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Do you have plenty of prescriptions? You need to manage your medications

by Emily Koelsch | Contributor
March 5, 2020


As people age, the number of medications that they take usually increases. With an increased number of prescription medications and over-the-counter medications comes an increased risk of adverse drug reactions and dangerous drug interactions. As a result, it’s important that older adults work with medical professionals to create a system for managing medication to avoid some of the dangerous risks that come with polypharmacy.

What is polypharmacy?

Polypharmacy broadly refers to the condition of taking multiple medications and is generally defined as taking five or more drugs at the same time. While many medical professionals have raised concerns about the risks associated polypharmacy, the number of older adults who fall into this category continues to rise.

Harvard research that tracked drug usage from 1998 to 2012 indicates that 39% of American adults over 65 are on five or more medications. Some more recent research puts those numbers even higher – showing that 44% of men over 65 and 57% of women over 65 take five or more medications. These numbers continue to rise as more individuals are taking over-the-counter supplements and vitamins.

As a result of different doctors prescribing different medications and an increased usage of over-the-counter medications, natural supplements and vitamins, polypharmacy is becoming increasingly common and concerning.

What are the risks and concerns surrounding polypharmacy?

Taking multiple medications increases the risk of having an adverse drug reaction (ADR) and creates risks for harmful drug interactions. The more medications that you take, the more likely you are to have an ADR. It’s important to note that even medications that are all-natural or over the counter can interact with other medications and lead to harmful side effects.

Researchers found that in 2005 and 2006, 8% of older adults were at risk for major drug interactions. In 2010, that risk factor had increased to over 15%. It would logically follow that as more people experience polypharmacy, this risk factor would continue to rise.

The concerns about adverse effects from polypharmacy are more severe for older adults. One reason is that metabolic changes and reduced drug clearance, due to aging, make older adults more at risk for adverse reactions. Another reason is simply the increased number of medications that older adults take – the more drugs that you take, the more at risk you are for adverse reactions.

Additionally, the effects can be more concerning because they are often harder to identify in older adults. ADRs present differently in seniors and many of the common symptoms are issues that are more prevalent in older adults. Common symptoms of ADRs or drug interactions in older adults include tiredness, being less alert, constipation, diarrhea, incontinence, decreased appetite, confusion, dizziness, falls, weakness, tremors, anxiety and depression.

For many, this means that troublesome drug interactions can be difficult to identify. What’s worse, they can lead to more medications through what is known as a “prescribing cascade,” something that occurs when a physician prescribes a medication to address a symptom that is caused by another medication.

Some of the most frequently used medications that contribute to ADRs are common over-the-counter medications, including acetaminophen, ibuprofen and asprin. The categories of drugs that are most commonly a part of ADR include cardiovascular agents, antibiotics, diuretics, anticoagulants, hypoglycemics, steroids, opioids, anticholinergics, benzodiazepines and non-steroidal anti-inflammatories.

Recent research is clear in showing that older adults are more at risk for adverse drug reactions caused by polypharmacy. Further, the effects can be more acute in older adults and harder to detect. The result can be dangerous and have a negative impact on quality of life and overall well-being.

How do you prevent and avoid adverse drug reactions and interactions?

One of the best ways to avoid some of the concerns associated with polypharmacy and multiple medications would be an overhaul of the health care system to make it less fragmented. Until that happens, it’s important to be proactive about managing medications and reducing the risks of taking multiple drugs.

Ways to be proactive about managing medication

  • Request a “brown bag review” from your physician
  • Utilize your pharmacist's expertise regarding drug interactions
  • See if you qualify for a medication review through Medicare
  • Create a system at home for tracking and taking medications

One of the best ways to do this is by asking your doctor for a “brown bag review.” This involves bringing in everything that you’re taking – including over-the counter medications and natural supplements – and letting your physician review your regimen. Doing so helps to identify concerning interactions and can identify duplicative medications, often reducing the number of pills needed each day. This type of review can also help to simplify a medication schedule, which can help to reduce the risk of mistakes in taking the medication, which obviously can lead to ADRs. A comprehensive review of all medications is important for older adults and it should be done regularly. In fact, if your medications or dosages change regularly, it’s important to have a physician review everything on a monthly basis.

Woman holding a handful of perscription medication

In addition to brown bag reviews, you can always utilize pharmacists to avoid drug interactions. These professionals understand drug interactions and can help identify concerning combinations of medications. In seeking their guidance, it’s important to share all medications taken, including those that are over-the counter.

Another good resource for managing medications is a medication review. Many seniors qualify for medication reviews through Medicare, so it’s worth checking to see if this is something that is available to you. This is a review that you should always take advantage of if you qualify for it.

In addition to seeking professional support in managing medications, it’s important to have your own systems to ensure that you’re properly taking all medicines and reducing the risks of adverse effects. A few things you can do to help manage your medications at home include:

  • Keeping an updated list of all medications taken, including supplements, is important. That list should be up to date and include dosages, purpose of medication, appearance and potential adverse effects.
  • Using daily pill boxes can help to ensure that you’re properly taking all medications and that you’re aware of everything you take over the course of the day.
  • Consulting with your physician before taking any supplements or vitamins, as doing so could lead to adverse interactions. A recent study published by the Journal of the American Medical Association found that 42% of patients did not tell their primary physician about supplements or vitamins that they were taking, most commonly because they simply didn’t think it was important. Letting your doctor know everything you’re taking is an easy way to reduce the risk of dangerous drug interactions.

As older adults take more and more medications, concerns of the risks associated with polypharmacy are heightened. However, identifying and avoiding any concerning interactions can lead to better outcomes and an improved quality of life. As a result, it’s important to be proactive about managing medications.

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