Polypharmacy occurs when a patient takes too many medications for their own good. It is most common among seniors and individuals with multiple medical conditions. Since older people metabolize drugs differently, the combined effects of numerous medications can be especially harmful.
What Is Polypharmacy?
Polypharmacy is the simultaneous use of multiple medications. While this may not seem like a bad thing, being on too many medications can lead to potentially dangerous drug interactions and means exposure to many different side effects all at once. This applies not to just prescriptions but also to over-the-counter (OTC) medications and dietary supplements, which patients often use as needed without informing their doctors.
Treating only one chronic medical condition may require several prescriptions, but for seniors who often have several ailments, their medication regimens can be very complex. It can get to the point where the patient does not know all the drugs they are taking, why they are needed, or how to take them properly. Medication errors are more likely with complex regimens and can be dangerous as well. What is worse is that physicians may not be aware of all the medications their patients are taking.
Research shows that the average older adult takes four or more prescription drugs each day, but a whopping 39 percent of seniors take five or more prescriptions each day. While each one was created to treat or manage a specific medical problem, each also comes with its own risks and side effects. The more medications a person takes, the higher the chances are for experiencing adverse reactions, negative side effects and even life-threatening conditions. Overall, polypharmacy in the elderly is a major contributor to disability, frailty, falls, long-term care placement and a decreased quality of life.
Symptoms of Too Many Medications
“Polypharmacy is a huge problem in our society,” says Stephen Sinatra, M.D., F.A.C.C., F.A.C.N., C.N.S., C.B.T., internationally renowned cardiologist and author of The Great Cholesterol Myth. According to Dr. Sinatra, elderly patients are often put on five or more medications at once and it’s no surprise that they develop serious side effects. This is especially true for those who have been diagnosed with heart disease or recently suffered a heart attack or stroke.
“Unfortunately, many doctors attribute these side effects to just getting older,” Dr. Sinatra notes, but age isn’t always the culprit.
If a loved one takes multiple prescriptions, OTC medications and/or supplements each day, it’s important to keep an eye out for troubling side effects.
Common Adverse Effects of Multiple Medications
- Tiredness, sleepiness or decreased alertness
- Constipation, diarrhea or incontinence
- Loss of appetite
- Confusion (either continuous or episodic)
- Falls and other mobility issues
- Depression or general lack of interest
- Hallucinations (such as seeing or hearing things)
- Anxiety or excitability
- Changes in sexual behavior
- Skin rashes
How to Decrease the Dangers of Polypharmacy
Responsible medication management is the best way to prevent adverse health outcomes related to medication use. A senior and their entire care team must work together toward this goal.
Make a Complete Medication List
The first and most important step is to inform every physician involved in your loved one’s treatment of every medication and supplement your loved one takes. The easiest way to do this is to collect every pill bottle/container and make a detailed account of their medication regimen. The list should include each drug’s name, strength (in milligrams or international units), recommended dosage, instructions (such as frequency and timing), and any cautions stated on the bottle or package.
Retain a copy of this medication list for your own records and provide each of your loved one’s physicians with a copy. Each time a drug is added, removed or changed, be sure to update the document. This tool allows all doctors to get a complete and accurate picture of your loved one’s health and medications before making any treatment decisions. Having a copy on hand in the event of an emergency can be extremely useful for first responders and hospital staff as well.
Read Medication Inserts and Instructions Carefully
Whenever a new drug is prescribed, it is crucial to read the printed medication guide that comes in the package. This insert will provide information about the medicine, how to take it, possible interactions with certain medical conditions, other drugs, and foods, and tips for avoiding adverse effects while taking it.
You can look up a medication package insert using the DailyMed database provided by the National Library of Medicine (NLM).
Use One Pharmacy to Fill Prescriptions
As another line of defense against medication related problems, make your loved one’s pharmacist a larger part of their care team. Some people like to shop around for the best prices on their prescription medications, which often means filling them at several different pharmacies. Unfortunately, this prevents pharmacists from gathering complete information about all the medications a patient is taking and detecting possible side effects and adverse drug interactions. It is best to use one pharmacy for all prescriptions to minimize the chances that potential risks might be overlooked.
Schedule Regular Medication Reviews
Depending on how frequently a senior’s regimen changes, it is wise to attend a “brown bag” checkup or medication review with your loved one’s physician or pharmacist at least once a year. Traditionally, this involves bringing all a senior’s medications in a brown bag (or you can use a current copy of your loved one’s medication list) to discuss improvements that might be made to their regimen. Of course, a doctor will have more insight into and control over these changes, whereas a pharmacist can only make minor alterations to a prescription after receiving approval from the prescribing physician.
Vik Rajan, M.D., president and founder of Houston Patient Advocacy in Texas, recommends asking these questions during a medication check-up with a doctor:
- What medications is my loved one taking and why?
- How necessary is each medication? Can any be removed or have dosages reduced?
- Are any medications interacting with each other in a negative way?
- Could these medications be causing additional symptoms or conditions?
It may be wise to schedule a doctor’s appointment specifically dedicated to answering these questions to ensure there is enough time to address all concerns. Squeezing everything into a generic 15-minute appointment slot is often a challenge.
A pharmacist can run a database analysis of each drug your loved one is taking and the overall combination. This service identifies possible side effects and drug conflicts, typically at no additional cost. While consumers can walk in and consult with a pharmacist, making an appointment with the pharmacy for a full medication review will help ensure you won’t be kept waiting.
Polypharmacy is one of the biggest threats to seniors’ health, quality of life and longevity. As a caregiver, you can work with your loved one’s care team and spearhead efforts to prevent medication issues. Following all the suggestions above can help you get started.
Sources: Polypharmacy Among Adults Aged 65 Years and Older in the United States: 1988–2010 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4573668/pdf/glv013.pdf); Polypharmacy: Evaluating Risks and Deprescribing https://www.aafp.org/afp/2019/0701/p32.html)