With a goal of diligently working to combat the negative effects of ageism in the specialized provision of in-home services, Colleen Wilhelm, the Family Lifeline (FLL) Director of Strategic Partnerships/Programming for Older Adult and Persons with Disabilities, shared how she interfaces with pharmaceutical usage and compliance among older adults in her specialized role.
The most frequent medical intervention performed by clinicians is writing a prescription, and this comprises a vital piece of health care. Numerous conditions rely on prescriptions to alleviate or slow the progression of disease. Each time a medication is prescribed, a risk/benefit ratio must be evaluated with caution to side effects, overuse, misuse, and polypharmacy (operationally defined as the use of more medications than are medically necessary) which are all common occurrences carrying counterproductive and negative consequences. According to the Centers for Medicaid and Medicare Services, in 2014 60% of Americans had at least one chronic condition and 42% had multiple chronic conditions (1). Data confirm that multiple chronic conditions are highest among older adults and nearly 50% of older adults take one or more medications that are unnecessary based on statistics from those receiving care at ambulatory (outpatient) and inpatient care settings (2). Adverse drug effects among older adults have a greater impact because of the percentage increase in the elderly population in parallel with an increased prevalence of chronic disease pathology prevalent with aging. Multiple existing health conditions combined with polypharmacy markedly enhances the risk of adverse drug–drug or drug–disease interactions.
Negative health outcomes associated with polypharmacy necessitates vigilance on the part of caregivers and prescribers (3). A cornerstone of proper geriatric medicine involves close contact between patients and a care team well-versed in drug safety and also room for critical thinking in the prescription process.  A majority of older adults trust physicians to provide price and drug efficacy information. Patient confidence in physicians as a source of information on prescription drugs may create opportunities for and improve the quality of doctor-patient communication about medication adherence and drug cost.  However, only a quarter of older adults discuss all of their current medications with their provider or in the instance that they stopped a prescription (non-adherence).
As previously discussed, multiple chronic conditions contributes to risk of negative health outcomes in the presence of polypharmacy from various prescribing physicians. As older adults seek several specialists for various conditions, a lack of sharing prescribing decisions between physicians across those various specialties combined with high trust among older adults in their physicians to make appropriate decisions contributes to heightened adverse drug effects & polypharmacy (4).  Patients more attuned with details of their medical care may achieve better health outcomes and understanding of how adherence contributes to health maintenance. Explaining the medication indication, or what a medication is used for, can also convey medication purpose. Wilhelm cites that locating physicians aware of the comprehensive set of medications a senior has been prescribed and is also actively taking while evaluating the appropriate nature and possible drug-drug and drug-disease side effects is a service that she maintains with her clients at Family Lifeline. Wilhelm states that pharmacies are progressively becoming more attuned to counterproductive combinations, but only if a patient goes to a singular pharmacy for all prescriptions. As the staff working with seniors at Family Lifeline practice vigilance in medication management, they are contributing to overall health, safety, well being and avoidance of iatrogenic disease* complications.
Tune in for future blog series as we explore first-line prescription decisions, Medicare pharmacy reviews and medication compliance factors. Read our previous post on Perceptions on Healthcare and Ageism. 


Written by Melanie Johnson, a member of FLYP (Family Lifeline’s Young Professional Council), she works with older adults in clinical research for neurodegenerative diseases. As a gerontologist, Melanie is committed to community care and resource provision, promoting healthful aging, and disrupting ageism.
References:
(1) Buttorff, Christine, Teague Ruder and Melissa Bauman. Multiple Chronic Conditions in the United States. Santa Monica, CA: RAND Corporation, 2017. https://www.rand.org/pubs/tools/TL221.html.
(2) Maher, R. L., Hanlon, J. T., & Hajjar, E. R. (2014). Clinical Consequences of Polypharmacy in Elderly. Expert Opinion on Drug Safety, 13(1), 10.1517/14740338.2013.827660. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3864987/
(3) Permpongkosol, S. (2011). Iatrogenic disease in the elderly: risk factors, consequences, and prevention. Clinical Interventions in Aging, 6, 77–82. http://doi.org/10.2147/CIA.S10252
(4) Tarn, D. M., Heritage, J., Paterniti, D. A., Hays, R. D., Kravitz, R. L., & Wenger, N. S. (2008). Prescribing new medications: A taxonomy of physician–patient communication. Communication & Medicine, 5(2), 195–208. http://doi.org/10.1558/cam.v5i2.195