Polypharmacy in the Elderly: Avoiding Harmful Side Effects

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Polypharmacy, which is when a senior is on far too many medications for his or her own good, is a common problem among elders. It is common among seniors and anyone with multiple medical diseases. It can get to the point where the individual doesn't know what all he or she is taking and why, but what's worse is . . . even the physicians may not know either.

Being on too many medications can lead to potentially dangerous drug interactions and exposure to multiple drug side effects. Keep in mind, this applies not to just prescription medications, but also to over-the-counter supplements and herbal medications (which act like drugs in their own right but are without FDA regulation for quality standards since they fall into the "herbal" category).

This is not to say that taking medications for one's diseases or ailments is routinely a bad thing. It's often necessary to take medications. But when one is on a bunch of medications, it is important to take some time to think about several things and ask your doctor about it.

Questions to ask to avoid polypharmacy in the elderly

  1. What medications is my parent taking and why?
  2. How necessary is each medication? Can any be removed?
  3. Are any medications interacting with each other in a negative way?
  4. Could their medications be causing additional symptoms or conditions they are experiencing?

You might do better to schedule an appointment specifically dedicated to answering these questions, since it might not be easy to squeeze it all into a routine disease follow-up appointment. In order to properly get the answers to these questions, you need to make sure you always carry an accurate list of the medications (including supplements/herbals) you are taking. If necessary, bring bottles to the appointment. For the elderly patient, whose memory may not be so good, a family member will need to help put together the list. Have the medication list ready, updated and accurate before the appointment.

There may not be enough time for the doctor to thoroughly double-check your list during the appointment (especially if it's the routine 15-minute appointment). You would be surprised how often doctors are not fully aware of all the medications the patient is taking if they are on multiple medications, especially if they are prescribed by a variety of doctors and specialists. Although there may be a medication list on the electronic medical records, it can be outdated. Although there may be a med list taken by a nursing aide, it may not be thorough enough.

Doing all the suggestions above can help reduce the risk of polypharmacy. If doing it all on your own seems a challenge, a patient advocate can make this process easier.


Disclaimer: Though the author of this information is a licensed physician, the information provided above is FOR EDUCATIONAL USE ONLY, and DOES NOT CONSTITUTE MEDICAL ADVICE/OPINION, is not meant to diagnose or treat any illness or disease, and is not a substitute for the medical advice of your (or your loved one's) primary care physician or other medical professional. While striving to be factual and exact, no warranties are made with regards to the accuracy of the information provided above. You are always advised to talk with your (or your loved one's) doctor about any health concerns that you have and about any of the information provided above. Sole reliance on the information provided above is not advised and would be solely at your own risk and liability.

Dr. Vik Rajan is the founder of Houston Patient Advocacy, which provides health information and advocacy to patients and families who have questions about their health, feel lost in the medical system and need guidance, or need assistance with insurance claim denials or medical billing problems.

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17 Comments

If my mother had her way she would have additional medications perscribed to her. The more pills she takes the more important she feels. Never reads the side affects or warnings that come with the perscriptions. My mother has medical issues and does need medications for them, but as a walking hypochondriac, she is taking medications for illnesses that are more in her head than actuality. Can't challenge her, the doctor perscribes them so officially to her, she needs them. She is competent to make decisions on her medical choices so my POA is useless. I don't have the time or energy to deal with my mother's pill popping delightment. She wants to over medicate herself and ignore my concerns so be it.
Having worked in a pharmacy after college, I wouldn't rely on my physician to review my medications. I'd take the complete list to a pharmacist and have them review them. And even better, if I were a senior, I'd find a pharmacist who specializes in elder care pharmacy, which is an important specialty. Those folks can be found on the American Society of Consultant Pharmacists' website.

My mom's cardiologist prescribed benedryl and a steroid to put her to sleep for a heart procedure. He wasn't aware that benedryl can cause dyskinesia in the elderly, which it did in my mom. I'm sure he's very knowledgeable about the heart, but senior pharmacy care and the effects of drugs on the elderly? Not so much. So go to the folks who specialize in medications - pharmacists - to get a medication review.
I created an online account at my mom's pharmacy. I can go into the Rx history and print out a list for any & all doctor appointments. It helps she has only used one pharmacy. If she was getting pills filled all over town, then this would be much harder to do. She has 19 pills currently, and can't keep what's what straight or even if she's taken it or not (usually not). Her independent living facility has a nurse come in to do med setup in her pill box once a week, so I can see for real if she has or has not taken her meds. Then it's not an argument with me over it.