Polypharmacy refers to the act of taking multiple medications concurrently. While there is no universally accepted threshold, polypharmacy is generally defined as taking 4 or more prescription drugs daily. Taking several medications is not inherently problematic, but it introduces uncertainties. An old principle of prescribing holds that the likelihood of adverse reactions and inability to predict interactions rises as the number of medications exceeds four.
An excellent article titled “Preventing Polypharmacy in Older Adults” by Kathleen Woodruff MS, CRNP, which appeared in American Nursing Today in 2010 explains:
“Adverse reactions are common in older adults and often manifest differently than in younger patients. An estimated 35% of ambulatory older adults experience an adverse drug reaction each year, with 29% of these reactions requiring hospitalization or a physician’s care.”
Moreover, some reactions get misidentified as standalone health issues. For instance, frequent falls, dementia, and urinary incontinence in seniors could stem from either underlying conditions or medication side effects. Per Ms. Woodruff, practitioners sometimes prescribe more drugs aiming to address those symptoms without recognizing their root cause.
Medications and Dizziness Symptoms
In my clinical experience, two medication classes often associate with patient complaints of dizziness, lightheadedness, and increased falling risk:
- Cardiovascular drugs like blood pressure regulators and antiarrhythmics
- Central nervous system agents including anxiety relievers, sleep aids, and antidepressants.
While dizziness from blood pressure fluctuations garners extensive discussion, falling related to psychoactive medications draws less attention despite posing substantial concerns.
As Lord and colleagues (2007) summarize, these psychoactive agents may:
“…reduce mental alertness, slow transmission within the central nervous system, cause sedation, blur vision, increase confusion, cause neuromuscular incoordination, impair overall balance and induce Parkinsonism.”
Though patients might benefit from lowering doses of these medications, each drug got prescribed for a reason originally. In some cases, unintended effects represent unavoidable trade-offs for essential medications. Often the only method to confirm if complaints arise from a certain drug is to stop it temporarily under medical supervision and observe outcomes.
As such decisions carry risk, they should involve the prescribing doctor or primary care provider.
In summary, while taking multiple medications (polypharmacy) is sometimes necessary, recognizing and addressing their interactions poses an essential issue in caring for older adults. As the number of drugs increases, so does likelihood that side effects go overlooked, culminating in harm. More awareness of frequent triggers for instability like cardiovascular and psychoactive agents allows for proactive, collaborative steps towards safer solutions.
About the author
Alan Desmond, AuD, is the director of the Balance Disorders Program at Wake Forest Baptist Health Center, and holds an adjunct assistant professor faculty position at the Wake Forest School of Medicine. He has written several books and book chapters on balance disorders and vestibular function. He is the co-author of the Clinical Practice Guideline for Benign Paroxysmal Positional Vertigo (BPPV). In 2015, he was the recipient of the President’s Award from the American Academy of Audiology.
**this piece has been updated for clarity. It originally published on April 21, 2015
