An older parent sees several specialists for different health conditions. A cardiologist prescribes heart medications. An endocrinologist manages diabetes. A rheumatologist treats arthritis. A primary care doctor adds medicines for sleep, pain, or stomach symptoms.
Over time, the medication list becomes long. Prescription drugs, over-the-counter sleep aids, vitamins, pain relievers, and herbal products may all be taken together. Then the family begins to notice new concerns:
- More dizziness or falls
- Unusual fatigue
- Confusion or slower thinking
- Poor appetite
- Difficulty keeping track of the medication schedule
These symptoms can have many causes. They should not automatically be blamed on medications. But when an older adult is taking many drugs, a comprehensive medication review may be an important part of figuring out what is helping, what is still necessary, and what may be creating avoidable risk.
This guide explains what polypharmacy means, how prescribing cascades can happen, what the Beers Criteria are—and are not—how deprescribing works, and how families can prepare for a safer medication review.
Important note: Never stop, reduce, or skip a prescription medication without speaking with the prescribing clinician or pharmacist. Some medicines require gradual tapering, and abrupt withdrawal can be dangerous. This article is for general educational purposes only.
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| A full medication review should include prescriptions, over-the-counter products, vitamins, and supplements. |
What Is Polypharmacy?
Polypharmacy generally refers to the use of multiple medications at the same time. In older adults, this often happens for understandable reasons: a person may be managing heart disease, diabetes, arthritis, insomnia, depression, reflux, or other chronic conditions simultaneously.
Taking several medicines is not automatically inappropriate. Some people genuinely need multiple medications to stay stable. The concern arises when the overall regimen becomes difficult to manage, contains duplicate therapies, includes drugs that no longer match current goals, or creates a higher risk of side effects and interactions.
A better question than “Is this too many pills?”
“Does each medication still have a clear purpose, current benefit, and acceptable risk for this person?”
Why Medication Lists Grow Over Time
Medication burden can increase gradually. Common reasons include:
- Different specialists prescribing for different conditions
- Hospital discharge medicines being added without a later review
- Temporary medicines continuing longer than intended
- Over-the-counter sleep, allergy, or pain products being added without the medical team knowing
- New symptoms being treated before considering whether an existing medication may be contributing
The National Institute on Aging recommends keeping an updated medication list and reviewing medicines with healthcare professionals, especially when new medications are added or when symptoms change.
What Is a Prescribing Cascade?
A prescribing cascade can happen when a medication side effect is mistaken for a new medical condition, leading to the addition of another drug.
For example:
- A medicine causes swelling in the legs.
- The swelling is interpreted as a new problem rather than a possible side effect.
- A second medication is prescribed to treat the swelling.
AHRQ describes prescribing cascades as one way medication-related harm can become harder to recognize in older adults, especially when multiple clinicians are involved and symptoms are attributed to aging or new disease instead of a drug effect.
Important caution
Not every new symptom is caused by a medication. But when a symptom begins after a drug change, it is reasonable to ask whether a side effect or interaction should be considered.
What Are the AGS Beers Criteria?
The American Geriatrics Society Beers Criteria are clinical guidance documents that identify medications or medication classes that may be potentially inappropriate for many older adults, or that may require caution in specific diseases, combinations, or kidney-function situations.
They are not a simple “bad drug list,” and they do not mean every listed medication must always be stopped. Instead, they help clinicians weigh risks and benefits more carefully in older adults.
The 2023 AGS Beers Criteria organize recommendations into several categories, including:
- Medications generally considered potentially inappropriate in many older adults
- Medications potentially inappropriate in certain diseases or syndromes
- Medications to use with caution
- Potentially important drug-drug interactions
- Medications that may need dosage adjustment based on kidney function
Medication Classes Families May Want to Ask About
Families should not use online lists to decide which medications to stop. But they can use them to prepare better questions for the clinician or pharmacist.
Examples of medication groups often discussed in older-adult reviews
- Benzodiazepines and certain sedatives: May increase risks such as cognitive impairment, falls, fractures, or motor vehicle crashes in many older adults.
- Strong anticholinergic medicines: May contribute to confusion, constipation, urinary retention, or other burden in susceptible patients.
- Long-term proton pump inhibitor use: May deserve review when there is no clear ongoing indication for extended therapy.
