The Malaysian population is rapidly ageing, with over 11% currently aged 60 and above.
This figure is projected to rise to 17.3% by 2040.
The demographic shift has led to increasing healthcare demands, particularly in managing chronic diseases such as diabetes, hypertension (high blood pressure) and heart disease.
These conditions require long-term medicine use.
Alarmingly, studies indicate that nearly half of older Malaysians experience polypharmacy.
Many are also prescribed potentially inappropriate medications or fail to adhere to their treatment regimens.
This issue calls for coordinated care, increased awareness and targeted interventions.
Understanding polypharmacy
Polypharmacy is generally defined as the use of five or more medicines at the same time.
However, the number of medicines alone does not determine the impact.
The necessity and appropriateness of these medicines are equally important.
Polypharmacy can be both beneficial and harmful.
Appropriate polypharmacy occurs when multiple medicines are clinically necessary, carefully monitored and effectively managed.
For example, a person with high blood pressure, diabetes and heart disease may require several medicines to maintain stable health.
Problematic polypharmacy occurs when medicines are prescribed to treat the side effects of other medicines (a situation known as a prescribing cascade), or when the medicines themselves are potentially harmful.
Polypharmacy is common among older adults for several reasons.
Understanding these contributing factors is essential in order to design effective strategies to minimise medicines-related harm and improve overall patient care.
Some of the factors that can be attributed to the high frequency of polypharmacy among older adults are:
The presence of multiple chronic medical conditions, for which the long-term use of medicines is necessary,Prescription of medicines on multiple different occasions by different healthcare practitioners, which increases the risk of duplication or drug interaction.Prescribing cascades, where medicines are prescribed to treat the side effects caused by other medicines.The absence of regular medicine reviews, which may allow unnecessary or outdated prescriptions to continue without reassessment.Poor communication between patients and healthcare providers, which can result in confusion or misuse of medicines.Widespread and accessible pharmaceutical promotions, which encourage patients to use traditional or over-the-counter medicines alongside prescribed medicines without medical advice.
Potential dangers
Polypharmacy carries genuine and significant risks, especially for older adults.
Community pharmacists are one resource patients can easily access to ensure that their medicine regime is up-to-date and not causing any unnecessary side effects. — Filepic
Due to slower metabolisms and potentially impaired kidney function, the elderly are more vulnerable to the negative effects of multiple medicines.
Some of the most concerning consequences include emergency hospitalisations due to medicine-related complications, drug interactions that lead to undesirable side effects or reduced effectiveness, and adverse side effects such as dizziness, confusion or gastrointestinal issues.
In addition, when medicines impair alertness or physical coordination, they may contribute to falls, fractures and cognitive decline.
Several studies conducted in Malaysia also show that the majority of older adults do not take their medicines as prescribed.
Polypharmacy has a direct impact on medication adherence, which refers to how well patients follow their prescribed treatment plans.
As the number of prescribed medicines increases, the elderly often struggle with complex dosing schedules, leading to missed or incorrect doses.
This not only compromises treatment outcomes, but also increases the risk of hospitalisations and complications.
To address these, it is essential to provide patient education, simplify medicine regimens, and offer support through technology and caregiver involvement.
Reducing the risks
Healthcare systems around the world are adopting more proactive strategies to ensure the safe and effective use of medicines, especially in light of growing concerns about polypharmacy.
One important strategy is regular medicine reviews.
Patients are encouraged to inform their doctors and pharmacists about all the medicines they are taking, including prescriptions, over-the-counter products and supplements.
This open communication allows more regular medicine reviews, which helps healthcare providers identify medicines that may no longer be necessary or could be potentially harmful.
Another key practice is deprescribing, which involves gradually reducing or stopping medicines that are no longer beneficial.
Medicine reconciliation is also essential.
This process ensures that any changes to a patient’s medicine list, such as during hospital admission, discharge or transfer to a nursing home, are accurate and appropriate.
Technology also plays a helpful role.
Electronic health records can alert healthcare providers to potential interactions or duplicate medicines.
Most importantly, a patient-centred approach is needed.
When patients are involved in decisions about their treatment, it builds trust, improves adherence to medicines and leads to better health outcomes.
The most effective strategies to manage polypharmacy involve active participation from both patients and their caregivers.
Several steps are encouraged to support safe medication use:
The role of pharmacists
As the number of elderly individuals taking multiple medications daily continues to rise, the role of pharmacists has become increasingly vital.
While doctors are responsible for diagnosing conditions and prescribing treatments, pharmacists ensure that medications are used safely, correctly and effectively.
With specialised knowledge in pharmacology and drug interactions, pharmacists are often able to detect issues that may be overlooked by others.
These include overlapping therapies, potentially harmful drug combinations, and unnecessary or duplicate prescriptions.
Community pharmacists, in particular, are in a unique position to support patients directly.
As the most accessible healthcare professionals, they can offer personalised counselling, conduct routine medication reviews and help patients understand the purpose and proper use of each medicine.
They can also identify early signs of adverse effects or non-adherence, and refer patients for further medical attention when necessary.
Addressing polypharmacy requires a coordinated approach that centres on the patient.
As the population grows older, providing safe, effective and individualised treatment is crucial.
Balancing illness management with quality of life is key to delivering better and safer care to older adults.
For any inquiries regarding medicines, please call the National Pharmacy Call Centre (NPCC) at the toll-free number 1-800-88-6722 during weekdays from 8am to 5pm, except on public holidays.
Payal Choudhury is a pharmacist at Hospital Tengku Ampuan Najihah in Kuala Pilah, Negri Sembilan. This article is courtesy of the Health Ministry’s Pharmacy Practice and Development Division. For more information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only, and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this article. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.