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What is Polypharmacy? Is It Happening to Your Aging Loved One?

by | Jul 26, 2023

Here’s what it is and what you should know.

Taking many prescription medications isn’t good — especially as we get older. Why? 

Understanding polypharmacy will help explain this. Polypharmacy is most commonly defined as one person taking five or more medications. This seems like no big deal, right? Lots of people seem to be taking this many. 

On the contrary, taking 5 or more medications is concerning enough that it could be considered its own condition worth monitoring

Why Five or More?

When someone has this multitude of medications they require careful attention and their regimen needs to be analyzed together by a prescriber or pharmacist, focusing on what is happening amongst all of them, making sure the benefits outweigh the risks and side effects. 

Individual medications by themselves may not cause significant side effects, but when a person is on multiple medications, problems can start to occur.

With each additional medication, the risk of possible drug-drug interactions increases exponentially. By the time someone takes five, there is a dramatic increase, being fairly sure interactions are taking place. Can you imagine all that is happening when someone is prescribed 10 or 20? 

Taking many medications should be scrutinized the same way a disease state would be— it has its own risk factors, symptoms, and possible harm to the patient

Before this makes everyone panic, I must clarify: not all interactions need to be avoided. Sometimes they are minimal or not significant and the benefits outweigh the risks. However, it is important for your healthcare provider to know and sufficiently monitor them.

Why Is It Critical To Address Polypharmacy in Older Adults?

While we still need to be cognizant of the effects of multiple medications on any age group, senior citizens are most at-risk. 

Keep in mind, this is also the age group prone to suffering in silence, trusting that they just need to take what the doctors tell them. 

Part of Getting Older and Wiser

As our bodies change, the more difficult it is to decipher a side effect from other changes. Consider these factors:

  • Older adults can have more conditions (and therefore more prescriptions — polypharmacy!).  
  • Their bodies naturally have less resilience to extreme conditions.
  • In their bodies, the kinetics that processes medications have changed over time. (FYI — our kidney function starts to decrease in our 30’s!)
  • Drug studies rarely include the older adult population, and the dosing and other effects on them are less known. 

According to the Centers for Disease Control, between 2015 and 2018, more than 40% of adults age 65 years and older, had taken 5 or more prescriptions within the last 30 days.

If that percentage stayed the same, (but the trend has been increasing) in 2022, more than 22 million of these adults in the United States were experiencing some level of drug-drug interaction. 

How To Tell if Polypharmacy Is Causing Harm

There is no definitive list of symptoms to tell when numerous medications together are taking a toll on someone. That’s what makes it tricky. Keep in mind the bigger picture of how things are trending.

Quality of Life

Some of the symptoms can be overlooked as “signs of getting older” — forgetfulness, personality change, abnormal fatigued and drowsiness, loss of balance, dry eyes and/or mouth, digestive changes, incontinence, increase or decrease in blood pressure and/or heart rate — just to name a few. 

On the other hand, an above-mentioned symptom could also be mistakenly considered a new condition. And since there is a pill for every ill, another medication (along with its possible side effects) is added. And this kind of prescribing can take place several times over. There is a term for this called the prescribing cascade.

Simply asking, “how are you feeling?” is a good start. Look at your loved one’s quality of life and notice if it’s worsening.

Basically, it’s difficult to know. Always checking if polypharmacy is the culprit is the best thing to do. 

Be Proactive

Do not wait until it is too late! 

Be proactive and address your concerns before something worse happens. Lightheadedness can lead to a fall and broken bones. Too many psychoactive medications can lead to becoming wheelchair-bound, etc. 

Sadly, some folks spend many years suffering from unnecessary medication side effects. 

Before moving on, it must be stated: do not change or discontinue medications without the guidance of an appropriate healthcare professional. Worse problems could occur. 

Here’s What to Do

When you recognize something doesn’t seem right or you notice your loved one’s quality of life is worsening, these are some tips. 

1. Trust Your Instincts

First of all, it’s normal to think, “maybe it’ll pass” or even convince yourself everything is “fine”.

“If the provider didn’t notice anything at the last appointment, everything should be okay.” 

This is not always true. 

Write down your observations, even if it seems minor. Keeping track of what happens and when can be helpful for you to recognize if there is a worsening trend. It is also useful when explaining your concerns to a healthcare provider. 

2. Let a Qualified Healthcare Provider Know Your Concern

Address the changes you see with a healthcare professional such as the primary care provider (PCP) or a senior care pharmacist. 

Primary Care Provider

One option is to schedule an appointment with the PCP, ask for a medication management appointment, and explain the concern about the symptoms and what you have noticed about the quality of life. 

Senior Care Pharmacist

Another option is to contact a senior care pharmacist, who is also known as a geriatric pharmacist or a consultant pharmacist. 

These are pharmacists who are Board-certified in geriatric pharmacy, which includes the skills to identify and address polypharmacy. Although more difficult to find than a retail pharmacist, there is access to some in every state in the United States. These specialized pharmacists are available in many other countries as well. 

The United States’ leading senior care pharmacist organization, called The American Society of Consultant Pharmacists, has a directory of them. You can access it by clicking here. 

If your loved one lives in a nursing home or assisted living, ask if they have a senior care pharmacist at the facility. 

If you contacted the PCP and still feel the concerns with polypharmacy were not completely addressed, try working with a senior care pharmacist. The pharmacist will likely have more time to spend with you to provide explanations and answer more questions. (The pharmacist, in most cases, will contact and involve your PCP with the client’s permission.)

3. Monitor

Expect the provider or pharmacist to monitor for improvement, and if not, be diligent to make sure this happens. You, as the loved one, or the person him/herself can monitor for changes as well. Again, write down what you notice and when.

Making too many interventions at once may not be recommended, so the changes may be implemented and monitored over time. 

Caring for Our Loved Ones

Although medications are supposed to be improving our health, we need to be alert for when they are not. They should be helping not harming, and sometimes it is difficult to know. 

Understanding that the number of medications is a risk factor for a decreased quality of life, and the risk is higher as we get older, puts a spotlight on the situation. 

Even though there is more attention on polypharmacy and terms such as deprescribing are now a buzzword in the geriatric pharmacy world, there are lots of folks out there as we speak suffering from polypharmacy. 

It could take years for changes in the medical system (i.e. prescribing and monitoring in older adults) to reach the patient, but at least the patient and loved ones can be empowered to seek the healthcare they want from the medical system

  1. Be aware of your loved one’s quality of life or other problems. Don’t wait until there is an emergency. 
  2. Trust your instincts and be proactive. 
  3. Contact a qualified healthcare professional who can address your concern — even if you have to contact several. 
  4. Monitor for improvement. 

Not everyone taking numerous medications is suffering. However, for those who are, taking these steps is one way to help them live their golden years as well as possible. 

Stephanie Paugh is a Doctor of Pharmacy, Board Certified Geriatric Pharmacist, and owner of Pharmacist 360, PLLC. She was inspired to specialize in medications with older adults after years of witnessing significant improvements in their lives through medication management.

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