Polypharmacy: When Quantity Affects Quality

One pill makes you larger and one pill makes you small … go ask Alice if she remembers which one is which. Managing multiple medication may take a song or two to remind you which medication you take for which aliment. Polypharmacy is a common problem facing many older adults but managing those medications does not have to be a song and dance.

“Because mixing meds can render some ineffective and cause dangerous side effects in others, it’s important to educate yourself and loved ones about their medications and how to manage them,” says Teleia Farrell, Community Relations Director at YourLife™ of West Melbourne, a new Memory Care community coming soon to West Melbourne, Florida. “And, with a doctor’s help, you may be able to find safer combinations to treat your loved one’s multiple conditions but with reduced risk of negative side effects.”

In this post, we’ll discuss polypharmacy and what to watch out for.

First, What Is Polypharmacy?

Polypharmacy is typically defined as the concurrent use of multiple medications by the same patient. Clinically, the criteria utilized for identifying polypharmacy involves the following:

  • Taking medications that have no apparent indication
  • Using therapeutic equivalents to treat the same illness
  • Concurrent usage of interacting medications
  • Using an inappropriate dosage
  • Utilizing other medications to treat adverse drug reactions

The Department of Health and Human Services reported in Healthy People 2000 that polypharmacy was the principal medication safety issue. Polypharmacy increases the possibility of drug-drug and drug-disease interactions. The elderly population is at greater risk because of the normal physiological changes that occur in the aging process. Specifically, renal and hepatic functions contribute to changes in pharmacodynamics and in the pharmacokinetics process.

Therapeutic Polypharmacy vs. Contra-Therapeutic Polypharmacy

Polypharmacy can be categorized into two major classes: Therapeutic Polypharmacy, when multiple drugs are carefully monitored by healthcare professionals and are necessary for the treatment and therapeutic goal, and Contra-therapeutic Polypharmacy, which is the unanticipated or unintentional adverse effects with a drug regimen that is not monitored. This can be detrimental when multiple medications are taken at high doses for extended periods of time without being monitored.

Medications can be prescriptions, over-the-counter, recreational drugs and alcohol, herbal remedies/alternative medicines. Medication-related problems are more likely to happen with aging and disability. About one-fourth of nursing home admissions are due to improper medication management. Patients, caregivers, doctors and pharmacists can function as a team to prevent complications from polypharmacy. Family Caregiver Alliance recommends asking these questions to help identify and avoid polypharmacy problems:

  • Why is this medicine prescribed? Is this medication really needed? Is the medication the most appropriate for the medical condition being treated?
  • How does the medicine work in my body?
  • How can I expect to feel once I start taking this medicine?
  • How will I know that the medicine is working? Is there a typical time period after which my symptoms should improve?
  • How long will I have to take the medicine? Will I need a refill when I finish this prescription?
  • Will this medicine interact with other medications—prescription and nonprescription—that I am taking now? Will the medication be a problem with other medical conditions that are occurring at the same time?
  • Should I take this medicine with food? Are there any foods or beverages I should avoid? (Grapefruit, for example, may interfere with the action of certain medications.) Is it safe to drink alcohol while on this medicine?
  • Are there any activities I should avoid while taking this medicine?
  • Can this medicine be chewed, crushed, dissolved, or mixed with other medicines? Can the medication be taken correctly based on specific patient circumstances?
  • What possible problems might I experience with the medicine? How can I prevent these problems from occurring? At what point should I report problems with the medicine?
  • What should I do if I miss a dose of this medicine, or take too much?
  • What is the cost of the medicine prescribed? Is there a less expensive alternative prescription?
  • Is a generic version of this medicine available? If so, should I purchase the generic instead of the brand name medicine?
  • Do you have written information about the medicine that I can take home with me?
  • Does the pharmacy provide special services such as home delivery or comprehensive medication review and counseling?

The following are red flags that can indicate contra-therapeutic polypharmacy:

  • Excessive drowsiness
  • Confusion
  • Depression
  • Delirium
  • Insomnia
  • Parkinson’s-like symptoms
  • Incontinence
  • Muscle weakness
  • Loss of appetite
  • Falls and fractures
  • Changes in speech and memory


If you suspect contra-therapeutic polypharmacy, please contact your healthcare provider or pharmacist. If you suspect there is a life-threatening situation, contact emergency services or 911.

Other ways to prevent contra-therapeutic polypharmacy are to keep a list of medications, both prescription and over-the-counter, that are taken frequently (once-a-month or more) and review it at doctors’ visits. Be sure to include the dosage and how often each medication is taken. Clear out medicine cabinets regularly and discard of discontinued or expired medications properly.  

RELATED: The Best Pill Dispenser for Seniors: 8 of the Top Contenders


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Inspiring Memory Care Designed for You. Defined by You.
YourLife™ Senior Living was created to provide the most exceptional Memory Care and uplifting lifestyle for our residents. We focus all our energy, attention and resources on creating a community that caters to each resident’s personal needs, respects their choices and honors individuality while providing unmatched peace of mind and support for families.

Because Memory Care is our sole focus, we have the unique ability to design and personally tailor plans around our residents. We understand that each resident is an individual that has their own story, specific needs and retained abilities, so we develop personally inspired care plans that value and support each person’s independence.

Our team of attentive, caring YourLife™ Personal Care Specialists is on site 24 hours a day, seven days a week to provide assistance with everyday activities, gentle reminders and redirection.

With YourStory, our signature programming, we create an individual experience centered around each resident. From cultural, educational and holistic health and wellness programming, outings and an array of other special events to personal care, assistance and therapies, we create days with meaning. At YourLife™ Senior Living, our residents and families know that this is a community designed for you, with a lifestyle defined by you. Contact us to learn more!

Call us at 321-236-4578 for more information or to schedule a personal visit today.