How many prescription medications are you or your older loved one taking? How many is too many? If you or someone you care for is taking five or more you may be taking too many.
Taking five or more prescription medications daily is considered polypharmacy. The National Institutes of Health describes polypharmacy as the use of excessive or unnecessary medications which increases the risk of adverse drug effects. These effects include falls, cognitive impairment, harmful drug interactions, and drug-disease interactions, in which a medication prescribed to treat one condition worsens another or causes a new one. Additionally, patients may be prescribed medicines that are unlikely to help or may be harmful. Polypharmacy can be overwhelming for patients and their families, who need to understand the purpose of the many prescriptions written by multiple providers, get refills, take each medication at the correct time of day, and recognize side effects.
Who Takes too Many Medications?
Many people are aging with multiple chronic conditions (MCC) often necessitating prescription medication for disease management. They may start with one or two prescribed medications from their primary medical care provider. As they begin to see specialists, more medications are added. Suddenly, they find themselves taking handfuls of pills per day. Older adults living in Assisted Living Facilities, Memory Care, or Skilled Nursing Facilities are at risk for polypharmacy as well.
A 2016 American Academy of Family Physicians (AAFP) study found that 36% of community dwelling adults aged 62 to 85 were taking five or more medications. This is a 31% increase since 2005. If this trend continues, almost half of the older population could be affected by polypharmacy by 2030.
Tips to Avoid Polypharmacy
Keep an up to date list of all your medications including prescriptions, non-prescription, vitamins, and herbals. Dangerous reactions can occur when mixing prescription medications with non-prescription, vitamins, and herbals.
Keep a copy of this list with you at all times. Share it with all of your medical care providers. Make sure your loved one, spouse, significant other, or caregiver knows what you are taking.
Know what you are taking. Read the medication insert and/or information received from the pharmacy. Be familiar with potential side effects and possible harmful interactions.
Use the same pharmacy whenever possible. It’s easier for the pharmacist to identify possible interactions and safety issues.
Try alternatives to prescription medication before taking any new drugs. For example, can changes to your diet help you control your chronic illness? Discuss with your medical care provider first.
Schedule a medication review with your medical care provider or pharmacist. Don’t be afraid to ask questions. Why are you prescribed a medication? Is there a safer alternative?
Tips to Avoid Polypharmacy for Your Elderly Loved One
Research non-prescription alternatives and review with their medical care provider.
Read the medication insert and focus on side effects and interactions. Report any that are experienced to their medical care provider.
Use only one pharmacy if possible.
Keep an up to date list of all their medications (including non-prescription, supplements, and herbals). Share this list with their medical care providers every time you visit them. Don’t assume that all of your loved one’s medical care providers are aware of what each have prescribed.
Schedule a medication review with a senior care pharmacist (you can find one here).
Deprescribing
Deprescribing is the process of discontinuing drugs that are potentially harmful, no longer required, or no longer effective. It can be accomplished in older adults and may be associated with improved health outcomes without long-term adverse effects.
Why deprescribe? Older adults are disproportionately affected by chronic conditions, such as diabetes, arthritis, and heart disease. Nearly 95% percent have at least one chronic condition, and nearly 80% have two or more. Living with MCC can lead to more complicated medication regimens for patients and is associated with a greater risk of adverse side effects and drug interactions. This includes cognitive changes and higher rates of hospitalization and mortality. Reducing the number of medications through deprescribing can help avoid adverse drug effects and improve outcomes for all patients with MCC.
How a Geriatric Care Manager Can Help
A Geriatric Care Manager (GCM), also known as an Aging Life Care Manager, acts as an advocate and liaison for your older loved one. GCMs are typically nurses or licensed clinical social workers with extensive experience working with older adults and their families. They can help you identify polypharmacy and the potentially harmful interactions and side effects associated with it. The GCM can attend medical appointments with your older loved one and advocate for deprescribing.
The answer to the question, how many medications is too many for an older adult, does not have a simple answer. Each person is unique with individual needs and their responses to medications. However, we do know that the more they take, the more likely they are to experience the potentially harmful effects of polypharmacy. It is important that they, you, or an advocate, stay up to date and knowledgeable about their medications. Appropriately reducing the number of medications your older loved takes may improve their quality of life.