The Rising Tide of Medications: Navigating Polypharmacy in the Silver Tsunami Era
by Erin Marriott, RPh, BCGP
The Silver Tsunami is coming, and it is bringing a tidal wave of medications with it. By 2030, around 70 million baby boomers will be 65 or older. One-third of these older adults use five or more prescription drugs, a situation known as “polypharmacy.” By the time they require long-term care (LTC) services, 65 percent of them will be taking more than 10 medications. Considering that approximately half of older adults are prescribed at least one medication that is unnecessary or no longer needed, deprescribing might be appropriate for up to 35 million prescriptions.
A variety of factors are driving this polypharmacy trend. More drug options on the market, earlier treatment of chronic diseases, use of multiple prescribers, and prescribing cascades (when a medication is used to treat the side effects of another medication) all contribute to this phenomenon. Polypharmacy nearly doubles overall healthcare costs and contributes to poorer health outcomes. It is also associated with increased drug interactions, adverse drug reactions, falls, fractures, hospitalizations, lengths of stay, frailty, cognitive decline, and behavioral changes.
Benefits of Deprescribing
Aside from the obvious benefits of reducing direct medication costs and medication error rates, addressing polypharmacy proactively offers a range of benefits to LTC providers. Reducing the total number of doses being administered each day reduces staffing hours needed to order, prepare, administer, monitor, and document medications. By preventing falls, hospital readmissions, and functional decline, initiatives that effectively combat polypharmacy can also have a positive impact on quality outcome measures.
It’s important to prioritize these positive outcomes over the total number of medications, since some individuals with multiple comorbidities may require multiple medications. For example, a resident who has had a heart attack and lives with diabetes may genuinely require five or more daily medications. However, when an individual takes more medications than is necessary to treat a single condition, takes medications without a clear reason for use, or receives multiple drugs from the same class, deprescribing might be in order.
Key Steps Providers Can Take
Preparing for a future with even more medications includes embracing a culture of deprescribing and taking steps now to address polypharmacy.
Start by leveraging the expertise of the clinical consultant pharmacist as a key member of the interdisciplinary team (IDT) early in the process. Initiatives to address polypharmacy should be a core component of each community’s quality assurance and performance improvement (QAPI) program and begin well in advance of a resident’s admission. Additionally, go beyond simply documenting a reason for use for each medication in the medical record at admission.
A proactive approach to identifying deprescribing opportunities includes conversations with residents and their families about each medication. Ask questions, including:
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Do they understand what each medication is being used for?
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Is the medication working as intended?
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Are they experiencing any side effects?
Delivering More than Medicine
Partner with an LTC pharmacy that proactively reviews each medication prior to dispensing, intervenes where appropriate, and provides the clinical leadership team with data and analytics monitoring the pharmacy’s impact. By tracking pharmacists’ interventions for drug interactions, duplicate therapies, and unnecessary medications, the IDT can pinpoint drivers of inappropriate prescribing and identify opportunities for deprescribing.
Taking a proactive approach to polypharmacy by increasing awareness, engaging residents, and integrating pharmacists at each step of the stay, providers can reduce hospitalizations, reduce costs, improve quality outcomes and enhance the quality of life for their residents.
Erin Marriott is a board-certified geriatric pharmacist and seasoned long-term care clinical consultant. She serves as the Director of Clinical and Regulatory support for Guardian Pharmacy Services and can be reached at clinicalsupport@guardianpharmacy.net.
![Alzheimer’s disease is a devastating condition that affects millions of people worldwide, particularly older adults. This year, Guardian Pharmacy is proud to announce the Alzheimer's Association as our charity of choice. We recognize the critical importance of addressing this pervasive disease and supporting those affected by it. With each of our 48+ locations nationwide, we have a unique opportunity to make a significant impact in the communities we serve. Here’s why we’ve chosen to stand with the Alzheimer’s Association and how you can join us in making a difference. The Prevalence and Impact of Alzheimer’s Disease Alzheimer’s disease is a common condition among older adults, and its prevalence increases with age. Despite a slight decline in the proportion of older adults with dementia from 13% in 2011 to 10% in 2019, demographic shifts, particularly the aging baby boomer generation, are expected to drive an overall increase in the number of individuals affected by this disease. Quick Facts By age 65, approximately 10% of individuals are affected, a figure that escalates to as high as 50% among those aged 85 and older The diagnosis rate for Alzheimer’s doubles every five years beyond age 65 More than 7 million people aged 65 and older had dementia in 2020, a number that could surpass 9 million by 2030 and nearly 12 million by 2040 if current trends continue. The prevalence of Alzheimer's disease, related dementia, or cognitive impairment is high among nursing home residents, exceeding 40%. This statistic underscores the urgent need for specialized care and support within long-term care facilities, a demand set to grow alongside the projected rise in dementia cases in the coming decades. Dementia, encompassing Alzheimer’s disease and related disorders, profoundly impacts memory, cognition, and social functioning, severely curtailing independence and necessitating extensive caregiving. Not only does dementia take an emotional toll on families, but caring for a person living with dementia is also more expensive and time-consuming than other conditions common at older ages. Why Guardian is Committed Guardian Pharmacy serves more than 162,000 residents of long-term care facilities across the U.S. As a provider of pharmacy services to a large number of residents who may be affected by Alzheimer's disease, we see firsthand the impact this condition has on individuals, their families, and their caregivers. By choosing the Alzheimer's Association as our charity of choice for 2024, we are committing to support an organization that works tirelessly to advance dementia care and support those affected by Alzheimer's disease. This cause not only enhances our presence in our communities but also shows solidarity with the many individuals we serve who are directly affected by this disease. The Collective Impact Joining the Alzheimer's Association community of fundraisers has a profound impact. In FY23, contributions to the Alzheimer’s Association from donors and partners totaled over $374 million, directly supporting those affected by Alzheimer's and advancing research. The Walk to End Alzheimer's alone raised $89.5 million, engaging over 300,000 participants. Strategic fundraising efforts across various platforms have shown significant results, demonstrating the power of collective action in the fight against Alzheimer's. Together, we can make a real difference. What We’re Doing Each Guardian Pharmacy location is encouraged to form a team and connect with their local Alzheimer's Association chapter. Whether it’s participating in a Walk or Ride to End Alzheimer's, hosting educational events, or volunteering, each pharmacy’s involvement in their local community can create a meaningful contribution. For example, the Birmingham, Alabama pharmacy team showed incredible community spirit by rallying its employees to support The Alzheimer’s Association’s The Longest Day on June 20th through a baked goods silent auction. This event not only raised funds but also increased awareness about Alzheimer's disease within their community. [Read more about the Birmingham team's efforts] Our Goal Our goal for 2024 is for each of our 48+ pharmacy locations and our corporate support services to commit to building a team and getting involved. We recognize that no action is too small to make a big difference in the fight to #ENDALZ. Join Us in the Fight to #ENDALZ We invite everyone to join us in our stand against Alzheimer’s in 2024. Getting involved is easy. Sign up for an Alzheimer's Event near you, find volunteer opportunities in your community, or start your fundraiser event. By coming together as a community, we can make a significant impact in the fight against Alzheimer's disease. Join Guardian Pharmacy in supporting the Alzheimer’s Association and help us work towards a future without this devastating condition. Together, we can #ENDALZ.](https://guardianpharmacy.com/wp-content/uploads/2024/07/Purple-Ribbon-1179x500-1-110x80.jpg)