OBJECTIVES: Polypharmacy (concomitant use of multiple drugs) is common in older and multi-morbid patients and has been shown to increase the risk for drug-drug interactions, prescription of potentially inappropriate medication, and lacking adherence, finally leading to poor treatment efficacy. So far, little is known about the actual extent of polypharmacy in the elderly German population. Therefore, this study aimed to describe the prevalence and characteristics of patients experiencing polypharmacy in Germany.

METHODS: The analysis was based on a subset (10%) of an anonymized German claims dataset representative of the statutorily insured German population concerning age and sex. (Excessive) polypharmacy was defined as the prescription of (≥10) ≥5 distinct drugs (excluding topical preparations/vaccinations/diagnostics/additives to intravenous solutions) in ≥2 quarters of 2019. The occurrence of polypharmacy, patient characteristics, and treatment use were assessed in 2019. Results were additionally reported for subgroups of patients aged ≥65 years and patients ≥65 years old diagnosed with cardiovascular disease (CVD).

RESULTS: Out of 308,148 individuals analyzed, prevalence of (excessive) polypharmacy was found to be (1.5%) 12.7% in 2019. The mean age of the identified polypharmacy cases was 70.4 years (median: 73), and 54.8% were female; 78.0%/82.8% also indicated polypharmacy in 2018/2020. Among patients aged ≥65 years/and with CVD, rates of (excessive) polypharmacy were considerably higher, with (5.1%) 40.0%/(5.9%) 45.3%.

On average, individuals experiencing polypharmacy used 10.1 distinct drugs (median: 9) and redeemed a mean of 32.0 prescriptions (median: 28) in 2019. The most commonly used medication classes were agents acting on the renin-angiotensin system (79.7% of patients), beta-blockers (67.0%), and drugs for acid-related disorders (52.2%).

CONCLUSIONS: A substantial proportion of the insured German population is affected by polypharmacy, which is especially high in persons ≥65 years with cardiovascular comorbidities. In light of the significant burden of multi-medication, cases of polypharmacy should be monitored closely in clinical practice.