When Medications Mix

what families and caregivers need to watch for

As a family member or caregiver of someone in long-term care, you may not always notice what’s happening behind the scenes — how medications are prescribed, changed, combined and monitored. But a recent study shows this is very important. According to research cited by McKnight’s, nearly two-thirds of nursing-home residents were exposed to medication combinations known to raise the risk of harmful drug–drug interactions.

What that means for you: this is a wake-up call. It doesn’t mean panic, but it does mean staying curious, engaged and proactive so that the person you’re caring for isn’t quietly at risk because of a “harmless” pill combination.

Why this matters

Older adults often take many medications at once — for blood pressure, pain, sleep, mood, heart conditions, and more. When two or more drugs are taken together, they can interact: one may make the other stronger (or weaker), increase side‐effects, affect how the body breaks them down, or lead to unexpected consequences.

The study found just how common this is: about 62% of nursing-home residents experienced one or more potential drug–drug interactions. That doesn’t automatically mean harm occurred, but it does mean the risk is very real. For families and caregivers, that means: don’t assume “they’re in a place that’s taken care of it.” You need to ask questions, stay involved, and help keep the system honest.

What to ask and watch for

Here are practical tips you can use to keep on top of things. Make it conversational, do it with questions, not accusations: you’re an advocate not an adversary.

1. Get a full medication list from the community (and update it).
   Ask the nursing‐home or care setting for a list of all medications the resident is taking — including prescriptions, over‐the-counter (OTC) drugs, vitamins, herbal supplements and “as needed” meds. Then ask to review it regularly (e.g., monthly or when things change).

2. Ask: “Who reviews this regimen for interactions?”
   Make sure there is a pharmacist or qualified nursing/medical staff who is explicitly reviewing the combinations, not just writing orders. If no one is doing that, ask why.

3. Watch for red-flags in behavior or symptoms.
   Sometimes interactions show up in subtle ways: increased confusion, sudden falls, dizziness, excessive drowsiness, or changes in appetite or mood. If you notice something new — even if minor — bring it up with the care team and ask: “Could that be a medication-interaction effect?”

4. Keep a personal “snapshot” of the resident’s meds, conditions and labs.
   Having a copy (or photo) of the medication list, plus the major health conditions (e.g., “has atrial fibrillation, takes blood‐thinner X, also has kidney disease”) gives you the power to speak with clarity. You may say: “I notice we’re adding drug Y while still on drug Z — can we check potential interactions?”

5. Encourage “less is more” when possible.
   Ask if every medication is still needed, what the goal is (“why are we still on this?”), and whether non-drug options have been considered (e.g., physical therapy instead of another sedative). The more pills one takes, the higher the interaction risk.

6. Schedule regular “medication check‐ins.”
   I suggest at least annually, or more often if a lot changes (new diagnoses, hospital stays, new medications). During the check-in ask the team:

   • Has anything been eliminated recently?

   • Are there medications with overlapping effects?

   • Have labs (kidney, liver, electrolytes) been done to ensure the body is still safely processing these drugs?

   • Are there “as needed” meds being used frequently (which may indicate the core regimen isn’t working)?

7. Be your loved one’s voice in the room.
   If the care-team uses shorthand like “it’s fine for now” or “we’ll keep an eye on it,” you can politely say: “Thanks, but can you tell me what you are watching, how you’re watching it, and when we’ll check it again?” Make sure it’s measurable, not vague.

A few closing thoughts

It’s important to remember: medication-interaction risk does not mean care is bad. Many excellent nursing homes and care settings have rigorous protocols. What it does mean is: due to the sheer number of medications and the fragility of older adults, the margin for error is smaller.

By staying engaged, asking the right questions, and helping the care team view you as a partner (not a check-on), you’re doing what families do best: watching out for their own.