Polypharmacy in Seniors: Understanding and Managing Multiple Medications

Many seniors use prescription and over-the-counter medications to treat health-related changes that sometimes occur with normal aging. In a recent survey, over 80% of older adults in the U.S. reported using at least one prescription drug in the last month. And, nearly one-third experienced polypharmacy, meaning they were taking five or more medications at the same time to manage multiple conditions.

In addition to increasing expenses, polypharmacy may increase the likelihood of serious health risks, including unexpected drug interactions, cognitive challenges, household accidents, and more frequent hospitalizations.

Because of this, if you’re taking multiple medications, it’s crucial to keep everything properly documented and to regularly review your medications with your geriatrician, physician, or care partner at every clinic visit or hospitalization. Doing so can help confirm that your medications are working as intended and that you’re only taking those that support your health without causing unnecessary harm.

In this guide, we’ll discuss polypharmacy, why it’s common among seniors, and the potential health risks linked with overmedication. We’ll also go over the Beers Criteria, a useful guideline used to identify potentially high-risk prescriptions, and share helpful tips to help you manage medications more effectively.

What Is Polypharmacy? Understanding the Definition and Scope

Polypharmacy is the simultaneous use of multiple medications, typically five or more prescription drugs, to manage coexisting health conditions. Some definitions also include vitamins, herbal supplements, and over-the-counter medications that people may not always report to their doctors.

Polypharmacy is more common among older adults, who often need multiple medications to manage different health issues. That’s, in part, due to longer life expectancy, rising rates of chronic conditions, uncoordinated prescribing across multiple health care providers, and, in some cases, clinicians following established clinical guidelines without fully reviewing the patient’s entire medication list.

For instance, a medication’s side effects may appear like a new symptom, leading to yet another prescription that can cause more side effects. This cycle of unnecessary medications is sometimes referred to as a prescription cascade.

Why Seniors Are at Higher Risk for Polypharmacy

Research shows that about 40-44% of adults age 65 and older take five or more prescription medications at the same time. Let’s take a closer look at why polypharmacy is more common among seniors:

• Multiple Chronic Conditions: Due to normal aging and other factors, many adults age 65 and older manage two or more chronic health conditions (multimorbidity), including hypertension, diabetes, heart disease, arthritis, and depression. People with these conditions are often prescribed multiple medications.
• Age-Related Changes: As we age, our bodies undergo physiological changes, including a decline in kidney and liver function, shifts in body composition (increased body fat and decreased water), and reduced stomach acid production. These physiological changes can sometimes affect how medications are dissolved, absorbed, and processed.
• Multiple Health Care Providers: Many older adults see several specialists for different conditions. Occasionally, new medications are prescribed without full knowledge of what other providers have already prescribed, which can lead to duplicate treatments and unwanted drug interactions.
• Inadequate Coordination: As seniors transition among different care services, gaps in communication or missed medication reviews can lead to an increasing list of medications.
• Automated Prescription Services: Seniors managing ongoing prescriptions often rely on automatic refills or mail-order pharmacy services to keep their medications stocked. However, without regular review, these services can sometimes lead seniors to continue medications that are no longer necessary or have already been discontinued.
• Not Reviewing Medications Regularly: Not consistently reviewing all medications can lead to unnecessary prescriptions accumulating over time. For that reason, it’s crucial to review your medication list with your physician regularly. Doing so can reduce the number of medications you’re taking, simplify medication management, and lower the risk of drug interactions.
• Reluctance to Stop Long-Term Medications: Without the necessary medical guidance, some older adults may be hesitant to stop medications they’ve taken for years. In some cases, people assume that taking more medications reflects better treatment, or they may overlook mentioning all prescriptions, over-the-counter drugs, or supplements to their health care providers during their doctor’s appointment.

