Too Many Pills: The Patient Advocacy Perspective

I have been a Registered Nurse for many years, and an Aging LIfe Care Professional, also known as a geriatric care manager or senior care advocate, for the past 7 years. As a nurse I have always thought of myself as a Patient Advocate, especially when it comes to my patients who are older adults.

While 7 out of 10 adults are expected to need assistance as they age, geriatric specialists and other professionals note it will be difficult to continue to rely so heavily on family caregivers because of declining future numbers, complexity of our healthcare system, and competing responsibilities for modern families.

That is where an Independent Health Care Advocate like myself can be of tremendous help to a family in need. I am a resource for information and education, relieving much of the caregiver burden, especially for those families separated by distance, as I understand how difficult it is to navigate our current health care system. Because I am also a Registered Nurse I can assist in medical management, respond to any emergencies that arise, and keep families fully informed.

Many seniors see several medical providers and take multiple prescription medications. Sometimes these medications can interact with each other or may be inappropriate.

One of the biggest problems I see with older adult clients is polypharmacy, too many medications. Many seniors see several medical providers and take multiple prescription medications. Sometimes these medications can interact with each other or may be inappropriate. They can cause troubling issues, side effects, balance challenges, increased fall risk and may contribute to cognitive decline. If I see a client who has these types of problems the first thing I look at are the medications. I will communicate any concerns I have regarding their medications to the prescriber or primary care provider (PCP). Sometimes the client or family does not realize medications may be the culprit. It is gratifying when I see an improvement in client function after a simple dose adjustment or even deprescribing of a medication. Issues with medications often arise after a hospitalization, because some prescriptions may be changed, discontinued or added. It is important to ensure a client is seen by their PCP within 2 weeks of discharge if possible. COVID has made this more difficult, but as an advocate I can help arrange and participate in a virtual or telehealth visit if an in-person visit is not possible.

Issues with medications often arise after a hospitalization, because some prescriptions may be changed, discontinued or added...Sometimes the client or family does not realize medications may be the culprit.

A valuable resource I often use when reviewing medications is the Beers Criteria. In 1991, Dr. Mark Beers and his colleagues created a list of criteria to identify medications whose risks outweigh the benefits, those that should be avoided or used with in caution in adults 65 years and older. The American Geriatrics Society (AGS) revises and updates the criteria every 3 years, most recently in 2018. The AGS and an interprofessional panel of 13 geriatric care and pharmacotherapy experts review and grade an extensive list of medications for drug-related problems and adverse effects in older adults. The Beers Criteria is meant as a guideline for prescribers, and leaves room for the professional's clinical judgement as the final say. More physicians are using and recognizing the importance of the Beers Criteria when deciding what medications to give older adults.

If you are interested in learning more about polypharmacy and medications, check out an article I wrote for American Nurse Today, the official journal of the American Nurses Association discussing the importance of Monitoring Medications in the Older Adult

(For more information on Elder Care, check out these blogs: 1, 2, 3)