Polypharmacy Concerns and Risks for Seniors


Polypharmacy is a term used to describe the prescribing of multiple medications, leaving a patient at risk of dangerous drug interactions and potential adverse side effects like confusion and balance problems.  Polypharmacy can occur in a variety of ways:

  • Prescribing of an inappropriately high number of medications
  • Prescribing of more medications that may be necessary for a given condition 
  • Prescribing of an inappropriate medication for that condition

According to a research letter published in 2013 in the Canadian Pharmacists Journal, almost a third (30%) of Canadian seniors over the age of 85 were taking more than 10 prescribed medications at a time, with a higher prevalence among patients in nursing homes.  A 2014 paper published in 2014 reports that nearly half of older adults take one or more prescriptions that are not medically necessary.  Indeed, some elderly adults are taking up to 25 different medications concurrently, with up to 60 separate daily doses, according to the editorial.  Add to this sensitivities to medication that may increase with age and the dangers of overprescription multiply.

If You Take Too Many Medications at Once

It's not hard to imagine a patient with even mild cognitive impairment mixing up the prescriptions or suffering from adverse drug reactions.

 Indeed, the authors highlight a complicating factor of "prescribing cascades", in which a prescription is written for yet another medication to counteract symptoms of a negative side effect or interaction between two or more other prescribed drugs.

Polypharmacy can lead to potentially devastating falls, broken hips, and head injuries, many of which account for preventable visits to emergency care and higher mortality risk overall.

What Can Be Done to Prevent Polypharmacy?  

Polypharmacy can be addressed on two fronts: by health-care providers, and patients themselves.

Pharmacists and clinicians have called for better monitoring of a patient's total drug load, with improved tracking of prescriptions, and efforts to "deprescribe".  The 2013 paper advocates gradually weaning patients off dubious medications and educating patients about the risks and benefits of the drugs they're prescribed, along with information about how to manage multiple prescriptions.  

If you or someone you love suspects overprescription of medications, here are some ways to combat this potentially dangerous problem:

  • Keep a list of all your medications including vitamins and over-the-counter items. Bring this list to all your appointments and show it to your care providers. Ask them to check the list for any possible complications and remember to also ask if any of your symptoms might really be side effects.
  • Go online. There are many websites you can check to see if there are potential problems in your polypharmacy regimen. To learn detailed information about a medication, go to Drugs A to Z. 
  • Appoint a lead physician. Ask a family practitioner or a geriatrician to be your "lead physician." As part of this role, your doctor will evaluate your care from all your other providers, look over medications and make phone calls to coordinate care when necessary. 
  • Ask your pharmacist. Pharmacists are trained to look for drug interactions and other problems - but they can only do that if they have all your information. Hand them your prescription list and ask them to look it over. This is especially important if you get your medications from more than one pharmacy.

Edited by Sharon Basaraba

View Article Sources
  • Barbara Farrell, Salima Shamji, Anne Monahan, Veronique French Merkley. "Reducing Polypharmacy in the Elderly: Cases to Help You "Rock the Boat". Can Pharm J (Ott). 2013 Sep; 146(5): 243–244.
  • Hajjar ER1, Cafiero AC, Hanlon JT. "Polypharmacy in Elderly Patients." J Geriatr Pharmacother 2007 Dec;5(4):345-51. doi: 10.1016/j.amjopharm.2007.12.002.
  • Maher RL, Hanlon J, Hajjar ER. "Clinical Consequences of Polypharmacy in Elderly." Expert Opin Drug Saf. 2014 Jan;13(1):57-65.
  • Sujit Rambhade, Anup Chakraborty, Anand Shrivastava, Umesh K. Patil, and Ashish Rambhade. "A Survey on Polypharmacy and Use of Inappropriate Medications." Toxicol Int. 2012 Jan-Apr; 19(1): 68–73.