Macular degeneration — when vision fades and adaptation becomes essential

This article is for educational purposes only and does not constitute medical, legal, or financial advice. Every family situation is different, and you should consult with appropriate professionals about your specific circumstances.

Your mother takes one medication for her heart, another for blood pressure, another for cholesterol, another for arthritis, another for her thyroid, another for anxiety, another for her stomach. That's seven. Then there's the aspirin for prevention, the vitamins, the over-the-counter sleep aid she takes sometimes, the antihistamine for allergies. That's eleven. Your father probably has a similar list. When you look at the bottles lined up on the bathroom counter, it's hard not to feel that something is wrong here, even though every single medication was prescribed by a doctor for a legitimate reason.

This is polypharmacy, the phenomenon of taking many medications at once. It's not inherently bad. Some people with multiple conditions genuinely do need multiple medications. But there's a point where the number of medications becomes part of the problem. Each medication has side effects. Each medication interacts with other medications in ways that sometimes aren't predictable. Each medication your parent takes increases the chance that the confusion they're experiencing, or the falls, or the dizzy spells, or the digestive problems, or the memory difficulty, is actually caused by a medication rather than the disease it was prescribed to treat.

The challenging part is that nobody designs this situation. It sneaks up gradually. A cardiologist adds a medication for the heart. A rheumatologist adds a medication for arthritis. An endocrinologist adds a medication for diabetes. Each specialist is solving their part of the problem. Nobody is standing back looking at the full list and saying, "Wait, let's think about whether all of these together are actually making things better or worse." That's where you come in.

The Pill Collection

Start with the reality of what a typical older adult is taking. Not a few medications. Not five or six. Many older adults take ten, fifteen, twenty, or more medications and supplements daily. Some of this is prescription medications. Some is over-the-counter. Some is supplements. Each one adds up.

When you ask your parent, "What medications are you taking?" they might list five or six. When you look at the bottles, you find ten. When you get their pharmacy records, you find twelve because they forgot the aspirin and the calcium supplement and the migraine medication they take occasionally. This is normal. Most older adults don't have a clear picture of everything they're taking.

The reasons this happens are understandable. A patient sees a cardiologist for heart problems. The cardiologist prescribes a medication. A few months later, they see a gastroenterologist for acid reflux. That doctor prescribes something. They've been taking ibuprofen for arthritis for years, and now their blood pressure is up, so their primary care doctor talks about stopping the ibuprofen and starting something else. But the patient is still buying ibuprofen over-the-counter, so they're actually taking both. Meanwhile, a family friend recommends a supplement for joint health, so they're taking that too.

Each individual decision makes sense. The problem is that nobody is looking at the aggregate picture. Each doctor is focused on their specialty and the conditions they're treating. The interactions, the cumulative effects, the question of whether this combination is optimal, these are questions that rarely get asked systematically.

Some medications are legitimately necessary. A patient with heart disease might genuinely need a statin, an ACE inhibitor, a beta blocker, a diuretic, and an anticoagulant. That's five medications, each targeting a specific problem. But what if the patient is also taking something for depression, something for anxiety, something for heartburn, something for arthritis, something for allergies, something for a bladder problem, and two or three supplements? Now you're up to twelve medications, and you need to ask whether every single one is necessary.

How It Happens

The system is structured in a way that makes this happen almost inevitably. Your parent sees specialists. Each specialist is excellent at what they do. But they're also focused on their specialty. They're not coordinating with the other specialists. Your parent's primary care doctor is sometimes in communication with specialists, sometimes not. There's rarely a single person with a bird's-eye view of the entire medication list and the overall picture of what's happening.

As your parent ages and more health issues develop, more medications get added. If something isn't working optimally, the instinct is often to add another medication rather than to step back and reconsider the whole approach. If your parent develops a new symptom, a doctor might prescribe a medication to treat it without initially considering that the symptom might be a side effect of a medication already being taken.

When something stops being a problem, the medication isn't always stopped. Your parent had acid reflux for a while, took a medication for it, and now the reflux isn't really an issue anymore. But the medication is still there. They're still taking it. Nobody removed it from the list. Your parent used to have trouble sleeping, tried a medication, and it helped for a while. That medication is still in the bathroom cabinet, still being taken occasionally, even though the original problem has resolved.

The other thing that happens is that medications accumulate over time without being re-evaluated. When your parent started medication A ten years ago, it was the right choice for their situation. But in ten years, they've aged, other health issues have developed, other medications have been added. The original medication might no longer be necessary or appropriate. It should have been reviewed and potentially discontinued. But it wasn't. It's still there.

The Dangers

The risks of polypharmacy are real and significant. One is the increased chance of side effects. Every medication has a possible side effect profile. Most people tolerate most medications fine. But some people have adverse effects. When someone is taking many medications, the chance that they're experiencing a side effect from one of them goes up. More importantly, the chance that they're experiencing a side effect that's being mistaken for a new disease goes up significantly.

Your parent develops tremor, and the instinct is to think about Parkinson's disease. They start taking a medication for that. But the tremor is actually a side effect of another medication, and now they're taking an additional medication for something they don't have. Your parent becomes confused, and everyone worries about dementia. They get evaluated for cognitive decline. But the confusion is from a medication interaction. Your parent develops fatigue, dizziness, or balance problems, and these are attributed to aging or attributed to a disease, when they're actually medication side effects.

