Ambulatory Care
Many studies in ambulatory care define polypharmacy as a medication count of five or more
medications. However, current medical practice guidelines often require multiple
medications to treat each chronic disease state for optimal clinical benefit. Therefore, an
elderly patient with at least two disease states, such as heart failure and chronic obstructive
pulmonary disease, will usually exceed this arbitrary threshold of > five medications . For
example, a 2005-2006 study from the USA reported by Qato et al used a population-based
survey of community dwelling persons 57-85 years of age . Overall 37.1% of men and
36% of women between 75 and 85 years of age took at least five prescription medications.
Table 1 shows the most common prescription medications reported. Moreover, among this
older age group taking at least one prescription medication, 47.3% reported the use of an
over-the-counter medication and 54.2% a dietary supplement. The use of unnecessary drugs
was studied in 128 older male outpatients from the United States . Overall 58.6% of
patients took one or more unnecessary prescribed drug. The most commonly prescribed
unnecessary drugs are summarized in Table 1.