Health Risks and Consequences of Polypharmacy in Older Adults

Polypharmacy can significantly increase the risk of negative effects among seniors, including:

• Drug–Drug Interactions: Taking multiple prescriptions can raise the risk that one medication will interfere with another or amplify its side effects. Cardiovascular medications, including warfarin, amiodarone, and digoxin are among the drugs most often involved in serious and potentially dangerous drug–drug interactions in older adults.
• Adverse Drug Reactions (ADRs): Available statistics show that adverse drug reactions account for roughly 5% to 28% of acute hospital admissions among older adults, and experts note that the risk increases with each additional medication.
• Safety Risks: Polypharmacy can double the likelihood of falls among seniors, according to studies. In particular, taking certain medications together, including sedatives, blood pressure medications, and anticholinergics, can significantly increase the risk of falls or car accidents among older adults.
• Cognitive Impairment and Confusion: Medications that affect the central nervous system can cause or worsen cognitive problems, including confusion, memory loss, and delirium. This can be especially concerning for older adults living with memory-related conditions like dementia and Alzheimer’s disease.
• Medication Non-Adherence: Many seniors who live alone may struggle to keep up with complex medication schedules, leading to missed doses or incorrect timing.
• Hospitalization and Emergency Visits: Research has consistently linked polypharmacy to higher rates of emergency department visits, hospital admissions, and longer hospital stays.
• Reduced Quality of Life: In some circumstances, taking multiple medications can lead to unwanted side effects and adverse drug reactions, hence a lower quality of life.
• Financial Burden: Because most prescriptions require copays, taking multiple medications can increase out-of-pocket costs for seniors and their families. This added expense may cause some people to skip doses or delay filling their prescriptions.

Common High-Risk Medications for Seniors: The Beers Criteria

The American Geriatrics Society Beers Criteria® is an updated list of potentially inappropriate medications (PIMs), used by health care providers to help guide safer prescribing for older adults.

The updated 2023 AGS Beers Criteria lists medications to avoid for most older adults, those to avoid with specific conditions, drugs to use with caution, and potentially harmful drug–drug interactions.

According to the guideline, combining three or more medications that affect the central nervous system (CNS) can significantly raise the risk of falls, decline in cognitive function, and even mortality among seniors. Common examples may include antidepressants, sedatives, opioid pain relievers, and antipsychotics.

In addition, long-term use or taking multiple medications with anticholinergic properties has been linked to several negative side effects, including increased confusion, dry mouth, constipation, urinary retention, and a higher risk of developing dementia.

Other commonly high-risk medications for seniors include:

• Sedative-hypnotics, including sleep medications such as Ambien
• Benzodiazepines, like Ativan and Xanax
• Anticholinergics, including certain allergy and incontinence medications
• Nonsteroidal anti-inflammatory drugs (NSAIDs), including ibuprofen and naproxen
• Certain diabetes medications, which may increase the risk of hypoglycemia

If you or a loved one takes any medication on this list, it might be a good idea to bring it up when reviewing your medications with your health care provider.

Importantly, the Beers Criteria is intended as a guideline, not a strict rule. Some medications on the list might still be appropriate for individual patients after careful review by a doctor or pharmacist.

For this reason, it’s best to avoid stopping any medications without proper guidance from your medical provider or pharmacist.

Signs Your Loved One May Be Experiencing Polypharmacy Problems

Some symptoms of polypharmacy in seniors can occasionally be mistaken for normal signs of aging. That’s why it can be helpful to carefully review your loved one’s recent medical history, including:

• Taking five or more medications daily
• Seeing multiple doctors who prescribe separately
• Being on the same medications for years without regular review

If any of these factors apply, the following warning signs may indicate polypharmacy issues:

• Physical Symptoms: Drug interactions and side effects from multiple prescriptions can sometimes cause serious physical symptoms, including dizziness, confusion, frequent falls or near-falls, unusual fatigue or drowsiness, dry mouth, constipation, and urinary problems.
• Cognitive and Behavioral Changes: Certain medications, especially when combined, can accelerate cognitive decline. Watch for new or worsening confusion, increased forgetfulness, trouble concentrating, or unexplained mood changes.
• Difficulty Managing Medications: A long list of prescriptions can be challenging for some seniors to manage. Warning signs may include missed doses, taking the wrong amount, confusion about timing, or having multiple bottles of the same medication. In these circumstances, it’s worth looking into additional support services that can assist with managing medication.
• Repeated Hospitalizations: Polypharmacy can reduce medication effectiveness or worsen side effects, sometimes leading to more frequent hospital or emergency room visits.

