As the polypharmacy phenomena continues to grow in the United States, so does its risk to seniors and senior living operators.
Generally defined as taking five or more medications, polypharmacy brings significant burden and risk to senior living operators and their residents.
In 2015, the Journal of Post-Acute and Long-Term Care Medicine (JAMDA) published a systematic review of polypharmacy in long-term care facilities. The review included 44 studies, where the authors found that 91% of residents were taking five or more medications, while 65% were taking 10 or more.
That was eight years ago. With rising acuity, increased availability of new medications to treat specific conditions, direct-to-consumer drug advertising, and clinical guidelines that promote multiple medications to manage single conditions, polypharmacy in senior living has become rampant.
Here is a look at 3 strategies that senior living operators can use to minimize the impact from polypharmacy — and 4 benefits of doing so.
3 strategies for reducing harm from polypharmacy
Strategy 1: Understand polypharmacy — and its risks
For senior living operators to effectively mitigate risks from polypharmacy, they must first understand it. While that sounds obvious, the combination of the nuance of the definition (it includes over-the-counter medications as well as vitamins and supplements) and severity of outcomes means operators must know exactly what they’re dealing with.
By increasing a resident’s risk for falls, hospitalizations and both cognitive and functional decline, polypharmacy stands directly in the way of outcomes-based care delivery. More medications equate to higher risk for med errors and liability exposure related to monitoring and adverse drug effects.
“There are some cases of appropriate, or necessary, polypharmacy when we treat complex patients with multiple comorbidities consistent with current clinical practice guidelines. In these situations, it’s important to monitor their therapy closely and simplify regimens to the extent possible,” says Erin Marriott, RPh, BCGP, Director of Clinical and Regulatory Support for Guardian Pharmacy Services. “Then, as the individual’s prognosis and goals of therapy change over time, we will re-evaluate and consider the appropriateness of deprescribing.”
Ensuring clinical staff members are educated on what polypharmacy is, the significant risk it poses to the residents under their care, and when to report concerns to the physician or pharmacist are key to reducing harm. Everything starts with an awareness of the true scope of each resident’s medication burden — both how many medications they receive and why each has been prescribed.
Strategy 2: Prevent prescribing cascades
A prescribing cascade occurs when a new symptom in a patient is misinterpreted and treated as a new condition when, in fact, it is a side effect or adverse reaction to another of their medications. This occurs commonly in practice — consider someone prescribed a sedative to help them sleep who then struggles with side effects of dry eyes and constipation. This results in the addition of two new medications, artificial tears and a laxative, when the best course of action would be to discontinue the sedative.
That’s why training for staff responsible for administering medications must begin with the basics:
- knowing the purpose of each medication that a resident receives
- the common side effects associated with each
- when to report concerns to the clinical team
“This is an opportunity to prevent polypharmacy before it starts,” Marriott says. “Pharmacists are inclined to evaluate every new patient complaint as a possible adverse drug effect first and look for opportunities to deprescribe before recommending additional treatment. It’s an effective strategy to avoid the prescribing cascades that contribute to polypharmacy.”
If a resident’s medical record does not include the reason for use of a medication, staff should ask the physician to either document a reason or consider discontinuing the drug. Complete medication lists that include an associated diagnosis for each drug are essential for clinical teams to have at hand when reviewing the plan of care and wellness goals with residents and their families.
Strategy 3: Leverage the expertise of your long-term care pharmacy provider
Medication reviews by pharmacists, physicians, or multi-disciplinary teams can all be effective ways to identify residents who may be candidates for deprescribing medication. Pharmacists, however, are the medication experts. Many long-term care pharmacy partners have pharmacists on staff who have specific training in geriatric medication management.
This knowledge can be particularly helpful when residents are seeing physicians that primarily care for more independent, community-dwelling patients. One study showed that the first pharmacist medication review and intervention decreased polypharmacy by 67%, while a second intervention brings another 39% decrease.2 To realize the full value they can bring to the table, operators should consider utilizing the services of a consultant pharmacist in their communities on a quarterly basis, at a minimum.
“It is always a good idea to consider bringing a senior care pharmacist into the conversation,” Marriott says.
4 benefits to the operator of reducing polypharmacy
Polypharmacy poses a real threat to senior living residents, yet many operators aren’t aware of its true cost. Four key benefits to reducing polypharmacy in senior living stand out, starting with cost itself.
Benefit #1: Reduced costs
A 2022 cross-sectional study in the American Journal of Cardiology2 found a stark difference in the expected average total health care expenditures and pharmacy expenditures for patients with or without polypharmacy.
Those with polypharmacy clocked in at $19,068 for all health care costs, with $1,286 on pharmacy costs.
Those without polypharmacy: $8,815 and $488, respectively.
Benefit #2: Improved operational efficiencies
One significant and perhaps overlooked area of cost savings that polypharmacy reduction can bring is around the reduction of labor hours. When a community is administering fewer medications, they spend less time not only on meds but on monitoring for adverse effects, processing residents to and from the hospital, and overall documentation.
By minimizing staff time on medication administration, monitoring and documentation, operators improve their overall operational efficiencies.
Benefit #3: Longer lengths of stay, fewer hospitalizations
Polypharmacy is associated with higher rates of emergency department visits, hospitalizations, falls, fractures, frailty, and cognitive decline. One study found that polypharmacy was associated with 30% of all hospital admissions.
Keeping residents off of unnecessary medications helps keep them in their communities longer.
Benefit #4: Better overall resident outcomes
Add it all up and operators see better resident outcomes. It all starts with the basics: understanding the reason and risks associated with each medication being administered. Then, by leveraging the clinical expertise available to them, operators can be assured that each resident’s medication regimen is optimized to be the safest, simplest, and most cost effective possible.
This article is sponsored by Guardian Pharmacy Services. To learn more about the benefits of a Guardian Pharmacy partnership for senior living operators, visit guardianpharmacy.com/providers.