This is the podcast, Surgery I C rounds. My name is Jeff Guy. The topic that I want to talk about today is Polypharmacy of the elderly patient. We recently had a patient on our service who got admitted to the intensive care unit, and as we were going through her medication list, we were all very much stunned by just almost you know almost two dozen

medications that she was on and during the course of the hospitalization as we

tried to wean down some of these medicines in consultation with our general

internists and our various medical specialties the patient became very anxious

about being on less than her two dozen medications.

And Polypharmacy is really defined as giving somebody more than four medications.

It's actually a very dangerous but a reasonably common practice, particularly in the United States.

I remember my first day of pharmacology, having the chairman ofology come in in medical school and tell us that there were no such things as good medicines.

And this was reasonably alarming for a medical student who is now going to spend the next year studying pharmacology.

And the pharmacologist went on to describe the fact that medications have their desired

effects for the treatment of a particular illness, be it treated an antibiotic for eradication

of an infection or an analgesic for the relief of pain, and on the other side they had their adverse effects.

And all medications had adverse effects.

And in each patient, and in each medication, you have to evaluate, do the benefits of that medication

outweigh the adverse effects?

And as we accumulate more and more medications, we clearly accumulate our adverse effects.

And this brings us to the topic today of polypharmacy in the elderly patient.

We're all aware of seeing, certainly in the United States, the surprising numbers of elderly

patients that are going to be in the next 10 or 15 years, as it certainly makes up a large

portion of the United States.

And older patients, as we are aware, have a lot of chronic medical problems that they bring with them to the intensive care unit,

be it chronic obstructive pulmonary disease, vascular disease, heart disease, or diabetes.

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