Over-medicating can result in severe side effects and serious risks, including falls and hospitalizations, and is a particular threat for older people in the U.S. The more drugs a person takes, the more likely these events are to occur. Alarmingly, an estimated 40 percent of older adults (those 65 and over) take more than five prescription medications every day, a 200 percent increase over the previous 20 years. Many take far more.
It’s no wonder that polypharmacy—a term used in the clinical and research community to describe the use of many medications—has garnered so much attention in recent years.
As to how we got here, there are several overlapping factors: the aging population is growing and has multiple chronic conditions, treated with multiple medications; there is a general culture of prescribing among the health care profession, often without an end-game for each prescription; people often see multiple doctors, but those doctors may not communicate with each other to coordinate care; and the public lacks awareness about the harms of polypharmacy.
TACKLING OVERPRESCRIBING IN NURSING HOMES
Recognizing these complex issues and risks, United Hospital Fund began tackling the issue of polypharmacy in 2022. We brought together a group of nursing homes—hotspots for polypharmacy and its dangers—to find ways to address the problem for their long-term care residents. These included routinely reviewing the high-risk drugs each resident was taking and deprescribing those that were unnecessary or causing harm. Nursing home leadership teams also monitored data to root out potentially inappropriate prescribing. The project proved a success: There was enthusiasm among nursing home staff, residents, and their families to reduce unnecessary medications, and in the project’s first four months, the proportion of residents taking 10 or more drugs dropped from 61 percent to 51 percent.
While our project offered important insights to those who deliver and make policy for long-term care, it merely scratched the surface of addressing this problem. Nursing home residents represent only a fraction of the population of older adults, and many will arrive at the nursing home already experiencing polypharmacy.
RAISING AWARENESS MORE BROADLY
It follows that raising awareness of polypharmacy across the wider population—for both older and younger adults—is a necessary approach to dealing with the problem. In early 2024, UHF extended its work on polypharmacy to older adults living in the community. We used the pioneering work of the Deprescribing.org group—an organization which creates guidelines, tools, and approaches to support deprescribing in Canada—to develop two short workshops for community members living in JASA’s Coney Island Active Aging – Naturally Occurring Retirement Community or those using services at ArchCare Senior Life PACE Harlem.
Participants learned a number of important lessons: how to keep track of one’s medications; the importance of seeing supplements and over-the-counter products as medications in addition to the ones that are prescribed; what questions to ask one’s prescriber or pharmacist; and how to advocate for oneself with prescribers.
Feedback from the sessions was overwhelmingly positive: Over 90 percent of participants said that what they learned will make it easier to both keep track of their medications and to ask questions or raise concerns about medications with their doctor. Health care staff also found the workshops valuable.
“Participating in the workshops was enlightening,” said Dr Sonya Jhaveri, medical director of ArchCare Senior Life PACE Harlem. “It sensitized me to the vulnerability of a patient’s experience and how overwhelming it can be to navigate the complexities of prescribed medications.”
These workshops demonstrate that education can be an important tool to empower health care consumers to mitigate the risks of polypharmacy. There is a clear need for this sort of intervention; based on our experience, it would be valued by members of the community and the people who serve them.
For more information on the series of workshops that UHF held in New York, click here. For more information on the original, extended workshops designed by Deprescribing.org, click here.
NEW YORK’S GROWING OLDER POPULATION
Although mass public awareness campaigns can require many resources, there has never been a more pertinent time to mount one to address polypharmacy. New York state alone is home to 4.6 million people over 60 years old, and this number is only growing.
Governor Hochul’s Master Plan for Aging aims to ensure that people flourish in older age, living with dignity and independence. The New York State Department of Health and New York State Office for the Aging are currently gathering input from local communities across the state to inform this plan. The burden of polypharmacy and its dangers should undoubtedly be addressed, and interventions that spread best practices to reduce medication overload in nursing homes and educate the general public—such as these community workshops—would be promising ways to do just that.
