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What Older Adults Should Know About Polypharmacy

At your last annual check-in with your doctor, did they ask you to provide a list of all the prescription medications you take and any over-the-counter supplements? Tracking your intake of both is important in managing your health and in alerting doctors and other providers to the potential for polypharmacy. 

Polypharmacy generally refers to a person’s use of five or more medications, although some definitions include taking medications that are unnecessary or where the risks outweigh the benefits. It is particularly common among older adults due to the multiple chronic conditions they often manage. 

How polypharmacy happens 

Older adults often develop multiple chronic diseases such as diabetes, hypertension, heart disease, and arthritis, each requiring various medications. They also typically see multiple healthcare providers, each one prescribing different medications, sometimes without full communication about other treatments the patient may be receiving. This can lead to a prescribing “cascade,” where side effects of one medication lead to the prescription of additional drugs to address these effects, potentially compounding the issue rather than resolving it. 

Risks associated with polypharmacy 

Polypharmacy increases the likelihood of adverse drug reactions and interactions, which can diminish the effectiveness of treatments, increase the risk of hospitalization, and decrease overall quality of life. Managing multiple medications can also be complex, leading to issues with adherence and increased healthcare costs. 

Include vitamins and supplements 

Your doctor needs to consider all substances that might affect your health, including over-the-counter medications, vitamins, herbal supplements, and other nutraceuticals. These can interact with prescription medications, possibly making them less effective or causing adverse effects. For instance, vitamin K can interfere with the efficacy of blood thinners like warfarin. 

Yes, also mention your use of CBD and marijuana 

CBD and marijuana – both recreational and medicinal – can also interact with prescription medications by inhibiting the activity of liver enzymes needed to metabolize many drugs. This can lead to higher drug levels in the body, increasing the risk of side effects. Moreover, the psychoactive components of marijuana (THC) can affect cognitive function and coordination, posing additional risks for confusion and falls in older adults.  

Is polypharmacy always bad? 

Not necessarily. When medications are properly managed, polypharmacy can be essential for controlling multiple conditions. However, it becomes problematic when the medications are not effectively coordinated. That might lead to an increased risk of adverse drug reactions and interactions, or simply affect the person’s ability to take the medications as directed. 

Preventing and managing polypharmacy 

Periodic reviews with each health care provider—like the annual check-in with your primary care physician—can help ensure that each medication is necessary and that all medications are managed effectively. 

Make sure you (and/or your caregivers) understand why you are taking each medication and how to manage it. It’s also important to inform all of your health care providers of everything you are taking.  

If your doctor has complete information about everything you are taking—prescribed and otherwise—they may be able to systematically discontinue medications that are no longer needed or beneficial for you. This process should be carefully managed by healthcare professionals. 

For older adults managing multiple medications, and for their caregivers, understanding and addressing the risks of polypharmacy is essential for maintaining health and quality of life. Always communicate openly with healthcare providers about all substances being taken, including over-the-counter meds, vitamins and other supplements, and even CBD or marijuana, to ensure safe and effective treatment of all health conditions. 

How LifeCare Advocates can help 

We at LifeCare Advocates can help our clients organize this information and help connect them with professionals who assess and address polypharmacy, including the use of CBD for health conditions. We can help weigh the various risks and benefits to meet clients’ goals and help them make the best choices.