More than 40% of adults over 65 are taking five or more medications at once. That’s not just common-it’s dangerous. In the UK, the US, Australia, and beyond, older adults are being prescribed more drugs than ever before. But each extra pill doesn’t just add benefit-it adds risk. Falls. Confusion. Hospital stays. Even death. And too often, no one is asking: Do you still need all of these?
Why Polypharmacy Happens
Polypharmacy isn’t a single mistake. It’s a slow build-up. One doctor prescribes a blood pressure pill. Another adds a statin. Then a painkiller for arthritis. Then a sleep aid. Then an antacid for the stomach upset from the painkiller. Before you know it, someone’s on ten medications-and no one’s taken a step back to look at the whole picture. It’s not just doctors. Many older adults keep taking meds they were given years ago because they think, “It was prescribed, so it must still be needed.” Over-the-counter drugs, herbal supplements, and even occasional pain relievers get forgotten in the count. But they all add up. A study of 2 billion patient visits found that people with 10 or more medications were, on average, two years older than those with fewer. Age brings more conditions-and more prescriptions. In nursing homes, the rate jumps to over 80%. People with heart disease, diabetes, or depression are especially likely to be on multiple drugs. And when multiple specialists are involved-cardiologist, neurologist, GP, rheumatologist-each focuses on their own area. No one’s looking at the whole list.What Happens When You Take Too Many Drugs
Your body changes as you get older. Your kidneys don’t filter as well. Your liver doesn’t break down drugs the same way. Your brain becomes more sensitive to sedatives, anticholinergics, and opioids. That means a dose that was fine at 50 can be risky at 75. The more drugs you take, the higher the chance of a bad reaction. With two medications, the risk of a harmful interaction is about 6%. With five, it jumps to 50%. With seven or more, it’s nearly certain. That’s not a guess-it’s clinical fact backed by decades of research. Common dangers include:- Falls and fractures: Sedatives, benzodiazepines, and even some blood pressure meds can make you dizzy. One fall can end your independence.
- Cognitive decline: Anticholinergic drugs-used for allergies, overactive bladder, depression, and sleep-can blur your thinking. Long-term use is linked to higher dementia risk.
- Kidney and liver damage: NSAIDs like ibuprofen, when taken daily with other meds, can silently harm organs.
- Hospitalizations: Nearly half of all drug-related hospital stays in older adults are caused by polypharmacy.
- Medication nonadherence: If you have to take eight pills at different times of day, you’ll miss some. It’s not laziness-it’s impossible.
And here’s the worst part: sometimes, one drug is prescribed to fix a side effect of another. That’s called a prescribing cascade. A patient gets dizziness from a blood pressure pill. The doctor prescribes a diuretic to reduce fluid. Then the diuretic causes low potassium, so they add a supplement. Then the supplement causes stomach upset, so they add an antacid. Five drugs for one original problem.
Deprescribing: It’s Not Stopping Medicines-It’s Smart Stopping
Deprescribing isn’t about cutting drugs just because you can. It’s about removing what’s no longer helping-or what’s doing more harm than good. The American Geriatrics Society’s Beers Criteria lists 80+ medications that are risky for older adults. These include long-term benzodiazepines, certain antipsychotics for dementia, and NSAIDs in people with kidney issues. The STOPP/START tools go further: STOPP finds inappropriate prescriptions; START finds ones you’re missing. But guidelines don’t help if no one uses them. Many GPs say they don’t have time. Patients fear their condition will come back. Family members panic if a pill disappears. And some doctors worry about liability if something goes wrong after stopping a drug. Real deprescribing works when it’s:- Personalized: Not a one-size-fits-all list. What’s right for one person may be dangerous for another.
- Gradual: Stopping a benzodiazepine cold turkey can cause seizures. It takes weeks of slow tapering.
- Collaborative: The patient must be part of the decision. “What’s your goal? To feel less tired? To stop falling? To save money?”
- Monitored: After stopping a drug, check in. Are symptoms worse? Better? No change?
Studies show success. In one trial, a pharmacist-led review cut falls by 22%. In another, emergency visits dropped by 30% after deprescribing anticholinergics and sedatives. Quality of life improved. People slept better. Felt clearer-headed. Didn’t need as many pills to get through the day.