The other major risk is drug interactions. When a person is taking ten or more medications, the possible interactions are numerous and often unpredictable. Two medications that individually are safe might interact with each other to increase the effect of one or the other, or to reduce the effectiveness of either or both, or to create a new and unexpected side effect. Some interactions are well-known and prevented by doctors prescribing drugs that don't interact. Others are more subtle. Some depend on individual patient factors like kidney function or liver function.

Medication interactions can increase the risk of falls, which for an older adult can be catastrophic. Multiple medications can cloud thinking and make confusion worse, which is devastating if your parent is already at risk for cognitive problems. Some drug interactions can affect the heart, the kidney, the liver. Some can cause dangerous changes in blood pressure.

Another risk is simply the compliance problem. When someone is taking ten or fifteen medications at different times of day, some in the morning, some in the evening, some with food, some without, some every other day, it becomes very difficult to take them correctly. Your parent might miss doses, double doses, take them at the wrong time of day. The medication regimen becomes complicated enough that it stops working the way it was supposed to.

Then there's the cost. When polypharmacy is happening, your parent might be spending hundreds of dollars a month on medications, some of which might not be necessary, some of which might be duplicative or contradictory in effect.

The Medication Review

The solution to this problem involves getting professional attention focused specifically on the medication list as a whole rather than on individual conditions. This can come from a pharmacist or a geriatrician, both of whom are trained to look at medications from the perspective of the total picture.

A pharmacist review, sometimes called a medication therapy management review, is a process where a pharmacist meets with your parent, reviews all the medications and supplements, looks at the doses, looks at the interactions, looks at the indication for each medication, and evaluates whether the current regimen is optimal. The pharmacist can identify medications that might be duplicative, medications that are causing side effects, medications that are interacting with other drugs, and medications that might no longer be necessary. If your parent has insurance, this service might be covered, especially if they're taking multiple medications or have multiple chronic conditions. The pharmacist can then communicate with the doctors about possible changes.

A geriatrician is a physician who specializes in the care of older adults and has specific training in managing medications in older people. A geriatrician review of the medication list involves evaluating each medication against established guidelines about what medications are appropriate for older adults. There are formal lists, like the Beers Criteria, that identify medications that are potentially inappropriate for older adults because the risks outweigh the benefits. A geriatrician can help identify which medications on your parent's list might fall into this category.

During this review, the goal isn't necessarily to get your parent off as many medications as possible. The goal is to make sure every medication your parent is taking is necessary, that the dose is appropriate, that it's not interacting harmfully with other medications, and that it's achieving its intended benefit. Sometimes that means stopping a medication that's no longer needed. Sometimes it means changing to a different medication with fewer side effects. Sometimes it means adjusting doses. Sometimes it means reorganizing the schedule to make it easier to remember. And sometimes it means that the current regimen is actually the right one.

The formal review process is valuable, but even without a formal review, things can improve if someone takes on the role of asking questions. Getting a complete list of all medications and supplements is the first step. Your parent should list everything: prescription medications, over-the-counter medications, vitamins, supplements, herbs, everything. Then looking at which ones are actually necessary, whether any could be stopped, whether the doses make sense, this is the conversation to have.

Your Advocacy Role

You don't need to be a medical expert to help with this. You need to be organized and persistent. The first step is getting the complete list. Ask your parent. Get the list from their pharmacy. Ask their doctor. Make your own list if they're willing to let you come along to appointments. Every medication needs to be on that list.

Then you need to understand what each medication is for. Your parent takes medication X because they have condition Y. Is that condition still relevant? Is the medication still working? Has anything changed since they started taking it that might mean it's no longer needed?

Bring the full list to your parent's primary care doctor or to a geriatrician, and ask, "Are all of these medications still necessary? Are any of these interacting with each other in ways we should be concerned about? Are any of these causing side effects we've been attributing to something else? Are there any that could be stopped?" Be specific about any symptoms your parent is having that might be medication-related.

Ask about a pharmacist review if that hasn't been done. Call the insurance company and ask if medication therapy management is available. Ask if your parent can see a geriatrician, either as a specialist or as a second opinion on medication management.

Be willing to bring this up repeatedly. The first conversation might result in no changes. The second conversation might. Medication issues aren't usually resolved in a single appointment. It takes persistence, but the rewards in terms of your parent's quality of life and safety can be substantial.

Watch for symptoms that might be medication-related. If your parent becomes confused, dizzy, falls, has new fatigue, develops tremor, experiences nausea or appetite changes, these should prompt a conversation about whether medications might be responsible. Keep a log of when symptoms started and which medications were started around that same time.

Encourage your parent to ask their doctor before starting any new medication whether it's necessary and whether it interacts with anything they're currently taking. Encourage them to ask about stopping medications periodically, not just adding them. The default shouldn't be that medications stay on the list forever.

The goal is for your parent to be taking the medications they actually need, in doses that work for them, with attention to the interactions and side effects, and without unnecessary medications that add burden and risk. That's achievable with attention and advocacy. It requires someone to step back and look at the whole picture rather than just individual conditions. That someone can be you.

How To Help Your Elders is an educational resource. We do not provide medical, legal, or financial advice. The information in this article is general in nature and may not apply to your specific situation. If you are concerned about a loved one's medication regimen, consult with their healthcare provider, a pharmacist, or a geriatrician. You can also contact your local Area Agency on Aging for guidance and support.