What Is Polypharmacy?

For those who may not be familiar with the term, polypharmacy is a clinical term used to describe an older adult taking five or more medications at the same time.

While many prescription medications are necessary and play an important role in managing chronic health conditions, taking multiple medications can increase the risk of adverse side effects, drug interactions, and medication-related complications.

Why Medications Affect Older Adults Differently

As we age, our bodies naturally change in the way they process medications. Normal aging affects how the body absorbs, distributes, metabolizes, and eliminates drugs.

Kidney function gradually declines, liver blood flow decreases, and changes in body composition—such as having less muscle mass, more body fat, and less total body water—can cause certain medications to remain in the body longer than they once did.

As a result, older adults are often more susceptible to medication side effects, even when they have been taking the same prescription for years.

Older Adults and Clinical Research

One aspect that surprised me during the course was learning that many medications are initially studied in younger, healthier adults during clinical trials. These individuals often metabolize medications more efficiently than older adults.

While medications continue to be studied after they are approved, older adults—particularly those with multiple chronic conditions taking several medications at once—have historically been underrepresented in many clinical trials.

This means that healthcare providers often need to carefully monitor how medications affect older adults in real-world practice.

Understanding the Prescribing Cascade

When medications remain in the body for longer periods of time, the likelihood of experiencing side effects increases. What makes this especially concerning is that these side effects can often resemble entirely new medical conditions.

Rather than recognizing that a medication may be the cause, the new symptom may be treated with yet another prescription. This is known as a prescribing cascade, and it can result in an ever-growing list of medications over time.

When Side Effects Look Like New Health Problems

For example, an older adult who has taken blood pressure medication for years may suddenly begin experiencing dizziness or lightheadedness as their body changes with age.

Certain antidepressants, antipsychotics, and blood pressure medications can also contribute to low blood pressure, increasing the risk of dizziness and falls.

Without considering whether a medication is contributing to the problem, these symptoms may be mistaken for a new medical condition instead of a medication-related side effect.

The Importance of Medication Reviews

Because of the potential risks associated with polypharmacy, it is important for older adults to have their medications reviewed regularly.

Many people do not realize that pharmacists are medication specialists. While physicians diagnose medical conditions and prescribe treatment, pharmacists are experts in how medications interact with one another, how they affect the body, and how aging changes medication safety.

This is why a pharmacist-led medication review can be incredibly valuable for older adults taking multiple prescriptions.

Symptoms Worth Discussing With a Healthcare Professional

For older adults experiencing new symptoms, it is worth asking whether medications could be contributing before assuming these changes are simply part of aging.

A medication review by a pharmacist, in collaboration with the prescribing physician, can often identify opportunities to reduce unnecessary medications, adjust dosages, or substitute safer alternatives.

What Families Can Do

If you or a loved one is taking multiple medications and you are concerned about polypharmacy, do not ignore new symptoms or assume they are simply part of aging.

Speak with your family physician or pharmacist about arranging a comprehensive medication review to ensure each medication is still necessary, effective, and safe.