What Is Polypharmacy-and Why Should You Care?
When someone takes five or more medications at the same time, that’s called polypharmacy. It’s not rare-it’s common. Nearly 4 in 10 older adults globally are on this many drugs. In the U.S., it’s even higher: over 65% of seniors visiting doctors are taking multiple prescriptions. And it’s not just pills from the pharmacy. Many also take over-the-counter painkillers, herbal supplements, or as-needed meds for sleep or anxiety. When you add them all up, the number climbs fast.
This isn’t about being on too many meds for fun. It’s usually because people have multiple chronic conditions-like high blood pressure, diabetes, arthritis, and heart disease. Each doctor treats their own piece of the puzzle. But no one’s looking at the whole picture. And that’s where things go wrong.
Why More Meds Don’t Mean Better Health
Every extra pill adds risk. It’s not linear-it’s exponential. With two drugs, there’s a 6% chance of a bad interaction. With five, that jumps to 50%. With seven or more, the risk is nearly 100%. Older bodies process drugs differently. Kidneys and liver don’t clear medications as quickly. That means drugs build up. Even small doses can become too strong.
Side effects get mistaken for new diseases. A dizziness from a blood pressure pill? That leads to a fall. A fall leads to a hip fracture. Then comes a new painkiller. Then a stomach protector. Then a sleep aid. This is called a prescribing cascade. One drug causes a problem. Another drug is added to fix it. And the cycle keeps going.
Studies show polypharmacy increases the risk of:
- Falls and fractures
- Hospital stays
- Cognitive decline and confusion
- Death
And it’s not just the drugs themselves. Managing ten different pills a day is overwhelming. Miss one? Take two by accident? Forget what each one is for? That’s normal for many seniors. And when that happens, safety goes out the window.
Who’s Most at Risk?
It’s not just age. It’s complexity. People over 70 are far more likely to be on multiple meds than those in their 60s. Those in nursing homes? Up to 80% are on five or more drugs. People with heart disease or diabetes? Their rates are even higher.
Women are more likely than men to be on polypharmacy-partly because they live longer, partly because they see doctors more often. And those with mental health conditions? One study found 80% of older adults hospitalized for psychiatric reasons were on five or more drugs, including multiple antidepressants, antipsychotics, and sedatives. That’s a dangerous mix.
And let’s not forget the financial toll. Paying for ten prescriptions a month adds up. Some seniors skip doses because they can’t afford them. Others take less than prescribed because they’re scared of side effects. Either way, it’s not working.
Deprescribing: Taking Meds Off, Not Just Adding More
Deprescribing isn’t about stopping everything. It’s about stopping what shouldn’t be there anymore. It’s asking: Is this drug still helping? Or is it just adding risk?
For example, a 78-year-old with mild arthritis might be on an NSAID for pain. But they also have high blood pressure and kidney issues. That NSAID could be doing more harm than good. A safer option? Physical therapy, heat packs, or a lower-risk pain reliever.
Another common case: benzodiazepines for sleep. These are sedatives like lorazepam or diazepam. They’re prescribed for short-term use-but many seniors stay on them for years. The risk? Falls, memory loss, confusion. The benefit? Maybe a few extra hours of sleep. Is it worth it?
Deprescribing follows a simple rule: Start with the drug that has the worst risk-to-benefit ratio. That’s often the one with the least evidence of long-term benefit and the highest chance of harm.
Tools Doctors Use to Decide What to Stop
There are two main guides doctors use to spot risky prescriptions:
- Beers Criteria: Developed by the American Geriatrics Society, this list names drugs that are generally unsafe for older adults. Examples include anticholinergics (like diphenhydramine in Benadryl), certain sleeping pills, and some NSAIDs.
- STOPP/START: STOPP finds inappropriate prescriptions. START finds ones that are missing. For example, if someone has heart failure but isn’t on a beta-blocker, that’s a START item.
These aren’t rules. They’re flags. A doctor might still prescribe a Beers drug if the benefits clearly outweigh the risks. But they shouldn’t do it without thinking twice.
Electronic health records now often flag these drugs automatically. But many doctors still don’t act on the alerts. Why? Time. Pressure. Fear.
Why Deprescribing Is So Hard
Even when the evidence says to stop, it’s hard to do.
Patients are scared. They think if a doctor gave them the pill, it must be necessary. They’ve been told for years, “Take this for your blood pressure,” “Take this for your sleep.” Stopping feels like giving up.