When supporting an older loved one, it’s useful to note any new symptoms that appear after starting or changing a medication. If you notice any of the warning signs above, consider scheduling a comprehensive medication review with a primary care physician or a geriatric specialist to ensure that your loved one’s medications are safe and necessary.

Deprescribing: Safely Reducing Unnecessary Medications

Deprescribing involves reducing or stopping medications that may no longer provide benefits or may be causing more harm than good. It’s typically done under the guidance of a health care professional to help reduce unnecessary prescriptions while maintaining or even improving a senior’s health outcomes.

Growing evidence suggests that, in many cases, reducing the number of medications does not increase mortality. In fact, experts suggest that careful, patient-specific deprescribing can sometimes help lower the risk of adverse outcomes and improve overall health.

Deprescribing may be most helpful for:

• Seniors taking multiple medications
• People experiencing side effects or drug interactions
• Individuals with limited life expectancy, where medication side effects may outweigh benefits
• Anyone whose health goals or priorities have changed

If any of these apply, a health care provider can review medications to identify those that may no longer be necessary or that could cause harm. Deprescribing usually involves five key steps:

1. Identifying potentially unnecessary or inappropriate medications
2. Determining whether each medication can be safely reduced or stopped
3. Planning a tapering schedule to minimize risks
4. Monitoring for withdrawal symptoms or changes in health conditions
5. Documenting outcomes and adjusting the plan as needed

Common examples of medications often considered for deprescribing include:

• Stomach acid medications (like proton pump inhibitors)
• Sedative-hypnotics and sleep aids
• Benzodiazepines (such as Ativan or Xanax)
• Certain blood pressure medications
• Preventive medications with long time-to-benefit

Importantly, many of these medications require gradual tapering to avoid serious withdrawal effects or rebounding of symptoms. For this reason, you shouldn’t stop taking any medications without your doctor’s approval.

Practical Tips for Medication Management in Seniors

Keeping up with multiple prescriptions can feel more challenging as we age. Here are a few useful tips to help you or someone you love manage their medication effectively:

• Keep an Organized Medication List: When managing multiple prescriptions, it’s helpful to keep an up-to-date list of all drugs you’re taking, including dosage, frequency, prescribing doctor, and reason for use. You might also include any over-the-counter drugs, prescription cannabis, vitamins, supplements, or herbal products.
• Use One Pharmacy When Possible: Refilling prescriptions at a single pharmacy can make it easier for pharmacists to watch for drug interactions and keep you informed of potential risks.
• Stay Organized With Pill Boxes and Reminders: Placing pills in a clearly labeled pill organizer with daily AM/PM compartments can help ensure seniors take the correct medication and the right dose. You may also consider using helpful tech tools, including smartphone alarms, medication reminder apps, or automated pill dispensers, to help you take medications at the correct times.
• Bring Medications to Every Appointment: Bring all medications you’re taking, including vitamins and supplements, to hospital visits. This allows your provider to see exactly what you’re taking, including any duplicates or discontinued medications you might still be using.
• Request Regular Medication Reviews: If you’ve been taking multiple prescriptions for a while, consider a comprehensive medication review at least once a year, or after any hospitalization, fall, or emergency visit. For eligible beneficiaries, Medicare Part B usually covers one Annual Wellness Visit that includes a medication review.
• Ask Key Questions at Every Appointment: When supporting an older loved one, it’s helpful to ask their health care provider about any new prescriptions, including why they’re being prescribed, how long they may be needed, possible side effects, and interactions with other medications your family member might be taking.
• Consider Involving a Professional: If you’re uncertain about any medications you’re taking, a medical professional, like a pharmacist or geriatrician, can help identify issues and suggest improvement strategies, including medication therapy management services.

