The Care Company

empowered caregiving™

The medical community speaks to you as though you understand what they are saying, or they assume you understand. It’s okay if you don’t know. One of the terms, however, that you need to fully understand is polypharmacy. Being proactive in this area of an elderly person’s care can actually save a life and help you feel Empowered.

Polypharmacy is a term used to describe when someone is taking multiple medications, often, more medications than are necessary. Elderly people are susceptible to polypharmacy because of the presence of multiple medical problems; because they take multiple medications and because of how their aging body is affected by each medication. The more medications one takes, the higher the risk of side effects and adverse drug reactions.

Many seniors have chronic diseases and are often under the care of multiple physicians. Each physician prescribes medications to treat a specific condition and the elder ends up taking multiple medications. Elders see many doctors for different reasons. Usually these doctors do not have the time to speak with each other or they have limited communication about the elder and the medication regimen and close monitoring for problems may not occur. The burden falls on the caregiver to keep the physicians updated on the current medication regimen and to monitor the elder for changes in their condition that may indicate possible side effects or adverse drug interactions.

The use of multiple prescriptions, over-the-counter medications, vitamins and herbal supplements combined with medical problems is related to an increasing number of adverse drug interactions and adverse drug events. Many medications are now available to purchase over-the-counter and their use may not be reported to the physician or pharmacist. The polypharmacy picture can be further complicated by the food and beverages consumed by the elder. Certain foods, caffeine and alcohol interact with different medications and should be avoided. Look at the label on the medication bottle and the information leaflet closely for any warnings regarding the medications. If you have further questions, ask the pharmacist directly.

It is vital to designate one physician, usually the primary care physician, to oversee and manage all medications including, prescription and over the counter medications, vitamins and herbal supplements. The physician designated to manage the elder’s medications should evaluate the medication regimen during each visit. If the potential side effects or adverse drug interactions far outweigh the potential benefits of the medication, the physician should strongly consider stopping or changing the medication. As the caregiver, you should feel comfortable and empowered asking questions and having this conversation with the doctor.

It is important to remember that when adding or discontinuing medications, or when making medication dosage changes, it should be done with one medication at a time. Making multiple changes to the medication regimen at one time can cause problems for the patient, and if problems arise, it can be difficult for the physician to determine which medication change is causing the problem. Do not discontinue a medication without the approval of the physician managing the medications. Some medications must be tapered slowly to prevent worsening of symptoms, withdrawal symptoms and disease exacerbation.

Polypharmacy also includes the inability of the elder to properly manage the medications because they take too many pills. The more medications they take, the more likely they are not able to take them correctly; this increases the risk of noncompliance with physician recommendations.

There are several factors that may contribute to the effects of polypharmacy. Physiological changes associated with aging include, decreased kidney and liver function, decreased muscle mass and total body water volume, resulting in the body not being able to appropriately distribute, metabolize or eliminate the medications from the system. Decline in vision, hearing, mobility and memory can also the affect the elder’s ability to understand or follow the necessary directions for accurately taking the medications.

Polypharmacy can be a major threat to the elder’s health and quality of life. Many problems can result from polypharmacy. The medications may interact with each other causing side effects, adverse drug interactions, and eliminating or diminishing the benefits of some of the other medications. There may be an increase in falls, increased risk of dizziness, an increase in memory problems, loss of appetite, tiredness, confusion, depression, weakness, and/or anxiety. Unfortunately, these symptoms that result from polypharmacy may be confused with the normal aging process and physicians may prescribe additional medications to treat these symptoms, often leading to disastrous results.

Having one physician monitor and manage all of the medications and one pharmacy fill all of the prescriptions will help identify side effects and potential drug interactions quickly, thus preventing major problems for the elder and the caregiver. The proper management of the elder’s medications cannot occur if the physicians and pharmacists are not aware of ALL of the medications taken by the elder.