Who Should Lead the Conversation?
GPs are the natural leaders-but they’re stretched thin. Pharmacists are trained to spot interactions, yet in the UK, they’re rarely asked to review full medication lists. Specialists rarely communicate with each other. And patients? They’re often too scared to speak up. Here’s what actually works:- Medication reviews: At least once a year, sit down with your GP or pharmacist and bring every pill, patch, and supplement you take-including aspirin and turmeric capsules.
- Use a pill organizer: But don’t just fill it. Ask: “Why am I taking this?”
- Ask the five questions:
- What is this medicine for?
- How do I take it?
- What side effects should I watch for?
- Is this still necessary?
- Can we try stopping one?
- Bring a family member: Memory fades. A second set of ears helps.
Some practices now use digital tools that flag risky combinations. But tech alone won’t fix this. It takes a conversation.
What to Do Right Now
If you or someone you care for is on five or more medications, don’t wait for the next appointment. Take action:- Make a full list: Write down every prescription, OTC drug, vitamin, and herbal remedy. Include doses and times.
- Check for red flags: Are any of these on the Beers Criteria? Anticholinergics? Benzodiazepines? NSAIDs used daily? Check online or ask a pharmacist.
- Ask your GP: “Is this still needed?” Don’t say “Can I stop?” Say “I’d like to review whether I still need this.”
- Start with one: Pick the drug with the highest risk or least clear benefit. Maybe it’s the sleeping pill you’ve taken for 10 years. Or the daily ibuprofen for mild knee pain.
- Track changes: After stopping, note how you feel. Better sleep? More energy? Less dizziness? Worse memory? Tell your doctor.
Deprescribing isn’t about going drug-free. It’s about having the right drugs-and only the right ones.
What’s Changing in 2025
More UK practices are now offering pharmacist-led medication reviews under NHS funding. The NHS Long Term Plan includes expanded roles for pharmacists in primary care. AI tools are being tested to scan EHRs for polypharmacy risks and flag high-risk combinations before they’re prescribed. But the biggest shift? A new mindset. Medicine isn’t just about adding treatments. It’s about protecting people from the harm of too many treatments. The goal isn’t to treat every symptom-it’s to help people live well, safely, and with dignity.Frequently Asked Questions
Is polypharmacy always harmful?
No. Some older adults need five or more medications to manage serious conditions like heart failure, diabetes, or atrial fibrillation. The problem isn’t the number-it’s whether each drug is still necessary, safe, and working as intended. A well-managed regimen with five drugs is better than a chaotic one with three.
Can I stop my meds on my own?
Never stop a prescription drug suddenly without talking to your doctor. Some meds, like antidepressants, blood pressure pills, or steroids, can cause dangerous withdrawal effects. But you can ask for a review. Say: “I’d like to talk about whether I still need all of these.”
What’s the difference between deprescribing and stopping meds?
Deprescribing is a planned, evidence-based process. It includes reviewing each drug’s purpose, checking for interactions, tapering slowly if needed, and monitoring outcomes. Stopping meds on your own is risky and often leads to confusion or rebound symptoms. Deprescribing is safe; random stopping isn’t.
Are herbal supplements safe 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 with aspirin or warfarin. Even common supplements like vitamin E or fish oil can interact. Always tell your doctor or pharmacist about everything you take-including what you buy at the health food store.
Why don’t doctors talk about deprescribing more often?
Time is a big reason. A typical GP appointment is 10 minutes. Reviewing 12 medications takes longer. There’s also fear-doctors worry patients will think they’re being neglected, or that stopping a drug will cause harm. But the bigger risk is doing nothing. More GPs are now trained in deprescribing, and tools like the Beers Criteria make it easier. Ask your doctor if they’ve reviewed your meds in the last year.
How do I know if a medication is no longer needed?
Ask these questions: Was this prescribed for a condition that’s now under control? Does it cause side effects I’m living with? Has it been more than a year since I last saw the specialist who prescribed it? Is it a drug that’s known to be risky in older adults? If the answer is yes to any of these, it’s worth reviewing.
