Polypharmacy in Older Adults: Risks, Interactions, and How Deprescribing Can Save Lives

When someone turns 70, they might be taking five, ten, or even fifteen different pills every day. Some for blood pressure. Others for diabetes, arthritis, sleep, or heart rhythm. It’s not unusual. But it’s dangerous. Polypharmacy-the use of five or more medications at once-is now the norm for millions of older adults, and it’s quietly putting lives at risk.

What Exactly Is Polypharmacy?

Polypharmacy isn’t just about taking a lot of pills. It’s about taking the wrong ones, at the wrong times, for the wrong reasons. The standard definition? Five or more medications daily. But experts now warn that even three or four can be risky if they interact poorly. The real problem? Many of these drugs aren’t necessary anymore-or they’re causing more harm than good.

By 2020, over 15% of the global population was 65 or older. By 2060, that number will jump to nearly 44%. With aging comes chronic illness: heart disease, diabetes, arthritis, dementia. Each condition often brings its own prescription. Doctors don’t always talk to each other. So a patient might get a statin from their cardiologist, a painkiller from their orthopedist, an antidepressant from their psychiatrist, and a sleep aid from their primary care doctor-all without anyone checking if they clash.

Studies show that 40% of older adults globally are on five or more medications. In U.S. physician offices, that number hits 65%. Among nursing home residents? Over 80%. And it’s rising. From 2010 to 2019, the percentage of older adults on ten or more drugs jumped from 10% to 14%. That’s not progress. That’s a crisis.

Why Do These Medications Become Dangerous?

Your body changes as you age. Your kidneys don’t filter as well. Your liver doesn’t break down drugs the same way. Your brain becomes more sensitive to sedatives. Even small doses can cause dizziness, confusion, or falls. And with each new pill you add, the risk of a bad interaction explodes.

Take two medications: there’s a 6% chance they’ll interact. Add three more? That jumps to 50%. With seven or more? You’re almost guaranteed a problem. These aren’t theoretical risks. They’re happening in real homes, in real ERs.

One common example: an older adult with arthritis takes an NSAID (like ibuprofen) for pain. But they also take blood pressure medicine. The NSAID reduces the effectiveness of the blood pressure drug-so the doctor increases the dose. Now the kidneys are under strain. Then they start retaining fluid, so a diuretic is added. Now they’re urinating too much at night, so a sleep aid is prescribed. That sleep aid causes confusion. Now they’re falling. The fall leads to a hip fracture. Hospitalization. Rehab. Loss of independence.

This is called a prescribing cascade: one drug’s side effect is treated with another drug, creating a spiral of harm. Painkillers, anticholinergics (used for overactive bladder or allergies), benzodiazepines (for anxiety or sleep), and opioids are the biggest culprits. The American Geriatrics Society Beers Criteria® lists these as medications older adults should avoid-or use only with extreme caution.

The Hidden Costs: More Than Just Side Effects

Polypharmacy doesn’t just cause falls or confusion. It leads to hospitalizations, emergency room visits, and even death. Older adults on five or more medications are twice as likely to be hospitalized. They’re more likely to end up in a nursing home. They’re more likely to die prematurely.

And it’s not just physical. Memory gets worse. Mood drops. People stop taking their meds because the routine is too confusing. A 78-year-old with eight pills to take three times a day? They forget. They double up. They skip doses. They run out. They stop paying for them. Financial strain is real-some seniors choose between food and their prescriptions.

Even caregivers struggle. A daughter helping her father with his meds might not know why he’s on five different pills. She doesn’t know if one was meant to be temporary. She doesn’t know if it’s still needed. She just knows she’s spending hours every week sorting pills into containers.

Deprescribing: Taking Pills Away to Make People Healthier

The solution isn’t adding more drugs. It’s removing the ones that don’t belong.

Deprescribing is the process of safely reducing or stopping medications that are no longer helping-or are hurting. It’s not about going cold turkey. It’s about thoughtful, step-by-step review. A doctor, pharmacist, or care team works with the patient to ask: Is this still necessary? Is the benefit still greater than the risk?

It sounds simple. But it’s not. Many patients are scared. They think, “If I stop this, my condition will come back.” Some doctors are afraid too. “What if they have a heart attack?” “What if their pain gets worse?”

But evidence is clear. When done right, deprescribing works.

• One study showed a 22% drop in falls after removing sedatives and anticholinergics.
• Another found 30% fewer emergency visits when benzodiazepines were tapered in older adults with dementia.
• Patients reported better sleep, clearer thinking, and more energy-even when their doctors expected things to get worse.

The STOPP/START criteria are tools doctors use to decide what to stop and what to start. STOPP identifies dangerous drugs (like long-term benzodiazepines in the elderly). START identifies needed drugs that are missing (like flu shots or aspirin for heart protection). These aren’t just guidelines. They’re lifesavers.

Why Isn’t Everyone Doing This?

If deprescribing works, why is polypharmacy still growing?

Because the system is broken.

Most doctors have 15 minutes per appointment. They’re not trained to review 12 medications. They don’t have time to call other specialists. Electronic health records don’t talk to each other. Pharmacists aren’t always part of the team. Insurance doesn’t pay for medication reviews. In fact, it pays more for prescribing than for stopping.

And then there’s patient fear. Many older adults believe their meds are working-even when they’re not. They’ve been told for years, “Take this for your heart,” “Take this for your sleep.” Stopping feels like giving up. They don’t know they have a choice.

Also, there’s no clear “winner” when you stop a drug. If a patient stops a sleep aid and sleeps better? Great. But if they have one bad night? The doctor might be blamed. So it’s easier to keep prescribing.

What Can Be Done Right Now?

You don’t need a perfect system to start making changes. Here’s what works:

1. Ask for a medication review. Every 6 to 12 months, ask your doctor: “Are all these medications still needed?” Bring a list-every pill, supplement, and over-the-counter drug.
2. Use a pharmacist. Community pharmacists are trained in drug interactions. Ask for a free medication therapy review. They’ll spot duplicates, dangerous combos, and unnecessary drugs.
3. Start with high-risk drugs. Focus first on benzodiazepines (like lorazepam), anticholinergics (like diphenhydramine), NSAIDs, and opioids. These are the most likely to cause harm.
4. Stop one at a time. Don’t try to remove five pills at once. Pick one, taper slowly, and watch for changes. Keep a journal: sleep, energy, pain, mood.
5. Involve caregivers. If you’re helping a parent or partner, be their advocate. Ask questions. Keep records. Don’t assume the doctor knows everything.

Some clinics now use AI tools to flag risky prescribing patterns. Others have pharmacist-led clinics where patients come in for 45-minute med reviews. These programs cut hospitalizations by up to 40%. But they’re still rare.

The Bigger Picture: A System That Needs Fixing

The rise in polypharmacy isn’t accidental. It’s built into how healthcare works. Doctors get paid for prescribing, not for reviewing. Hospitals profit from treating complications caused by bad med regimens. Drug companies market directly to doctors-and to patients-pushing new pills without asking if the old ones are still needed.

The solution? Shift from quantity to quality. Pay for medication safety. Reward doctors who reduce unnecessary prescriptions. Train all providers in deprescribing. Make pharmacists part of the core care team. Give patients the tools and confidence to ask: “Do I really need this?”

By 2050, there will be 1.5 billion people over 65. If we keep prescribing like we are now, we’ll drown in hospital beds, fractures, and dementia cases. But if we start deprescribing-thoughtfully, safely, and systematically-we can help older adults live longer, not just longer with pills.