Polypharmacy occurs when a patient takes too many medications for their own good. It is most common among seniors and individuals with multiple medical issues. Because older people metabolize drugs differently, the combined effects of numerous medications can be especially harmful.
Being on too many medications can lead to potentially dangerous drug interactions and exposure to many side effects at once. Keep in mind that 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 doesn’t know all the drugs they are taking, why they’re needed, or how to take them properly. What’s worse is that even their physicians may not be aware of all the medications they’re taking.
The average older adult takes four or more prescription drugs each day. While each one was created to treat or correct a specific medical problem, each 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.
Symptoms of Polypharmacy
“Polypharmacy is a huge problem in our society,” says Stephen Sinatra, MD, internationally renowned cardiologist and author of, The Great Cholesterol Myth. According to 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 people 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 the following red flags:
- Tiredness, sleepiness or decreased alertness
- Constipation, diarrhea or incontinence
- Loss of appetite
- Confusion, either continuous or episodic
- Depression or general lack of interest
- Hallucinations, such as seeing or hearing things
- Anxiety or excitability
- Decreased sexual behavior
- Skin rashes
Responsible Medication Management Can Minimize Polypharmacy
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 and instructions (such as frequency and timing), and any cautions stated on the bottle or package.
Retain a copy 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 as well.
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.
Try to 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 information about all the medications a patient is taking and detecting possible side effects and interactions. It’s best to use one pharmacy for all prescriptions to minimize the chances that potential risks are overlooked.
Schedule Regular Brown Bag Check-Ups
Depending on how frequently a senior’s regimen changes, it’s wise to attend a “brown bag” checkup 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, MD, 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 you have time to address all your concerns. It’s difficult to squeeze everything into a generic 15-minute appointment.
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, often at no additional cost. While consumers can usually 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 may be the biggest threat 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.