The prevalence of polypharmacy in elderly attenders to an emergency department - a problem with a need for an effective solution

Iatrogenic disease contributes significantly to morbidity and mortality in the elderly population [1]. The ageing population in the UK is steadily expanding, with associated increased use of prescription medications. The estimated resident population in the UK in mid-2009 was 61,792,000. Over the last 25 years the percentage of the population aged 65 and over has increased by 1.7 million from 15% in 1984 to 16% in 2009. By 2034, 23% of the population is projected to be aged 65 and over compared to 18% aged under 16. The fastest population rise has been in those aged 85 and over, from 660,000 in 1984 to 1.4 million in 2009 [2]. Emergency department (ED) attendances by those aged 75 years and over are also continuing to rise. It has been recognised that emergency presentations may be influenced by the prescription of multiple drugs. The issue needs to be revisited as part of the strategy to reduce increased pressures on hospital bed capacity in the UK, as there is a perception that iatrogenic disease may contribute to avoidable admission. These strategies should be expected to be extrapolated to other health economies.There has been a steady rise in the use of prescription drugs in the over 60 age group in England since 1997, the overall number of prescriptions dispensed during this period rising by nearly 60% [3]. In England, 796 million prescribed items were dispensed in 2007, while 500 million items were dispensed in 1997. The steepest rise in the period was in prescriptions for statins, from less than 5 million prescriptions in 1997 to 45 million in 2007. The costs of prescribing impose a financial burden on the NHS. At least 209 of our study cohort of patients were receiving five or more prescription drugs.We set out to look at the prevalence of over-prescribing in all patients aged 75 years and over attending our emergency department in 1 month. We suggest possible solutions, which warrant further exploration or enhancement.Four independent physician reviewers w