How Can Case Managers Help the Elder to Stay Safe?

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Polypharmacy is a simultaneous intake of four or more medicines aiming to manage the health problem. Aged people are especially responsive to polypharmacy therapy. Around 30 percent of prescriptions in the United States are given to elderly patients over 65 (Wooten & Galavis, 2005, p. 45). Usually, there are four or five drug prescriptions and one or two over-the-counter medicines. The risk of a drug-related problem is especially high if the patient is prescribed many conflicting medications by independent healthcare providers. The role of a medical manager in this chain is highly relevant, as he has an opportunity to identify and educate people at most risk.

Almost 12 percent of persons in the United States are 65 years old and older. These aged people take more drugs than others mostly due to chronic diseases. Conflicting prescriptions combined with a psychological response to the treatment can result in different conditions. The most usual are “adverse drug reactions, drug-drug interactions, poor adherence to medication regimens, and other problems” (Greenawalt, 2009, p. 56hn1). Usually, the most mistakes are made while prescribing the polypharmacy treatment. There are four positions that refer to polypharmacy. The first and second include the prescription of two or more drugs for the treatment of one illness and the usage of several drugs from the same class. The third and fourth positions refer to the wrong use of various drugs and self-treatment.

Aged patients are often faced with inappropriate prescriptions. This irrational treatment can lead to dangerous, serious and harmful conditions called Adverse Drug Events (ADEs). Instead, of reducing the dosage or changing the drug to the more suitable, irrational polypharmacy prescribes multiple drugs. These contradictory medical orders often lead to the pharmacists’ confusion. Hence, a nurse can assist an elder patient to avoid intake of two similar medications.

There are some methods that help reduce or avoid polypharmacy risks: information, instruction, and organization. Firstly, the patient must give all information about the list of prescribed drugs. At this stage, a brown bag check-up is an effective way of verifying the medications that the patient is currently taking. The brown bag check is a review of all drugs, pills, medicines, etc. which the patient is bringing to the practitioner. The essential function of a nurse in this stage is to determine the useless or inappropriate medications according to the condition of an aged patient. If there is no necessity to keep the original list of medications, a nurse can advise to switch the harmful drug to the one more tolerant or to reduce the dosage of the latter. Some potent drugs can be replaced or discarded in order to avoid ADEs.

A second critical stage in elderly assistance is giving detailed and precise instructions on both oral and written forms. If there is a possibility, it is recommended to encourage someone from the family of an aged patient to control and monitor the condition of his health after taking new pills.

Finally, aged people must be stimulated to change a lifestyle. “Where appropriate, healthcare providers should explore nonpharmacologic alternatives to drugs, such as dietary changes” (Woodruff, 2010, p. 7). In many cases, polypharmacy treatment can be discontinued or radically reduced.

The medication therapy saved and improved the lives of many people. Nevertheless, “Medication toxic effects and drug-related problems can have profound medical and safety consequences for older adults” (Fick et. al, 2003, par. 1). Practitioners are responsible for adequate and thoughtful medical assistance. Paying attention and carefully monitoring the condition of an elderly patient, nurses reduce the risk of getting ADEs and avoid other therapy-related problems.


Fick M. D., Cooper W. J., Wade E. W., Waller L. J., Maclean J. R., Beers, H. M. (2003). Updating the Beers Criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. JAMA Internal Medicine, 163(22).

Greenawalt L., K. (2009). How are all those medications affecting your older patient? Nursing2015, 39(5), 56hn1 – 56hn2.

Woodruff, K., (2010). Preventing polypharmacy in older adults. American Nurse Today, 5(10), 1-8. Web.

Wooten, J., & Galavis, J. (2005). Polypharmacy: keeping the elderly safe. RN, 68(8), 44-51.

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NursingBird. 2022. "How Can Case Managers Help the Elder to Stay Safe?" April 20, 2022.

1. NursingBird. "How Can Case Managers Help the Elder to Stay Safe?" April 20, 2022.


NursingBird. "How Can Case Managers Help the Elder to Stay Safe?" April 20, 2022.