Medication Safety for Older Adults: When a Medication Review May Help
As people get older, medication lists can gradually become more complicated.
One medication may be prescribed by a primary-care provider. Another may come from a cardiologist. A neurologist may prescribe something else. A hospital visit may result in additional prescriptions.
Then vitamins, supplements, over-the-counter medications, or as-needed medicines may be added at home.
Before long, the medication list may contain far more than anyone originally expected.
Older adults often receive medications from multiple providers, and sometimes no one has had the opportunity to review everything together.
Why Reviewing the Entire Medication List Matters
A medication list inside one doctor’s chart may not always show everything a person is actually taking.
A comprehensive medication review may need to consider:
- Prescription medications
- Specialist medications
- Hospital or urgent-care medications
- Over-the-counter products
- Vitamins
- Supplements
- As-needed medications
- Medication doses and schedules
- What the patient is actually taking at home
This process is often referred to as medication reconciliation.
The goal is to compare what appears on the medication list with what the patient is actually taking.
Signs That a Medication Review May Be Helpful
A geriatric medication review may be especially useful when an older adult:
- Takes several medications
- Sees multiple specialists
- Has recently been hospitalized
- Experiences frequent medication changes
- Uses several over-the-counter medications or supplements
- Has experienced dizziness or weakness
- Has new confusion or excessive sleepiness
- Has experienced a recent fall
- Has a caregiver who is unsure whether the medication list is accurate
What Can a Geriatric Medication Safety Review Look For?
A comprehensive review can consider several types of potential medication-related concerns.
These may include:
- Medication duplication
- Drug-drug interactions
- Drug-disease concerns
- Sedation
- Cognitive effects
- Fall risk
- Age-related medication considerations
- Unnecessary treatment complexity
- Opportunities for medication simplification when clinically appropriate
Evidence-based geriatric prescribing principles may also be used as part of the assessment.
For example, the American Geriatrics Society Beers Criteria® can help healthcare professionals identify medications that may deserve additional consideration in older adults.
However, appearing on such a list does not automatically mean that a medication should be stopped.
What Is Deprescribing?
Deprescribing does not mean simply removing medications.
It is a clinical process of identifying medications that may warrant discussion about dose adjustment, simplification, or discontinuation when clinically appropriate.
Any medication changes should be made under the direction of an appropriate prescribing clinician.
The goal is to make sure the treatment plan still makes sense for the patient’s current health needs.
Caregivers Are an Important Part of the Process
Medication management can become overwhelming for families.
Caregivers may be responsible for organizing pill boxes, coordinating refills, attending medical appointments, communicating with several doctors, and trying to remember which medications have changed.
A medication review can help bring together medication bottles, available medical records, pharmacy information, and caregiver observations to create a clearer picture of what the patient is actually taking.
That clarity can make conversations with the healthcare team much more productive.
Virtual and In-Home Medication Reviews
Medication reviews may not always require a traditional office appointment.
Virtual telehealth reviews may be available, and in-home medication reviews may be available for qualifying patients.
During an in-home review, medication bottles, over-the-counter products, supplements, and medication routines can be reviewed in the environment where the patient actually manages them.
Every Medication Should Have a Purpose
The goal of medication optimization is not simply to count medications.
It is to understand why each medication is being taken, how the medications fit together, whether potential safety concerns exist, and whether the overall treatment plan could be clearer or simpler.
Every medication should have a purpose, a reason, and a place in the patient’s overall plan of care.
For older adults managing a complex medication list, a structured review can provide greater clarity for both the patient and the people helping care for them.
Medical Disclaimer: This article is for educational purposes only. Do not stop, reduce, or change prescription medications without guidance from an appropriate prescribing healthcare professional.