Retirement and nursing homes 2.1.5 Polypharmacy: implement the GEMED project nationwide Definition of polypharmacy Polypharmacy means the simultaneous use of several medicinal products. The definition most frequently used in specialist literature is the simultaneous taking of five or more medicines. That corresponds with the WHO definition. The WHO speaks of hyperpolymedication if a person is administered more than ten active pharmaceutical ingredients. Experience of the NPM The commissions reported about polymedication in retirement and nursing homes in all of the Laender. The NPM pointed out avoidable serious health risks and restrictions in the quality of life of elderly persons predominantly connected with psychotropic medication in recent years (see in particular NPM Report 2014, p. 33 et seq.; NPM Report 2015, p. 38 and NPM Report 2017, pp. 35 et seq). The benefit and harm must be weighed up very carefully when prescribing medication to those in need of care. The experience of the NPM shows that this does not happen enough. The likelihood of interactions and undesired adverse effects increases with the amount of medication taken at the same time. This can cause serious complications such as bleeding, kidney or cardiovascular failure in geriatric residents who often have a limited kidney function. An average of six diagnoses usually requiring several longterm prescriptions are made for over 70-year olds (Ulrike Sommeregger in “Neurologie & Psychiatrie”, 3/2018, “Antipsychotika und Benzodiazepine in der Geriatrie”, p. 37). Awareness where benzodiazepines are concerned is generally not sufficient in the view of the commissions. Up to 17 long-term medicinal products a day Commission 5 reported that in a home in Lower Austria over 70% of the residents were prescribed more than five medicinal products by doctors. A random check of the documentation at another nursing home in Lower Austria indicated that four residents were administered between eight and 17 long-term medicinal products and a large number of medicines for individual ailments as well as local therapies. In a home in Styria, 20 of the total 36 residents received between ten and 15 medicinal products for individual ailments whereby in some cases several analgesics were prescribed twice in different pharmaceutical forms (e.g. Novalgin drops and Novalgin pills). This can be a contributory factor to overdose. One resident received 17 long-term medicinal products and 27 medicines for individual ailments. The commission also had the impression of a “medicated atmosphere” in a home in Vienna: in two of the wards, 75% and 71% of those in need of care were affected by polymedication respectively; 58% and 47% were given evening medication; 75% and 65% received night medication (sleep-inducing medication, psychotropic medication, neuroleptics). From the documentation, it was not clear whether and which non-medication-based measures had been considered. The operator explained that most of the residents had a psychiatric diagnosis and were regularly assessed by medical specialists. In a home in Tyrol, several residents were prescribed between ten and 15 different medicinal products, all of which had to be administered in the mornings. It 35