As we age, we often experience more than one chronic condition. Taking multiple medications often becomes part of our daily lives. It can help us manage our health, although polypharmacy is a significant problem among some older adults. Patient-related characteristics and beliefs regarding the taking of multiple drugs was the focus of a study by Rossi and coworkers. The goal of their research was to determine the prevalence and predictors of unnecessary drug use in older veteran outpatients, with a focus on patient-related factors and health beliefs. Community-dwelling veterans aged 60 or older, who: (a) took 5 or more medications per day, (b) were not cognitively impaired, (c) were able to speak and/or write English, and (d) received primary care and medications from a large urban Veterans Affairs Medical Center were eligible for the study. Clinical pharmacists applied the criteria of the Medication Appropriateness Index to each regularly scheduled medication to determine unnecessary drug use. Those drugs that received an inappropriate rating for indication, effectiveness, or therapeutic duplication were defined as unnecessary. Health beliefs regarding medication use were assessed with decisional balance, self-efficacy, and health locus of control scales. A total of 128 veterans were enrolled. Analyses showed that 58.6% of patients had one or more unnecessary prescribed drug. The most common reason for a medication being considered inappropriate was lack of effectiveness (41.4%). The most commonly prescribed unnecessary drug classes were for the central nervous system (19.5%), gastrointestinal problems (18.0%), and vitamins (16.4%). Factors with a tendency for association with any unnecessary drug use included race (white), income (less than $30,000/year), number of prescription medications, and lack of belief in a "powerful other" for their health locus of control.

VALUE OF STUDY TO READER: The authors found a high prevalence of unnecessary drug use in the older veteran outpatient population. Race, income, and polypharmacy, as well as health-related beliefs, were central factors associated with unnecessary drug use. A self-management program could be the solution to taking unnecessary drugs, particularly if self-efficacy were built into the program. Confident patients would be apt to discuss with their health care providers whether they need to continue taking medications that the patients think may be unnecessary.

MI Rossi et al. Polypharmacy and health beliefs in older outpatients. American Journal of Geriatric Pharmacotherapy, 2007;5:317-323.