The Special Select Committee of the Senate examining proposals for an Elderly Care and Protection Act heard on Tuesday that polypharmacy — the taking of five or more medications simultaneously — “is rampant in our senior community”.
A certified gerontologist says that polypharmacy — the taking of five or more medications simultaneously — “is rampant in our senior community” and has called for regulatory intervention to halt the practice as it “increases the risk of conditions like kidney problems which is the fourth leading cause of death”.
Nadia McKenzie, who is also founder of social enterprise outfit Good Company, delivered the information while appearing before the Special Select Committee of the Senate now examining proposals for an Elderly Care and Protection Act at Gordon House in downtown Kingston on Tuesday.
Arguing that “preventing polypharmacy and medication mismanagement is a crucial focus, because the benefits of taking medication must outweigh the potential harms”, McKenzie said. “Ideally, what we want is quality care access where seniors receive appropriate, safe, and necessary medications.”
This, she said, “involves a multi-disciplinary approach because as we age, our health issues are going to become more complex and so we may have a specialist, we may be going to a general practitioner, we may need to see a gynaecologist, we may visit the health centre for a specific health procedure and the result is, no one person is dedicated to reviewing cases in a way that prevents things like over prescription and drug conflicts”.
McKenzie, in noting that “there are health providers or physicians who try to intervene and to also be able to assess as they go through cases”, said “it is a difficult thing to do, especially if you are part of a system that is already overburdened”.
“So our seniors experience issues of things like polypharmacy, which is common among older adults especially those with chronic conditions, and polypharmacy just refers to the taking of five or more medications simultaneously. I know that polypharmacy globally is at about 40 per cent and I know it is under-reported,” she pointed out, adding that the practice is “rampant in our senior community” as many of Jamaica’s “seniors are taking several drugs”.
“I am not a physician, I can’t say whether or not it is clinically justified but there is actually appropriate and inappropriate polypharmacy. Appropriate polypharmacy, you could be taking more than five medications and it is clinically justified, based on the complexity of your problems, but you also have inappropriate polypharmacy where it can include medications that are not indicated, dosed incorrectly, used for extended periods and is not removed from your prescription; you just have a doctor filling a prescription because it has been used or cause adverse events,” she outlined.
“Somebody needs to conduct periodic medication reviews for seniors, ensuring appropriateness, necessity and safety of prescribed drugs. We can empower the set regulatory body to actively intervene and when identifying over-prescription or conflicts supported by clearer guidelines from regulatory bodies,” McKenzie recommended.
“Again, this may be something that requires resources that are limited, so one of the things I considered is, can we talk about, for instance, final-year student pharmacists who have their practicum, can they red flag cases where they are seeing over-prescription or conflicts and the regulatory body will provide ways to resolve those things,” she said further.
Government senator and trade unionist Kavan Gayle, commenting on the concern, said determining who would be ultimately accountable would be crucial.
“Something we lose sight of — and I recall representing the pharmacy group where the pharmacists would complain that ‘we administer, we don’t prescribe’ and so the level of accountability now is my concern because maybe at a later date you might want to give us some context in terms of accountability; who is going to be monitoring this, the role of strengthening the powers and authority of the pharmacist who may have to push back… so is the level of accountability resting with those who, in the first instance, prescribe?” Gayle said rhetorically.
Opposition Senator Dr Floyd Morris in 2021 had moved the private member’s motion resulting in the formation of the special select committee. The motion was approved by the Senate in October 2024. The committee, following its deliberations on the scope and details to be included in the legislation, will prepare a report for the Senate’s consideration before it heads to Cabinet.