Managing Polypharmacy in Older Adults: Best Practices for Safer Medication Use
Polypharmacy — the use of multiple medications by a patient — is increasingly common among older adults. With chronic conditions like hypertension, diabetes, arthritis, and heart disease prevalent in aging populations, it’s no surprise that many seniors find themselves juggling five or more prescriptions at a time.
While polypharmacy can be necessary for managing multiple health issues, it also brings significant risks, including drug interactions, adverse drug events (ADEs), decreased adherence, and even hospitalizations. Fortunately, with thoughtful planning and regular review, healthcare providers and caregivers can manage polypharmacy safely and effectively.
In this article, we’ll explore best practices for managing polypharmacy in older adults, highlight key challenges, and offer practical strategies for optimizing medication regimens.
Polypharmacy typically refers to the concurrent use of five or more medications. While it may be appropriate for certain medical conditions, polypharmacy becomes problematic when medications are unnecessary, duplicative, or cause harmful interactions.
Why Older Adults Are at Higher Risk
- Physiological changes: Aging affects how the body absorbs, distributes, metabolizes, and eliminates drugs.
- Multiple chronic conditions: Older adults often live with several long-term illnesses.
- Cognitive decline: Memory issues can lead to missed doses or incorrect medication use.
- Fragmented care: Multiple healthcare providers may prescribe drugs without a complete view of the patient’s regimen.
Best Practices for Managing Polypharmacy in Older Adults
1. Conduct Regular Medication Reviews
A comprehensive medication review (CMR) should be done at least annually—or more frequently if there are hospitalizations, new diagnoses, or changes in health status. This review should include:
- All prescription and over-the-counter drugs
- Herbal supplements
- Vitamins and alternative therapies
2. Use Tools Like the Beers Criteria
The Beers Criteria, developed by the American Geriatrics Society, lists potentially inappropriate medications for older adults. It serves as a helpful reference for minimizing risks associated with certain drugs.
3. Deprescribe When Appropriate
Deprescribing involves tapering or stopping medications that may no longer be beneficial or might be causing harm. This process should always be guided by clinical judgment and in partnership with the patient.
- Ask: “Is this medication still needed?”
- Consider therapeutic duplication
- Monitor withdrawal or rebound symptoms
4. Improve Communication Between Providers
Coordination between primary care physicians, specialists, pharmacists, and caregivers is crucial. Shared electronic health records (EHRs) can reduce redundant or conflicting prescriptions.
5. Promote Medication Adherence
Use pill organizers, reminder apps, or medication administration records (MARs) to ensure proper use. Involve caregivers when needed and simplify regimens when possible.
6. Educate Patients and Caregivers
Older adults and their families need to understand:
- What each medication is for
- Possible side effects
- When and how to take it
- Warning signs of adverse reactions
Educational interventions have been shown to reduce medication errors and improve outcomes.
Managing polypharmacy in older adults is a balancing act. While medications can vastly improve quality of life and longevity, their risks multiply when poorly managed. By embracing a patient-centered approach, conducting regular medication reviews, and coordinating care among providers, we can protect our seniors from the dangers of polypharmacy—and help them thrive.