“We live in a culture that’s taught us to expect that there’s a pill for everything,” said Dr. Nick Schneeman, Lifespark Chief Medical Officer. “It’s true that modern medicine has often delivered on that expectation, but it’s also contributed to the rise in polypharmacy, which is a disaster for frail and complex populations.”
Polypharmacy, defined as the simultaneous use of five or more prescription drugs, over-the-counter (OTC) medications, or dietary supplements, can lead to a host of problems. Those problems include dangerous drug interactions, harmful side effects, increased ER visits and hospitalizations, higher healthcare costs, reduced quality of life, and greater risk of mortality.
Causes of polypharmacy
Polypharmacy isn’t new, but Dr. Schneeman points to several factors fueling its growth:
- People are living longer which increases their chances of developing chronic medical conditions.
- Direct-to-consumer advertising drives consumer demand and puts pressure on doctors.
- Primary care physicians often defer to specialists to prescribe drugs related to their area of expertise.
- Direct-to-consumer advertising drives consumer demand and puts pressure on doctors.
- Our nation’s fee-for-service model rewards efficiency rather than outcomes.
- Physicians are not trained to review and deprescribe drugs.
Treating the problem
“A big part of geriatric medicine is eliminating the drugs a client doesn’t need and keeping them on the ones they do,” said Dr. Schneeman. But deprescribing is just one piece of a larger effort. Reining in the problem of polypharmacy also involves:
- Thorough medication reviews
- Client and family education
- Clinician training
Medication reviews
“When an older client isn’t feeling well—they’re dizzy, confused, constipated, nauseous—it’s often the result of drug interactions or harmful side effects,” said Sarah Johnson, APRN, CNP, Lifespark Associate Medical Director.
“The reality is that the body’s physiology changes with age, so what made sense at age 50 might be harmful at 80.”
It takes time to do a detailed review of 12–18 drugs—a practice that should be done whenever a new medication is prescribed or at least once a year—but for Sarah, it’s one of the most rewarding aspects of the job. “When you take away what’s contributing to poor health, it can really improve a client’s quality of life,” she said.
Another benefit of the med review is the insight it gives Sarah and her team, not just about the client’s medical history, but also about their goals and their understanding of their medications. “Often, neither client nor family member knows why they’re taking a certain drug or what’s it for,” said Sarah. “With their permission, we’ll call the specialist to find out why a certain drug was prescribed and then discuss the risks and benefits of deprescribing that drug.”
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Client and family education
A significant part of Sarah’s job is educating family members about the potential side effects of certain medications and how ranges differ for older adults. “When we look at blood pressure meds, for example, we’ll explain that a blood pressure target of 110 might be a great for a 25-year-old, but not for an 85-year-old who’s had some falls,” said Sarah. Depending on the client, she might recommend a gradual dose reduction with the understanding that they can always restart the drug.
Sarah also uses education to dispel the assumption that if you can buy it over the counter, it must be safe. “Some seniors use Advil PM to help them sleep, but that drug has a Benadryl component which increases the risk of falls and confusion—dangerous side effects for older adults,” she said.
Clinician training
Dr. Schneeman and Sarah are currently developing a training module that will be rolled out to all Lifespark clinicians to establish a standard of practice for medication reviews. “For every drug, we look at four different factors—indication, efficacy, safety, and cost—and discuss each one with the client to make sure they understand what’s behind our recommendation,” he said.
Questions they ask about each drug include:
- Does it have an FDA indication and are we using it properly?
- Is the drug going to work for this individual, given their other health conditions and life expectancy?
- Considering the other drugs the client is taking, what are the risks of this medication?
- Is there a cheaper option that’s just as effective as the high-priced drug the client is currently taking?
The Lazarus effect
Dr. Schneeman has often witnessed what he calls the “Lazarus effect” in elderly adults when their medications are deprescribed or doses reduced. “This is not an uncommon occurrence when a client enrolls in hospice,” he said. “In preparing for a peaceful late-life experience, the hospice team will usually deprescribe the client’s chronic medications, and two weeks later, Grandma’s dancing the polka!” Just one more reason why Lifespark is passionate about curtailing the crisis of polypharmacy.
To learn how Lifespark’s whole-person approach can help your loved one age magnificently, schedule a free consultation.