitals. Additionally, a significant number of service users, ranging from 20% to 60%, were either living alone, with a partner, experiencing hearing or visual impairments, lacking self-medication management skills, and prone to inappropriate medication usage.
According to previous studies conducted by the Hong Kong Pharmaceutical Services Fund, it was found that over 60% of elderly residents in nursing homes were also simultaneously using 10 or more medications, significantly complicating their medication regimen. Further analysis combining nursing home data revealed a correlation between elderly individuals classified under “potentially inappropriate medication” (PIM) and their readmission rates. The results indicated that elderly individuals simultaneously consuming multiple drugs listed as PIM faced significantly higher readmission rates, thereby exacerbating the burden on public healthcare services.
Chairperson of the Hong Kong Pharmaceutical Services Fund, Xiuzhu Jiang, identified four major issues concerning medication management among elderly individuals in the community. These include the problem of “polypharmacy” among the elderly, their lack of ability to handle multiple medications correctly – including proper administration methods, storage, and disposal, suboptimal medication usage, and the accumulation of excess medications at home leading to waste and environmental pollution. She further emphasized that these issues are expected to worsen with the aging population.
Dr. Jun-wen Chen, a specialist in geriatric medicine, shared a case where an elderly patient was prescribed 32 different medications, including topical, oral, inhalation, and injectable drugs. Dr. Chen highlighted three main reasons leading to “polypharmacy” among the elderly, including the prevalent use of multiple drugs in modern Western medicine to treat chronic conditions, the lack of a unified prescription drug system among healthcare providers in Hong Kong leading to potential medication duplication, and the time constraints preventing thorough monitoring of medication effects and side effects which could result in prescribing medications to counteract the adverse effects of other drugs, thereby creating a vicious cycle.
Professor Zhi-sheng Huang, from the School of Public Health and Primary Care at the Chinese University of Hong Kong and director of the Health Education and Health Promotion Center, explained that the concurrent use of multiple medications increases the likelihood of drug interactions among the elderly, affecting the efficacy and potentially raising the risk of side effects. Additionally, elderly individuals may struggle with distinguishing between different medications in terms of usage, dosage, or timing, heightening the risk of medication errors.
Professor Huang further noted that the combined use of multiple medications may overwhelm the elderly individuals’ bodies, making it challenging to cope with the side effects of various drugs, increasing the likelihood of adverse reactions. Complex medication regimens could also reduce patients’ adherence to treatment, making it difficult to manage their condition effectively. Moreover, elderly individuals are more susceptible to falls, malnutrition, cognitive impairment, emotional instability, and declining physical function due to the consumption of multiple medications, significantly increasing their risk of hospitalization and death.
Professor Huang recommended healthcare providers to simplify medication regimens for the elderly, assist them in managing medication boxes, conduct regular reviews of their medication plans, and provide medication education to both the elderly individuals and their families to enhance treatment effectiveness and minimize the risk of adverse reactions associated with “polypharmacy.”
Dr. Chen suggested that elderly individuals or their caregivers prepare a list of current medications for reference or take photos of medication labels and dosages on their phones. This proactive approach allows doctors to adjust medication prescriptions based on the latest medication list and medical condition, ensuring precise medication administration and optimal treatment outcomes.
Xiuzhu Jiang urged relevant authorities to pay attention to the issue of “polypharmacy” among the elderly in the community and provide more social resources to support proper medication use, enhancing the self-care abilities of the elderly population.