Why Polypharmacy Research Matters
Long-term care facilities across the globe have earned a reputation in the medical literature as hotbeds for prescribing and polypharmacy—a phenomenon so prevalent it’s been dubbed a “geography of high prescribing” (Oldani 2014). Over the years, interventions like STOPP/START screening tools, revamped models of care, and improved communication systems have promised change. Yet, the evidence is clear: these strategies have done little to untangle the persistent web of polypharmacy.
Polypharmacy is, at its core, a troubling paradox. Physician researcher Doron Garfinkel calls it an “iatrogenic epidemic,” even waging a self-proclaimed “War Against Polypharmacy” in academic journals (Garfinkel et al. 2007). On the flip side, a 2013 BMJ article resigns itself to calling polypharmacy a “Necessary Evil” (Wise 2013). What’s not up for debate is the toll it takes. Frail seniors, already at their most vulnerable, are enlisted into an daily regimen of medication management. The tasks are endless—tracking doses, timing their day around pill schedules, navigating the labyrinth of side effects, and trying to pin down the sometimes always-on-the-move floor physician. Even leaving Northwood requires careful calculation, lest the resident misses their next dose. This exhausting cycle, described by some as the “burden of treatment,” has led to urgent calls for “minimally disruptive medicine” (May et al. 2009).
My research steps into this space, not to question whether Resident A should or shouldn’t be taking Medication B, but to examine polypharmacy as a living, breathing practice. At Northwood, polypharmacy is not just a phenomenon but a labor-intensive process, woven into the routines, culture, and organizational dynamics of the institution. Every chart filled, every form faxed, every pill delivered is part of the machinery that sustains this complex system. Polypharmacy is not just something that happens at Northwood—it’s something everyone, from residents to healthcare practitioners, is doing, around the globe. And like all work, it comes with both intended consequences and ripple effects no one ever saw coming.
For some initial references see the reference list.