Polypharmacy in Older Adults: How Medication Interactions Increase Risk and What Deprescribing Can Do

More than polypharmacy is just taking too many pills. It’s a silent crisis creeping into the lives of older adults, one prescription at a time. In Australia, nearly 36% of seniors are on five or more medications daily. In nursing homes, that number jumps to over 80%. These aren’t just numbers-they’re real people struggling to keep track of pills, dealing with dizziness from a drug interaction they never knew about, or falling because a medication they’ve been on for years is no longer helping-and maybe even hurting.

What Exactly Is Polypharmacy?

Polypharmacy means taking five or more medications at the same time. It’s not a diagnosis. It’s a consequence. Most older adults aren’t on all those drugs because they want to. They’re on them because they have multiple chronic conditions: high blood pressure, arthritis, diabetes, heart disease, depression, sleep problems. Each condition gets its own prescription. A cardiologist adds one. A rheumatologist adds another. A psychiatrist adds two more. And then there’s the over-the-counter painkiller, the sleep aid, the magnesium supplement, the herbal tea for digestion. No one’s putting it all together.

The problem isn’t just the number. It’s the mix. As you get older, your body changes. Your kidneys don’t filter drugs as well. Your liver slows down. Your brain becomes more sensitive to certain chemicals. A dose that was fine at 55 might be dangerous at 75. And when you add five, seven, ten drugs together? The chances of a bad interaction jump from 6% with two drugs to over 50% with five. With seven or more? It’s almost guaranteed something will clash.

Why Drug Interactions Are So Dangerous in Older Adults

Think of your body like a complex machine. Each medication is a gear. Too many gears spinning at once? They grind against each other. One drug might make another stronger. Another might cancel it out. Or worse-they might create a side effect that wasn’t there before.

Take NSAIDs like ibuprofen. Common for arthritis pain. But when combined with blood pressure meds like ACE inhibitors, they can tank kidney function. Or consider benzodiazepines-used for anxiety or sleep. They cause drowsiness, dizziness, confusion. Add that to a blood thinner like warfarin, and now you’re at higher risk of falling and bleeding internally. One study found that seniors on four or more central nervous system drugs were twice as likely to fall.

Then there’s the “prescribing cascade.” A patient starts on a drug. It causes a side effect-say, constipation. The doctor doesn’t stop the original drug. Instead, they prescribe a laxative. Then the laxative causes diarrhea, so they add an anti-diarrheal. Now the patient’s on three drugs for one original problem. And no one’s asking: Do we even need the first one?

The most common culprits in older adults? Painkillers (especially NSAIDs), sedatives, anticholinergics (used for overactive bladder, allergies, Parkinson’s), and multiple psychiatric drugs. In fact, nearly half of all visits by seniors on major polypharmacy involve pain medications. That’s not a coincidence. It’s a red flag.

Deprescribing: Stopping Meds Is Sometimes the Best Treatment

Deprescribing isn’t about cutting pills randomly. It’s a careful, planned process of reducing or stopping medications when the risks outweigh the benefits. It’s the opposite of adding more. It’s asking: Is this still helping? Is it safe? Could I feel better without it?

The American Geriatrics Society’s Beers Criteria and the STOPP/START guidelines are the gold standards here. They list drugs that are risky for older adults-like long-term benzodiazepines, certain antipsychotics for dementia, or multiple antihypertensives when blood pressure is already low. But knowing the guidelines is only half the battle. Using them? That’s where things get messy.

Doctors don’t always have time. Patients are scared. “I’ve been taking this for ten years,” they say. “If I stop, what if I get sick again?” Some believe the pill is doing something-even if it’s not. And if a doctor doesn’t bring it up, the patient won’t either. Too often, deprescribing only happens after a bad reaction-like a hospital visit for a fall or kidney failure.

But when done right, the results are powerful. In one study, seniors who had a benzodiazepine slowly tapered off saw a 22% drop in falls. Another trial found that reducing unnecessary medications led to fewer ER visits and better quality of life. One woman in her 80s, on eight medications, had chronic dizziness. After reviewing her list, her pharmacist found she was on two drugs that both lowered blood pressure-and neither was actually helping her heart anymore. Once both were stopped, her balance improved. She didn’t need a cane anymore.

Who’s Responsible for Deprescribing?

This isn’t just the doctor’s job. It’s a team effort.

Pharmacists are often the first to spot the problem. They see the full list-prescription, OTC, supplements. They know the interactions. But in most clinics, they’re not part of the conversation. In Australia, pharmacist-led medication reviews are growing, especially in community pharmacies and aged care homes. These reviews take 30-60 minutes. They’re not quick checkups. They’re full audits: What’s this for? Is it still needed? Is there a safer alternative?

GPs need support too. Many aren’t trained in deprescribing. They’re pressured to meet targets for chronic disease management-check the box, write the script. But managing polypharmacy requires slowing down, not speeding up.

Patients and families need education. If you’re caring for an older parent, ask: Why is this medication prescribed? What’s it supposed to do? What happens if we stop it? Bring a list of every pill, capsule, and supplement to every appointment. Write down names, doses, and why they were started.

Barriers to Change

Why isn’t deprescribing happening more often?

First, the system doesn’t reward it. Doctors get paid for seeing patients and writing prescriptions-not for spending 45 minutes reviewing a medication list. Pharmacist services aren’t always covered by insurance. Medicare doesn’t pay for comprehensive medication reviews unless it’s in a very specific setting.

Second, fear. Fear of withdrawal. Fear of symptoms returning. Fear of being seen as negligent. A doctor might hesitate to stop a statin because “it’s been working.” But what if the patient is 90, has no heart disease, and the only side effect is muscle pain that makes walking painful? Is the statin still worth it?

Third, fragmentation. A patient sees five different specialists. Each one adds something. No one talks to the others. The GP might not even know what the cardiologist prescribed last month. Electronic health records don’t always talk to each other. Medication lists are outdated or incomplete.

What You Can Do Right Now

If you or someone you care for is on five or more medications, here’s what to do:

1. Make a complete list of everything: prescriptions, over-the-counter drugs, vitamins, herbal supplements, and even occasional meds like sleep aids or painkillers.
2. Bring that list to your next doctor’s appointment. Ask: “Which of these are still necessary?”
3. Ask about the goal of each drug. “Is this to prevent something, or to treat symptoms?”
4. Ask: “What would happen if we stopped this?”
5. Request a pharmacist-led medication review. Many community pharmacies offer this for free or low cost.
6. Don’t assume a drug is safe just because it’s been taken for years. Reassess every 6-12 months.

The Future of Medication Safety

New tools are emerging. Some hospitals now use AI to scan medication lists and flag high-risk combinations. Clinical decision support systems in electronic records can warn doctors when they’re about to prescribe something dangerous. But technology alone won’t fix this. People will.

The future lies in coordinated care: one team, one plan, one person responsible for the whole picture. It means more pharmacists embedded in primary care. More time in appointments. More training for doctors in geriatric prescribing. More respect for patient goals-like staying independent, avoiding falls, or just feeling well enough to enjoy breakfast with family.

The global population of people over 65 will hit 1.5 billion by 2050. If we keep prescribing like we’re trying to fix every symptom with a pill, we’ll drown in hospitalizations, side effects, and preventable decline.

But if we learn to step back-to ask not just “what can we add?” but “what can we remove?”-we can give older adults back their safety, their balance, and their peace of mind.