Polypharmacy is defined as the concurrent use of five or more medications. It's extremely common in older adults — up to 40% of those over 65 take five or more daily medicines — and its risks are significant and often underappreciated.
The risks of polypharmacy
- Drug-drug interactions — some combinations are dangerous; warfarin and NSAIDs, for example, greatly increase bleeding risk
- Drug-disease interactions — a medication appropriate for one condition can exacerbate another; diuretics for heart failure can worsen gout
- Adverse drug reactions — the more medications taken, the higher the cumulative risk of side effects, some of which are subtle and attributed to ageing rather than pharmacology
- Falls — many common medications cause postural hypotension, sedation and balance impairment, dramatically raising fall risk
- Cognitive impairment — anticholinergics, benzodiazepines and opioids can impair cognition; in older adults, this may be mistaken for dementia
- Non-adherence — a complex regimen with multiple medications and varying instructions is difficult to follow correctly
The medication review
A structured medication review — ideally with a clinical pharmacist — periodically assesses whether every medication remains necessary, appropriate and safe. The STOPP/START criteria provide a validated framework for identifying potentially inappropriate prescribing in older adults. Patients and carers can request this review; it doesn't have to happen only at a GP's initiative.
Bring every medication — including OTC drugs, supplements and herbal products — to each review appointment. Many interactions involve substances that aren't prescribed.
"The question at every medication review is not just 'should we add anything?' but 'what can we safely stop?'"
Dr. Lina Haddad, CMO, Looms