What Is Polypharmacy-and Why Should You Care?
When someone over 65 is taking five or more medications at the same time, that’s called polypharmacy. It’s not always wrong-many older adults need multiple drugs to manage heart disease, diabetes, arthritis, or depression. But the more pills you take, the higher the risk of dangerous side effects, confusion, falls, and hospital stays. In the U.S., nearly half of adults over 65 are on five or more prescriptions. In nursing homes, it’s as high as 80%. And that number keeps climbing.
It’s not just about the quantity. It’s about what’s in those pills. A 78-year-old with high blood pressure might be on a beta-blocker. Add a painkiller like ibuprofen, and suddenly their kidneys are under strain. Throw in a sleeping pill and an antidepressant, and now their balance is off. One drug masks the side effect of another. That’s called a prescribing cascade-and it’s happening more than you think.
Why Older Bodies Handle Medicines Differently
Your body changes as you age. Your liver and kidneys don’t filter drugs the way they used to. That means medications stick around longer. A drug that was safe at 50 might become toxic at 75. Older adults also become more sensitive to certain medicines. Benzodiazepines, for example-used for anxiety or sleep-can cause dizziness, memory lapses, and falls. Yet they’re still prescribed too often.
Even over-the-counter drugs and supplements add up. A daily fish oil capsule, a turmeric tablet, or a melatonin gummy might seem harmless. But when combined with blood thinners or antidepressants, they can cause serious reactions. Studies show that nearly 40% of older adults don’t tell their doctor about their supplements. That’s a blind spot in safety.
The Hidden Dangers: Drug Interactions and Real Risks
With two medications, there’s a 6% chance of a bad interaction. With five, it jumps to 50%. With seven or more? The risk hits 100%. That’s not a guess-it’s based on clinical data from thousands of patients.
Common dangerous combos include:
- NSAIDs (like ibuprofen) + blood pressure meds → kidney damage
- Anticholinergics (used for overactive bladder or allergies) + antidepressants → confusion, memory loss
- Benzodiazepines + opioids → slowed breathing, higher death risk
- Warfarin + certain antibiotics or herbal supplements → bleeding
One study found that patients on ten or more drugs were over twice as likely to be hospitalized for a drug-related problem. And the biggest culprit? Pain medications. Nearly half of older adults on multiple prescriptions were taking NSAIDs or opioids-often without a clear plan to taper them.
Deprescribing: It’s Not Stopping Medicines. It’s Stopping the Right Ones.
Deprescribing isn’t about cutting pills just because there are too many. It’s about reviewing each one: Is this still helping? Is it doing more harm than good?
Think of it like decluttering your closet. You don’t throw everything out. You keep what fits, what’s useful, and what still serves you. The same goes for meds. The American Geriatrics Society’s Beers Criteria and the STOPP/START tools are used by doctors to spot medications that should be reconsidered in older adults. Examples:
- Long-term benzodiazepines for insomnia
- Proton pump inhibitors (PPIs) used for years without review
- Antipsychotics for dementia-related agitation
- Statins in very elderly patients with limited life expectancy
Stopping these doesn’t mean worsening disease. In fact, studies show that carefully planned deprescribing reduces falls by up to 22%, cuts emergency room visits, and improves quality of life. One trial found that older adults who had their sleep meds reduced reported better daytime alertness and fewer nighttime accidents.
Why Is Deprescribing So Hard?
If it’s so beneficial, why isn’t it happening more?
Doctors are stretched thin. A 15-minute appointment isn’t enough to review 12 medications. Many providers don’t feel trained in deprescribing. Others fear backlash-if a patient’s blood pressure rises after stopping a pill, they’ll blame the doctor, even if the drug was causing more harm than good.
Patients are scared, too. They’ve been told for years that these pills are life-saving. Asking to stop one feels like giving up. Some think, “If my doctor prescribed it, it must be necessary.” Others worry symptoms will come back worse.
