Avoid Risks

More Medications, More Risks

More Medications, More Risks

As we age, the challenges faced by our bodies can lead to a long list of medications, often prescribed by different doctors and sometimes taken chronically for years. While most medications help you live a longer, healthier life, taking a lot of them can lead to dangerous drug interactions and impaired cognition [1].

Taking multiple medications simultaneously, known as "polypharmacy," is a growing problem in older adults, with 30–40 percent of older Americans using 5 or more medications [1]. This includes prescription medications and the diverse array of drugs and supplements available over-the-counter.

Polypharmacy has many negative consequences for patients. It increases medical costs and the likelihood of duplicate prescriptions and missed dosages. Patients with polypharmacy are also more likely to experience side effects or adverse drug interactions including cognitive impairment and delirium [2-4]. The risk of such side effects can increase with age and with the use of certain combinations of drugs [1][4].

If the prescription drug is medically necessary, these risks may be outweighed by the benefits. Indeed, failure to take medications as directed is a common risk factor for hospitalization and death, particularly for cardiovascular diseases [5]. However, as our bodies age, the risks of side effects for drugs can increase and the strategies needed to manage a disease may change. Some drugs may be inappropriate for an older adult even if they were helpful and safe for the same person at a younger age. Roughly half of older adults are prescribed at least one drug that is not medically necessary, in some cases because they began using the drug at a younger age [1]. Taking risky combinations of drugs is also common, as reported in 57 percent of seniors in one study of Ohio residents [6].

Keep a list of all medications and supplements you’re taking, prescription and non-prescription, with dosages. If possible, fill all prescriptions at a single pharmacy. Ask your physician and pharmacist about possible side effects and contraindications and be on the look-out for them, even if you have taken the medication before. And check with your physician to see if any of your medications are on the BEERS Criteria list of potentially inappropriate medications for older adults and, if so, whether there are safe alternatives. Consult your physician before you change your use of a medication. De-prescribing can be complex and should be done carefully [7].

These action recommendations along with tip sheets and other resources can be found at healthinaging.org, a site from the American Geriatrics Society.

  1. Maher, R.L., J. Hanlon, and E.R. Hajjar, Clinical consequences of polypharmacy in elderly. Expert Opin Drug Saf, 2014. 13(1): p. 57-65.
  2. Oh, E.S., et al., Preoperative risk factors for postoperative delirium following hip fracture repair: a systematic review. Int J Geriatr Psychiatry, 2015. 30(9): p. 900-10.
  3. Salahudeen, M.S., S.B. Duffull, and P.S. Nishtala, Anticholinergic burden quantified by anticholinergic risk scales and adverse outcomes in older people: a systematic review. BMC Geriatr, 2015. 15: p. 31.
  4. By the American Geriatrics Society Beers Criteria Update Expert, P., American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc, 2015. 63(11): p. 2227-46.
  5. Munger, M.A., B.W. Van Tassell, and J. LaFleur, Medication nonadherence: an unrecognized cardiovascular risk factor. MedGenMed, 2007. 9(3): p. 58.
  6. Golchin, N., et al., Polypharmacy in the elderly. J Res Pharm Pract, 2015. 4(2): p. 85-8.
  7. Bokhof, B. and U. Junius-Walker, Reducing Polypharmacy from the Perspectives of General Practitioners and Older Patients: A Synthesis of Qualitative Studies. Drugs Aging, 2016. 33(4): p. 249-66.

Dr. Penny Dacks was previously the Director of Aging and Alzheimer’s Disease Prevention at the Alzheimer's Drug Discovery Foundation. She was trained in neuroscience at the Mount Sinai School of Medicine, the University of Arizona, and Queen's University (Canada) with individual fellowships from the National Institute of Health, the Evelyn F. McKnight Brain Research Foundation, the ARCS Foundation and the Hilda and Preston Davis Foundation. She has authored over 18 peer-reviewed scientific articles and is a member of the Society for Neuroscience, the Gerontological Society of America, the Endocrine Society and the Association for Women in Science.

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