How Caregivers Can Help Manage Polypharmacy

As a senior needs more assistance managing polypharmacy, it’s often family caregivers who step in. If someone you love is taking multiple prescriptions, here are some tips to help you show your best support:

• Become the Medication Coordinator: When helping an older family member experiencing polypharmacy, it can be helpful to create and maintain an accurate, up-to-date list of all their medications. This can help ensure all their health care providers know what medications your loved one is taking before prescribing new ones.
• Attend Medical Appointments: In addition to offering emotional support, accompanying your loved one to doctors’ appointments allows you to ask questions, note important recommendations and directions, or ask for a review of their current prescriptions.
• Watch for Warning Signs: If there are any changes to the prescription or dosage, it’s a good idea to monitor for new symptoms that could indicate adverse drug reactions, including changes in mood or behavior, dizziness, unusual fatigue, or difficulty breathing.
• Assist With Medication Management: Assistance with medication routines can help seniors follow prescribed doses. You might support an older loved one by filling pill organizers, setting up reminders, or coordinating prescription refills.
• Know When to Escalate Concerns: Timely care and support is often crucial when managing a senior’s health. If you notice possible signs of overmedication or drug interactions, like persistent drowsiness, confusion, frequent falls or near-falls, or declining health despite multiple medications, it may be helpful to schedule a comprehensive geriatric assessment.
• Recognize Caregiver Limitations: If medication management becomes overwhelming, consider seeking professional support, including home health services, assisted living communities, or medication therapy management programs.
• Take Care of Yourself: Managing a complex medication regimen along with other caregiving responsibilities can sometimes feel overwhelming, even for experienced caregivers. In these situations, it may help to ask other family members for support or explore additional services that can assist with medication management, including professional caregiving support or assisted living communities.

Questions to Ask Your Doctor About Medications

During appointments, seniors and their families often expect doctors to initiate conversations about medications. However, asking a few thoughtful questions can help ensure that every prescription is still appropriate and works as intended.

If you or a loved one has been on the same medication for a prolonged period, here are some questions you may consider asking during your next visit:

Before Starting a New Medication:

• What is this medication for?
• How long will I need to take it?
• What are the common side effects?
• Does it interact with my other medications?
• Are there non-drug alternatives?

At Regular Medication Reviews:

• Is each medication still necessary?
• Can any doses be reduced?
• Are there any medications I should stop taking?
• Am I taking any medications listed in the Beers Criteria?

About Side Effects:

• Could my [specific symptom] be a side effect of one of my medications?
• Is there an alternative medication with fewer side effects?

About Drug Interactions:

• Have you reviewed all my medications together for potential interactions?
• Should I avoid any foods or supplements while taking these medications?

Questions Caregivers May Ask:

• What symptoms should I watch for?
• When should I call about concerns?
• How should medications be stored?
• What should we do if a dose is missed?

Taking Control of Medication Management for Healthier Aging

Polypharmacy is common among older adults and can increase the risk of serious health issues, including fall-related injuries, decline in cognitive function, hospitalizations, and a lower quality of life.

When taking multiple prescriptions, it’s crucial to schedule regular medication reviews and maintain open communication with your health care providers. During your next appointment, you can ask your physician, “Is this medication still necessary?” Doing so helps ensure each medication you’re taking continues to provide meaningful benefits.

If you or someone you love could benefit from additional support services, including assistance with taking medication, our team is happy to help guide you through the next steps.

To learn more about StoryPoint Group communities, call us at 1-844-275-9990 or fill out our contact form, and a member of our team will be in touch shortly.