I note in your article “Falls in older people: causes and prevention” (BPJ
26, March 2010), that polypharmacy is defined as “the use of four or more medicines”. However, this
is at odds with the definition used in the bpacnz Polypharmacy
POEM (May, 2006) as, “the addition of one or more drugs to an existing regimen which provides no additional
therapeutic benefit and/or causes drug related harm”.
There is a lot of confusion out there and an assumption that polypharmacy is bad and the number of medicines a person
takes should automatically be reduced, when in fact four medicines might all be indicated and work perfectly well, and
there may well be a clinical need for one or two more for that person. To many, polypharmacy equates with wasted money.
A standardised definition is needed � that is something I thought we had with bpacnz’s work in May 2006.
If possible, could bpacnz promote one definition of polypharmacy in an effort to get this complex issue
Pharmacist, Palmerston North
Polypharmacy is difficult to apply a standard definition to and various values have been used in the literature, ranging
from four to seven or more medicines. A value (i.e. number of concurrent medicines) has often been selected for research
purposes so that associations can be made between events (e.g. falls, interactions, hospital admissions) and the “degree” of
polypharmacy. This is the context of the statement in the BPJ 26 which described a link between polypharmacy and increased
risk of falls. This is an association rather than a causal relationship and does not take into consideration specific
regimens which might be perfectly justified.
The statement in the May 2006 polypharmacy POEM was based on a therapeutic view rather than a research or literature
based definition. In this context our assertion is that one additional medicine is “polypharmacy” if it
is not indicated, no longer required or causes drug-related harm.
The main message is to encourage regular medicines review. This edition of BPJ (BPJ 27)
includes an article which provides practical guidance on how to stop unnecessary medicines in older people.