Doctors are scared too. What if the patient gets worse? What if they come back in a week with chest pain? What if the family blames them?
And there’s no financial incentive. Insurance pays for prescribing. It doesn’t pay for reviewing, questioning, or stopping. A 15-minute appointment doesn’t leave time for a full med review. Specialists don’t talk to each other. Primary care doctors are left holding the bag.
Pharmacists can help-but they’re often not part of the team. In Australia, pharmacist-led medication reviews are covered under Medicare. But in many places, they’re not. That’s a missed opportunity.
What Works: Real-World Success Stories
Deprescribing works when done right. One study in nursing homes found that when pharmacists reviewed all meds and worked with doctors to stop unnecessary ones, falls dropped by 22%. Emergency visits fell too.
In another program, older adults were invited to a medication review appointment. They brought all their pills-bottles, supplements, even the ones in the drawer. A pharmacist sat with them, one by one, asking: “Why are you taking this? What’s it for? Have you noticed any side effects?”
On average, they stopped 2.3 drugs per person. No one got worse. Many felt better. Less dizziness. Better sleep. More energy.
It’s not magic. It’s just asking the right questions.
What You Can Do Right Now
If you or someone you care for is on five or more medications:
- Make a full list. Write down every pill, patch, inhaler, supplement, and OTC med-even the ones you only take sometimes.
- Bring it to your next appointment. Don’t assume the doctor knows what’s in your cabinet. Bring the actual bottles.
- Ask these questions:
- What is this medicine for?
- Is it still needed?
- What happens if I stop it?
- Are there safer alternatives?
- Don’t stop anything on your own. Some drugs need to be tapered. Stopping cold turkey can be dangerous.
- Ask for a pharmacist review. Many pharmacies offer free med reviews. Use them.
The Future: Better Systems, Better Outcomes
Change is coming-but slowly. AI tools are being developed to scan health records and flag high-risk polypharmacy patterns. Some hospitals now have “medication reconciliation” teams that check all meds when someone is admitted or discharged.
Payment models are starting to shift. Instead of paying per prescription, some insurers are paying for outcomes: fewer falls, fewer ER visits, better quality of life. That changes the incentive.
But the biggest change? It’s not technology. It’s mindset. We need to stop thinking that more drugs = better care. We need to start thinking that less, when done right, can be safer and more effective.
For older adults, the goal isn’t to live longer with a dozen pills. It’s to live better-with fewer side effects, fewer falls, more clarity, and more freedom.
Is polypharmacy always dangerous?
No, not always. Some older adults need multiple medications to manage serious conditions like heart failure, diabetes, or kidney disease. The danger isn’t the number of drugs-it’s when the risks outweigh the benefits. A well-managed regimen with clear goals is safe. Polypharmacy becomes a problem when drugs are added without review, or when side effects aren’t monitored.
Can I stop my meds on my own if I feel better?
Never stop a prescription without talking to your doctor. Some medications, like blood pressure pills, antidepressants, or steroids, need to be tapered slowly. Stopping suddenly can cause rebound effects, withdrawal symptoms, or even life-threatening complications. Always ask before making changes.
What’s the difference between polypharmacy and inappropriate prescribing?
Polypharmacy just means five or more drugs. Inappropriate prescribing means taking a drug that’s risky for your age or condition-even if you’re only on one or two. For example, taking an anticholinergic like diphenhydramine (Benadryl) for sleep at age 75 is inappropriate, even if it’s your only medication. The Beers Criteria helps identify these cases.
Do herbal supplements count in polypharmacy?
Yes. Many seniors take ginkgo, fish oil, turmeric, or St. John’s wort, thinking they’re harmless. But these can interact with prescription drugs. Ginkgo can increase bleeding risk with blood thinners. St. John’s wort can make antidepressants or heart meds less effective. Always include supplements on your med list.
How often should older adults have a medication review?
At least once a year-and after any hospital stay, major illness, or change in health. If you’re on five or more drugs, consider a review every six months. The best time is during your annual wellness visit. Bring your full med list, and ask if anything can be safely reduced or stopped.
Are there any medications older adults should avoid completely?
Yes. The Beers Criteria lists several. Examples include: benzodiazepines (like diazepam) for sleep, anticholinergics (like oxybutynin for overactive bladder), and NSAIDs (like ibuprofen) for long-term pain in people with kidney or heart issues. These drugs have higher risks than benefits for most older adults. Safer alternatives usually exist.
