​ADVERTORIAL

Polypharmacy, broadly defined as the use of multiple medications, poses a formidable challenge in long term care (LTC), with negative f​inancial implications for communities and potentially harmful consequences for residents. As the older population in the U.S. continues to grow at an exponential rate and develops many of the medical conditions associated with aging, the reliance on multiple medications to address these issues has surged. As a result, the prevalence of polypharmacy in LTC communities has reached daunting levels. 

The consequences of polypharmacy not only include an increased risk of adverse drug reactions, drug interactions, hospitalizations, and falls among residents, but it also imposes a substantial financial strain on LTC operators as residents require a greater level of care.

Defining Polypharmacy and Its Drivers

Polypharmacy is a complex topic with varying perspectives. While no standard definition exists, it commonly refers to the use of five or more medications daily. A systematic review published in the Journal of Post-Acute and Long-Term Care revealed that among residents in these communities, 91 percent were taking more than five medications, while 65 percent were taking more than 10. With the Lown Institute predicting that inappropriate polypharmacy will cost the healthcare system an additional $62 billion between 2020 and 2030, it’s crucial to understand the drivers behind polypharmacy.

Factors That Contribute to Polypharmacy

Prescribing cascades: These occur when a medication causes a side effect that is mistaken for a new medical condition, leading to additional prescriptions. This creates a cycle of escalating medication use.

Clinical practice guidelines and limited deprescribing guidance: Guidelines often recommend multiple medications for residents with complex conditions, increasing the risk of polypharmacy. Meanwhile, few guidelines exist to support deprescribing—the supervised reduction or discontinuation of unnecessary or harmful medications—so residents may continue taking drugs they no longer need.

Increased availability of condition-specific medications: The expanding number of available drugs, combined with direct-to-consumer marketing and resident requests, drives up prescribing. Use of multiple prescribers, such as specialists, and guideline recommendations for multiple medications per medical condition further compound the issue.

The Detrimental Effects of Polypharmacy on Resident Outcomes 

Polypharmacy has serious consequences for residents, leading to a range of negative outcomes that affect their health and well-being. It increases the risk of falls, adverse drug reactions, medication interactions, and non-adherence. This results in longer hospital stays, more frequent readmissions, and even higher mortality rates. In fact, polypharmacy is responsible for nearly 30percent of all hospital admissions an

d ranks as the fifth leading cause of death in the United States, according to Health Research Funding.

But the consequences of polypharmacy go beyond health outcomes. Residents dealing with polypharmacy also face higher healthcare costs, with expenses nearly doubling compared to those without polypharmacy.

The Financial Impact of Polypharmacy on LTC Communities

Increased Labor Costs
With staffing challenges already straining the LTC industry, managing complex medication regimens adds to labor demands and costs. Polypharmacy results in longer med passes, more frequent monitoring, and increased risk of adverse drug events—all of which consume valuable staff time and limit their ability to complete other responsibilities. Often, communities must hire additional staff to manage the workload, compounding financial pressures.

More Care Transitions, Shorter Lengths of Stay
Keeping residents in lower-acuity settings is both cost-effective for operators and beneficial for residents. However, polypharmacy increases hospitalizations, emergency visits, and transitions to skilled nursing, shortening length of stay in assisted living. This creates added expenses—such as discharge and readmission coordination, extra nursing hours, and ongoing marketing efforts to replace residents and maintain occupancy—directly impacting the bottom line.

Strategies to Reduce Polypharmacy

Reducing polypharmacy in LTC settings can be challenging, but several effective strategies can help:

1. Know your residents, their conditions, and medication purposes. Staff should have a thorough understanding of each resident’s conditions and the purpose behind every medication. This insight helps flag medications that lack a clinical justification or are dosed inappropriately. Staff should feel empowered to consult prescribers or pharmacists, remain alert to side effects, and question prescribing patterns when needed. A team-based, inquisitive approach is key to addressing unnecessary medications.
2. Engage residents and their families to assess preferences and concerns. Proactive, face-to-face conversations with residents and families can uncover insights about medication preferences and concerns. Research shows residents are often open to reducing medications—but these discussions typically need to be initiated by clinical staff. By actively listening and relaying feedback to prescribers, staff help tailor safer, more personalized regimens and reduce the risk of adverse events linked to polypharmacy.
3. Utilize an LTC pharmacy partner and a collaborative approach to reduce polypharmacy.

In skilled nursing, the required monthly pharmacist medication regimen reviews focus on identifying and addressing polypharmacy. In assisted living—where consultant pharmacist involvement varies by state—savvy operators partner with LTC pharmacies and adopt a collaborative approach with the broader healthcare team to gain similar benefits. Across all settings, operators should expect their LTC pharmacy partner to:

• Be an active part of the multidisciplinary care team. LTC pharmacists are experts in spotting polypharmacy risks. They conduct medication reconciliations during care transitions, simplify regimens, and work collaboratively with residents, families, and the broader healthcare team—including primary care physicians, specialists, and nursing staff—to improve prescribing practices. Consultations should cover high-risk medications, antibiotic and psychotropic use, and prioritize deprescribing opportunities. In assisted living, even quarterly medication regimen reviews can significantly reduce polypharmacy.
• Use technology to enhance safety. LTC pharmacies combine technology and clinical expertise to detect interactions and duplicate therapies. While technology is essential, human oversight ensures its safe and effective use.
• Provide proactive interventions and data-driven insights. Pharmacists should intervene early—before a new medication is dispensed—to monitor outcomes and ensure drug combinations are safe and appropriate. LTC operators benefit from this type of reporting that tracks the pharmacy team’s clinical impact, offering valuable insights to improve resident care.

For example, in 2024, Guardian Pharmacy’s proprietary Clinical Intervention program reported more than 112,000 pharmacist-led interventions—identifying over 11,000 instances of duplicate therapy, more than 9,000 cases of unusual dosing (such as doses too high or too low for a resident), and over 28,000 orders that required clarification before dispensing.

Conclusion

Breaking the cycle of polypharmacy is key to improving outcomes and reducing costs. By eliminating unnecessary medications, communities lower the risk of side effects, drug interactions, falls, and hospitalizations. A pharmacist-led, collaborative approach helps optimize regimens and ensure safe, effective care. Communities should rely on their LTC pharmacy partners to lead in this area of expertise, promoting better resident health and long-term financial stability.

To learn more visit us at https://guardianpharmacy.com/provider-resources/.

References
Nguyen PV, Spinelli C. Prescribing cascade in an elderly woman. Can Pharm J (Ott). 2016 May;149(3):122-4. doi: 10.1177/1715163516640811. Epub 2016 Apr 1. PMID: 27

212961; PMCID: PMC4860747.

Erin Marriott is a board-certified geriatric pharmacist and a seasoned LTC clinical consultant pharmacist. A graduate of the University of Toledo School of Pharmacy and board certified in geriatrics, Marriott has more than 20 years of experience in the long term care industry. She currently serves as the senior director of clinical and regulatory support for Guardian Pharmacy Services in Atlanta, Georgia, and has an extensive background as a clinical consultant pharmacist, directly serving long-term care and senior living communities for more than 15 years. She is an active member of the American Society of Consultant Pharmacists and has received advanced training in antimicrobial stewardship and anticoagulation management.​