Does Your Loved One Really Need All Those Drugs?

Caring for an elderly loved one comes with many challenges, and one of the most complex issues is managing their drugs. Research shows that older adults are often prescribed multiple medications, some of which may be unnecessary or even harmful. This phenomenon, known as “polypharmacy,” can lead to adverse drug reactions, falls, hospitalisations, and even increased mortality.

If you’ve ever wondered whether a drug—or a combination of them—is doing more harm than good, you’re not alone. Managing medications effectively can be critical in making caregiving tasks smoother and improving the quality of life for your loved one.

The Hidden Dangers of Polypharmacy (when someone is prescribed more drugs than necessary)

Polypharmacy occurs when someone is prescribed more drugs than are clinically necessary. While medications can be lifesaving, they can also pose risks, especially when multiple drugs interact in unpredictable ways.
Common issues include:

• Adverse Drug Reactions (ADRs): Side effects from medications that may worsen existing conditions or cause new symptoms.
• Increased Fall Risk: Some medications can cause dizziness, confusion, or unsteady gait, leading to falls.
• Hospitalisations: Complications from improper medication use can result in emergency care.
• Mortality: Studies link excessive medication use to higher death rates among the elderly.

Real-life examples of Polypharmacy

Polypharmacy is a significant concern among elderly Australians, often leading to adverse drug interactions and health complications.

Here are some real-life examples illustrating these challenges:

1. Mrs. Johnson, an elderly Australian, was prescribed multiple medications for her chronic conditions. Over time, she began experiencing dizziness and confusion, which led to several falls. Upon reviewing her medication regimen, healthcare providers identified that some of her medications were interacting negatively, exacerbating her symptoms. Adjustments were made, including deprescribing unnecessary drugs, which resulted in significant improvements in her balance and cognitive function.

(Sydney Health Partners)

2.Mr. Lee, an 84-year-old man with dementia residing in a shared room at an aged care facility in Devonport, Tasmania, experienced adverse reactions due to his medication regimen. His wife, who lived with him, was reportedly making it difficult for staff to provide him with necessary care and pain relief medication. This situation highlights the complexities of managing medications in elderly patients, especially when cognitive impairments and caregiver dynamics are involved.

(Herald Sun)

These cases emphasise the importance of regular medication reviews and the need for clear guidelines on deprescribing to minimise the risks associated with polypharmacy in elderly Australians.

A national review led by researchers from Monash University revealed that only 29% of clinical guidelines mention deprescribing, and fewer than 10% provide guidance on how to reduce or stop medication dosages. This lack of guidance contributes to the continuation of potentially harmful medications among the elderly, increasing the risk of adverse drug interactions and complications.

Questions to Ask the Doctor

Navigating the healthcare system can feel overwhelming, but asking the right questions can make a world of difference.

Here are some questions to discuss with your doctor to ensure your loved one’s drugs are necessary and safe:

1. Are all these medications still necessary?
   Over time, a condition may improve, and certain medications might no longer be needed.
2. What are the side effects of each medication?
   Understanding potential adverse effects can help identify whether a drug is causing harm.
3. Are there safer alternatives?
   Sometimes, a lower dosage or a different medication can be just as effective with fewer risks.
4. Could any medications be causing the symptoms we’re noticing?
   Symptoms like fatigue, confusion, or appetite changes might be side effects of certain drugs.
5. Would a medication review with a specialist be helpful?
   A review by a geriatrician, pharmacist, or clinical pharmacologist can provide valuable insights.

The Role of Specialists

Not all doctors are the same, and different specialists can bring unique perspectives on medication management:

• General Practitioners (GPs): Often the first point of contact, GPs manage overall care and prescribe many medications.
• Pharmacists: Offer advice on drug interactions and can conduct medication reviews.
• Geriatricians: Specialists in older adults, geriatricians focus on balancing the benefits and risks of medications in aging bodies.
• Clinical Pharmacologists: Experts in the effects of medications, they can assist in optimising drug regimens.

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Accessing Help

Help is available for carers who feel overwhelmed by medication management. Many services, including local pharmacies, geriatric clinics, and online tools, offer medication review programs. In Australia, the Home Medicines Review program can arrange for a pharmacist to review medications in the comfort of your home.

Medication management is a critical aspect of elderly care, but it should never be done without professional guidance. While this article provides practical advice, always consult a doctor before making any changes to your loved one’s medications.

By staying informed and asking the right questions, you can help ensure your loved one receives the best care possible while reducing unnecessary medication-related risks.