- Oral NSAIDs: May require caution because of gastrointestinal bleeding risk, kidney effects, blood pressure concerns, or interaction with other medicines.
The right question is not “Is this medicine on a list?” It is:
“Given this person’s age, diagnoses, kidney function, fall risk, and treatment goals, is this still the best option?”
What Is Deprescribing?
Deprescribing is the planned and supervised process of reducing the dose of, tapering, or stopping medications that may no longer be beneficial, may be causing harm, or may no longer fit the patient’s care goals.
Deprescribing is not “anti-medication.” It is part of safer prescribing. The goal is to make the medication regimen more appropriate, not simply shorter.
A deprescribing review may consider:
- Whether the original reason for the medication still exists
- Whether the medicine is still helping
- Whether side effects or interactions may outweigh benefit
- Whether goals of care have changed
- Whether a safer alternative or lower dose is possible
- Whether tapering is necessary instead of abrupt stopping
The Brown Bag Medication Review
A practical way to prepare for a medication review is the brown bag method. AHRQ recommends gathering all medications and related products so the healthcare team can build a complete and accurate list.
Bring:
- Prescription medicines
- Over-the-counter pain relievers
- Sleep aids
- Cold and allergy medications
- Vitamins
- Herbal products
- Eye drops, inhalers, patches, and creams if relevant
- Put everything in one bag.
- Bring the bag to the appointment.
- Ask for a medication review, not just a refill.
- Confirm which items should remain, which may need monitoring, and which require a separate discussion about reduction or discontinuation.
Questions Families Can Ask During a Medication Review
- What is each medicine for?
- Is it still needed at the current dose?
- Could any medication be causing dizziness, confusion, appetite change, or falls?
- Are there duplicate medicines or overlapping effects?
- Are any medications potentially inappropriate for this person’s age or condition?
- Does kidney function require dose changes?
- If a drug might be reduced, does it need to be tapered slowly?
- Who will monitor symptoms after any medication change?
Symptoms That Should Prompt a Medication Conversation
Many symptoms in older adults can have multiple explanations, including infection, dehydration, neurological disease, heart problems, or medication effects. Families should avoid self-diagnosing. Still, it may be reasonable to ask for a medication review when new symptoms appear after a medication change or when the drug list has grown significantly.
Examples include:
- New dizziness or repeated falls
- Sudden increase in sleepiness
- New confusion or worsening attention
- Constipation or urinary difficulty
- Loss of appetite or nausea
- New weakness after several medication additions
These symptoms may or may not be medication-related. The point is to make sure medications are considered as one possible contributor instead of being ignored.
What Families Should Not Do
Medication safety improves when families ask questions early. It becomes riskier when they act alone.
- Do not stop a drug just because it appears on an online warning list.
- Do not split, crush, or taper a medication without instructions.
- Do not assume a symptom is “just old age” or “definitely caused by pills.”
- Do not leave specialists unaware of medicines prescribed by other clinicians.
A safer goal
The aim is not “as few medicines as possible.” It is the right medicines, at the right dose, for the right reasons, with the lowest reasonable risk.
A Practical Medication Review Checklist
- Make one complete medication list.
- Include supplements, OTC products, and as-needed drugs.
- Bring all items to a brown bag review.
- Ask whether any new symptoms could be medication-related.
- Ask whether the Beers Criteria or other geriatric tools raise questions for this regimen.
- Discuss deprescribing only with a clinician or pharmacist.
- Request a clear follow-up plan after any medication change.
Conclusion: A Long Medication List Deserves Review, Not Panic
Older adults often need multiple medications, and many of those medicines may be important. But medication lists should not grow forever without review.
If an older parent is taking many drugs and has new dizziness, falls, confusion, or other concerns, a structured medication review may help identify unnecessary duplication, side effects, or opportunities for safer prescribing.
The right question is not “How do we get rid of pills?” It is “Which medicines are still clearly helping, which deserve re-evaluation, and how can changes be made safely?”
Helpful resources:
National Institute on Aging: Taking Medicines Safely as You Age
AHRQ: Brown Bag Medication Review
American Geriatrics Society: 2023 Updated AGS Beers Criteria
Deprescribing to Reduce Medication Harms in Older Adults
Deprescribing.org
