Living Polypharmacy: The Everyday Medication Work in Long-Term Care

Key Interests and Perspectives

Introduction

This post continues on from the ‘about’ section. This Substack delves into the complexities of polypharmacy, starting with its role in long-term care facilities (LTCFs), where I conducted my Real-World or ethnographic empirical research. In LTCFs, polypharmacy is one of the more ordinary and profound realities of everyday life. This Substack isn't here to rehash the usual finger-wagging about too many prescriptions (though I am interested in the numbers as well) or lay blame at the feet of hardworking healthcare professionals. Instead, it's about peeling back the curtain to reveal how the everyday, seemingly mundane routines of medication work ripple through the lives of residents, care workers, the organizations, and the broader system itself.

Here's the thing, polypharmacy isn't just about the number of pills on a chart or on the medication cart or in the bodies of residents. It's a living, breathing practice, shaped by the messy and very human interactions between people, policies, technologies, and places. My research, set in the intimate corridors of a Canadian long-term care facility (Northwood, Halifax, NS), shines a light on the organizational rhythms that quietly, yet powerfully, keep this complex system in motion.

What I found was both surprising and, at times, unsettling. Long-term care is a tough place—not only because of the inevitable organizational systems but because it is fundamentally about aging, decline, and the vulnerabilities that come with them.

The reality of polypharmacy on the ground often looks very different from how it is portrayed in textbooks or public discourse. Doctors, nurses, pharmacists, LPN’s--they're not sitting around conspiring to overprescribe. These are smart, dedicated professionals navigating a system that's as much about habit, tradition, and power dynamics as it is about science. And the residents? They're not just passive recipients in this story. Their voices, their choices (or lack thereof), and their lived experiences are an integral part of the narrative.

This isn't a story about individual blame. We need to stop thinking about polypharmacy as something that can be "fixed" if only people tried harder or cared more. It's not that simple. Polypharmacy is a ‘wicked problem’ and the solutions are multi layered and complex. The practice is baked into the very fabric of our institutions. It's a product of routines that feel mundane and are, in reality, deeply powerful.

The effects of polypharmacy aren't just about whether medications are appropriate or excessive. It's also about different dynamics and elements that are part and parcel of any organization. Think hierarchies, bureaucratic tape (forms, endless forms), regulations and policies, understaffing, inefficient or rigid technologies, understaffing, cultural norms that devalue routine work. Whose voices are heard--or ignored--when it comes to decisions about care? How spaces and technologies are organized also matters to how people provide and receive care. The practice of polypharmacy, in its many forms, carries consequences that extend far beyond individual prescriptions, raising questions about autonomy, authority, quality of life, and agency.

This Substack is your invitation to explore those questions with me. We’ll dig into the everyday realities of polypharmacy in long-term care and beyond. We'll explore what it looks like on the ground, what it means for healthcare professionals and residents alike, and why it matters to all of us. This new perspective of understanding polypharmacy brings with it fresh language, new ways of thinking, and important questions that need to be explored. I believe this approach has significant implications for research, medical practice, and education.

Here are some of my interest for this substack:

• What does polypharmacy really look like? My research will take you inside the routines, conversations, and small acts that make up the daily dance of medication management.

• Who's shaping the story? From healthcare workers to patient advocacy groups to government bodies, let’s unpack the roles, motivations, and tensions driving the conversation about polypharmacy.

• What's missing from the research? Let's discuss the blind spots in how the research community studies polypharmacy and the new questions we need to ask if we want to really understand it.

• This isn't just about medications; it's also about the relationships and hierarchies that shape care decisions in ways we often overlook.

Ultimately, this is about changing the way we think and talk about polypharmacy. If we want to move forward--whether through research, medical education, or policy change--we need fresh perspectives, new language, and a willingness to question the status quo.