And then there’s the system. In the U.S. and U.K., doctors are paid per visit, not per outcome. There’s no incentive to spend 45 minutes reviewing meds. Pharmacies don’t always share data between chains. Specialists prescribe without knowing what other doctors have ordered. It’s a broken chain.
What Can You Do? A Simple Action Plan
You don’t need to wait for your doctor to bring it up. Here’s how to take control:
- Make a full list-include every prescription, OTC drug, vitamin, herb, and supplement. Write down why you take each one. If you don’t know, write “Don’t know.”
- Bring it to your next appointment-ask: “Which of these are still necessary? Are any of these causing side effects I haven’t mentioned?”
- Ask about deprescribing-say: “Could we review my meds to see if anything can be safely reduced?”
- Use a pill organizer-but don’t rely on it alone. Make sure someone checks the list monthly.
- Involve your pharmacist-community pharmacists can spot dangerous combos you might miss. Many offer free med reviews.
One woman in Manchester, 82, was on 11 medications. She was dizzy, confused, and falling. Her GP didn’t know she was taking a herbal sleep aid. After a pharmacist-led review, three drugs were stopped-her sleep aid, a long-term PPI, and a low-dose antipsychotic. Within six weeks, her balance improved. Her memory cleared. She stopped going to the ER.
The Future: Better Tools, Better Care
Change is coming-slowly. Electronic health records now flag dangerous drug combos. Some clinics have pharmacists embedded in geriatric teams. AI tools are being tested to predict which patients are at highest risk for polypharmacy harm.
But the real shift needs to be cultural. Medication isn’t a trophy. More pills don’t mean better care. Sometimes, less is more. The goal isn’t to eliminate all meds-it’s to make sure every one has a reason to be there.
As the population ages, this won’t be optional. It’ll be essential. The question isn’t whether we’ll deprescribe. It’s whether we’ll do it before someone gets hurt.
Is polypharmacy always dangerous?
No-not always. Many older adults need multiple medications to manage chronic conditions like heart failure, diabetes, or arthritis. Polypharmacy becomes dangerous when medications are no longer needed, when they interact harmfully, or when side effects outweigh benefits. The key is regular review, not just the number of pills.
Can I stop my meds on my own if I think they’re causing problems?
Never stop a prescribed medication without talking to your doctor or pharmacist. Some drugs, like blood pressure pills or antidepressants, can cause dangerous withdrawal effects if stopped suddenly. Even if you feel fine, stopping abruptly can lead to rebound symptoms, increased heart rate, or seizures. Always ask for a safe tapering plan.
How often should older adults review their medications?
At least once a year-but ideally after every hospital visit, when a new doctor prescribes something, or if you notice new side effects like dizziness, confusion, fatigue, or falls. If you’re on five or more meds, ask for a formal medication review every six months.
What’s the difference between Beers Criteria and STOPP/START?
The Beers Criteria list specific drugs that older adults should avoid or use with caution. STOPP/START goes further: STOPP identifies potentially inappropriate prescriptions (like giving a sedative to someone with dementia), while START identifies drugs that are missing-like a statin for someone with heart disease who’s not on one. Together, they give a fuller picture of what’s wrong and what’s missing in a medication list.
Do pharmacists really help with deprescribing?
Yes. Community pharmacists have access to your full prescription history across pharmacies. They’re trained to spot interactions, duplicate therapies, and outdated prescriptions. Many offer free medication reviews. In the U.K., NHS pharmacists can work directly with GPs to adjust regimens-especially for older patients with complex needs.
Are herbal supplements safe to take with prescription drugs?
Not always. St. John’s Wort can reduce the effect of blood thinners and antidepressants. Garlic and ginkgo can increase bleeding risk. Turmeric may interfere with diabetes meds. Many older adults assume “natural” means safe-but supplements aren’t regulated like drugs. Always tell your doctor what you’re taking, even if it’s from the health food store.
