Polypharmacy and Older Adults

It’s wonderful to live in a time when we have so many readily available and well-researched medicines for a variety of health conditions. Modern medicine has contributed to increasing lifespan and improved outcomes for chronic conditions, especially for older adults.

But as we age, the medicines begin to add up. Maybe it starts with just one little pill for blood pressure. Then, as time goes on, something for cholesterol is added, then something else for arthritis, and before we know it, we need a whole cabinet just to keep our medications organized. And that may not even be counting any supplements or dietary aids. We may start to wonder how much medicine is too much.

Polypharmacy is a fancy word for the practice of taking more than four or five medications regularly. The exact number of medications in the definition of polypharmacy varies among health care providers, but the consensus is that the more medications a person takes, the risk of complications, side effects, and oversedation increases. And it’s not a small problem—the Centers for Disease Control (CDC) estimates that about a third of Americans age 60 and older take five or more prescription drugs regularly.

This is especially a problem for cancer patients. A 2022 study by the University of Rochester Medical Center found that among older adults with cancer receiving chemotherapy, polypharmacy is associated with dramatic increases (up to 114%) in unplanned hospitalizations.

Another factor that leads to polypharmacy is what health care providers call “prescribing cascades.” Unfortunately, the fragmented nature of our health care system means a specialist in one field could prescribe a medication to treat complications from a medication prescribed by a different doctor.

“The lack of communication on prescriptions between different specialists can lead to drug interactions which further complicate health and quality of life” said Jim Gall, Owner of Right at Home – Northern Michigan.  “I’ve seen firsthand how different specialists, based on their specialty, can come into direct conflict for prescribing drugs” he added. “In one particular case, one specialist insisted on stopping a medication while the other wanted to double the dose! It’s important that your PCP, or a gerontologist, quarterback communications between specialists to make sure your loved one is getting the best care.”

An important strategy to this problem is “deprescribing.” Deprescribing is the planned reduction of medications to reduce the patient’s risk of harm. The University of Michigan National Poll on Healthy Aging found that eight in 10 older adults would be willing to take fewer medications if a health care provider thought it was appropriate. But first, the doctor needs a comprehensive list of all the prescription medications, supplements, and over-the-counter medication the older adult is taking. This review should happen at least once a year. Older adults who are taking a lot of medications should bring a complete list of medications to all health care appointments.

How does deprescribing happen?

Assessment: A health care provider reviews all the medications a patient is taking, including over-the-counter drugs and supplements.

Evaluation: The benefits and risks of each medication are evaluated in the context of the patient’s current health status and life expectancy.

Plan: A personalized plan is developed to reduce or stop certain medications. This plan considers the patient’s preferences and goals of care.

Ongoing supervision: The patient is closely monitored for withdrawal symptoms or the return of the condition that the medication was treating. Adjustments are made as necessary.

Role of in-home caregivers in deprescribing

While in-home caregivers cannot legally change a person’s medications, they can support the deprescribing process by:

Monitoring health changes: Caregivers can observe and report any changes in the patient’s condition and ensure that information is quickly relayed to the doctor.

Assisting with medication management: Caregivers can help organize medications and watch as the senior takes them, making sure the deprescribing plan is followed correctly.

Providing emotional support: The process of reducing medications can be stressful. Caregivers offer reassurance and support throughout the process.

Deprescribing is a collaborative effort involving health care providers, patients, and caregivers. It aims to maintain or improve quality of life by ensuring that the medications a person takes are truly beneficial and necessary.