Dr. Volker Schulze
Dr. Volker Schulze

Polypharmacy and inappropriate medication


When drugs are developed, they are first subjected to extensive testing in trials. From the results, it is easy to assess the benefits and risks of the new therapy. Of course, these drugs are tested on patients who correspond to the typical clinical picture that is to be treated.


Harmful or ineffective?

Of course, not all possible patients and concomitant diseases can be tested. This would not even be possible in a meaningful way, since there are an infinite number of possible combinations of patients and diseases.

As a rule, only everyday experience can help here. Even after many years of experience with a drug, there are occasionally indications that it is unsuitable for elderly patients or patients with rare comorbidities, for example.

This experience must be collected and made known even years later. To improve therapy, efforts have been made in recent years to make such information available to physicians.

Unsuitable medication - especially a problem for older patients

For elderly patients, unsuitable medications (potentially inadequate medications, PIM) are collected in the so-called Priscus list. This is a project of the UNI Witten Herdecke and is funded by the Federal Ministry of Health. Currently, this list has been updated.

If one wants to grasp the possibilities of wrong medication, one must first think about what can go wrong in the first place.

Somewhat simplified, medications can be wrong in three ways:


  • Indication: The wrong drug

    Particularly in the case of over-the-counter medications, or "loans" in the family/acquaintances, it happens that medications are taken that are not effective.
    The most common errors, however, are not taken into account concomitant diseases or restrictions in the indication (elderly patients, a not taken into account kidney weakness or bleeding risk).

  • Dosage: The dose makes the poison

    The overdose affects especially the elderly, or very light patients. With underdosage there is a risk of side effects but no benefit.
    A common example is high blood pressure therapy. The blood pressure is not measured, there are high values, despite therapy (i.e. risk without benefit). Another common example is cholesterol reduction: despite taking medication, the target values are not reached.

  • Duration: The drug becomes routine

    People often do not dare to omit a medication or to try an alternative. Many medications only cause problems when they are taken for too long (painkillers, sleeping pills, stomach acid blockers). The therapy becomes an apparent prophylaxis. However, this is often not useful. Overall, starting medication seems to be easier than stopping it.

The AOK, as the largest health insurer, has published in the new Pharmaceutical Compass how often such constellations occur among its patients. The results are worrying.

Drug Compass 

65-year-olds and older were prescribed an average of 4.4 drugs per day in 2021. That sounds like a lot at first, and it also surprises the experts. In the analysis, however, most of the drugs were very well indicated. An age effect is probably evident here. Life expectancy is increasing and many diseases actually require long-term medication. This was not the real problem!

In fact, almost half (49.5%) of the patients were prescribed at least one preparation unsuitable for elderly patients. This is, of course, a worrying number! However, further evaluations must follow here, since the data cannot simply be transferred to the population. After all, not everyone is in the AOK, and there are considerable differences between the health insurance funds.

Unfortunately, the evaluations are also not in a meaningful order for the general public. Not every wrong medication has the same consequences! It makes a difference whether they take 11 days instead of 10 days a stomach protection, or whether they take a wrong and toxic substance even once.

So this number must be evaluated with great caution, since health insurance data do not allow an objective medical evaluation for all patients*.

However, one lesson should be learned from the data:

At each visit to the doctor, the medication must be re-evaluated in terms of efficacy, benefit and risk. In case of doubt, you should calmly ask once.


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