Patient Case: Managing Polypharmacy in an Elderly Adult
Patient Profile
• Age: 82
• Living situation: Independently, with family support
• Medical history: Hypertension, atrial fibrillation, osteoarthritis, type 2 diabetes, insomnia, GERD
• Total medications: 12 prescription medications, plus over-the-counter supplements
• Referral reason: Dizziness, fatigue, recent falls, and medication confusion
Presenting Concern
The patient presented for a comprehensive medication review due to increasing dizziness, daytime fatigue, and two falls within the past year. She expressed feeling overwhelmed by her medication regimen and uncertain about the purpose and timing of several medications.
She brought all medications to the visit in a bag, including prescriptions from multiple prescribers, medications started during prior hospitalizations, and over-the-counter products she had added on her own.
The patient repeatedly expressed concern about “being a burden” and hesitation to question her physicians—highlighting a common emotional barrier seen in elderly patients managing complex regimens.
Medication Review Findings
A full medication reconciliation and assessment revealed several clinically significant concerns:
• Duplicate therapy within the same medication class
• Medications continued beyond their original indication, including one initiated during a hospitalization several years prior
• Overlapping side effects, particularly contributing to dizziness, orthostatic hypotension, and sedation
• Suboptimal timing of medications, worsening fatigue and balance issues
• Potential drug–drug interactions increasing fall risk
Importantly, none of these issues had been previously identified due to fragmented care across multiple providers.
Assessment
The patient was experiencing polypharmacy-related adverse effects, contributing to:
• Increased fall risk
• Reduced quality of life
• Medication nonadherence driven by confusion rather than intent
This case illustrates how cumulative prescribing—without periodic comprehensive review—can unintentionally compromise safety and independence in elderly patients.
Intervention (HoffMed Approach)
At HoffMed, the consultation focused on clarity, safety, and patient empowerment:
• Conducted a line-by-line medication review, discussing indication, benefit, and risk for each medication
• Assessed patient-reported side effects and concerns
• Identified medications appropriate for reassessment or deprescribing
• Optimized medication timing to reduce sedation and dizziness
• Simplified the regimen where possible to improve adherence
• Prepared a clear, organized medication summary for the patient and family
• Communicated recommendations to the patient’s primary care provider and specialists for coordination of care
All recommendations were evidence-based and patient-centered, with the goal of minimizing risk while maintaining therapeutic benefit.
Outcomes
At follow-up, the patient reported:
• Improved balance and reduced dizziness
• Increased energy throughout the day
• Greater confidence in managing her medications independently
• Improved comfort asking questions about her care
Most notably, she shared that she felt more like herself again—less fearful, less confused, and more confident navigating daily life.
Discussion
Polypharmacy is common in older adults, but it is not benign. Each additional medication increases the risk of adverse effects, interactions, and loss of independence. This case highlights the importance of routine, comprehensive medication therapy management—especially for elderly patients seeing multiple providers.
Medication-related problems are often mistaken for “normal aging,” when in reality they may be preventable and reversible.
Key Takeaway
Elderly patients deserve medication care that is proactive, thoughtful, and individualized.
At HoffMed, we believe medication management is not just about reducing pill counts—it’s about preserving dignity, safety, and quality of life.
Sometimes, the most meaningful intervention is simply taking the time to look at the whole picture.
