Welcome Wisdom

Polypharmacy: Strategies to Reduce Risk

by Felicia Juntunen, MA, CMC, Director of Care Management

Aging Life Care professionals provide medical advocacy on a regular basis, including becoming familiar with the medications their clients are taking. Part of the routine assessment of a client includes cataloging their medications, understanding which conditions the medications are treating, and how the medications are managed. Encountering older adults whose medication lists are lengthy is not unusual. Polypharmacy, or the regular use of five or more prescription, nonprescription, herbal, and vitamin products is increasingly common in the older adult population. With age, people are more likely to have multiple health issues indicating the use of medication and they are also more likely to have multiple healthcare providers prescribing medication.

Care managers are aware of the potential impact of polypharmacy on their clients. Those taking a larger number of medications (both prescription and nonprescription) have a higher risk of drug interactions and side effects, like falls, cognitive impairment, vision, or blood pressure issues. Often, patients do not realize that herbal and vitamin supplements can have interactions with medications they’ve been prescribed. Patients may be working with more than one medical provider who is prescribing medication and unaware of another prescriber’s efforts, resulting in potential duplication, or drug interaction. Nonadherence to prescribed medications is a common consequence of polypharmacy. Patients may experience confusion over complicated regimens such as medications that must be timed around taking other medications. Complicated medication regimens can interrupt daily routines and impact quality of life, discouraging patients from taking their medications. Patients taking multiple medications can experience ‘pill burden,’ and begin skipping doses. Finally, polypharmacy can also be expensive, especially if medications have high copays, and patients may elect not to refill medications or may skip doses. Nonadherence can have a cascade effect as symptoms may return, causing unaware physicians to question medication effectiveness and prescribe additional medications.

Aging Life Care professionals have an important role in helping to mitigate the potential complications of polypharmacy. For clients who live alone or are managing their own medications, the care manager can provide strategic support. Care managers frequently find that clients don’t understand what their medication is for or lack insight into special instructions for taking the medication. Clients may also lack a system that supports remembering to take their medication. A care manager can ensure medical providers are aware of medications the client is taking and assist the client in monitoring their symptoms and reporting accurately and timely to their physician. Because Aging Life Care professionals work from a holistic perspective – assessing their clients’ wants, needs, and abilities, they can provide insight to families and providers about a patient’s medication use and the factors that may be impacting their medication adherence. A care manager can help ensure that their client understands their medication, has a system in place that is functional for the client, and can support monitoring the adherence to the regimen. Transitions in care can lead to medication errors with even simple medication regimens but risk increases with polypharmacy. Care managers offer support to clients as they transfer between care settings, providing oversight to ensure medication reconciliation occurs so proper medications are administered.

The holistic assessment by an Aging Life Care Professional helps assess risk and reduce harm by encouraging safe use and minimal number of medications to accomplish client goals and support well-being. Care managers collaborate with other providers to support their clients who may be dealing with issues related to polypharmacy, whether they live at home and manage their own medications or live in a supported setting where medications are managed for them. Care managers regularly attend medical appointments with clients, providing advocacy for clients and ensuring physicians receive up-to-date and accurate information about their patient. When appropriate, care managers will request a medication review by a provider to address issues that may be causing side effects or nonadherence. They also consult with pharmacists, who are a knowledgeable resource regarding a medications use, side effects, and potential for interaction with other drugs. Collaboration can result in simplifying medication regimens to improve adherence and reduce risks associated with polypharmacy.