Medications can save your life or make a serious health condition more manageable. But taking too many medications, or the wrong combination of medications, can harm you. The sheer volume of medications, plus the special health considerations for seniors, leads to many medication issues for seniors. And the risk for seniors is made worse by the fact that few drugs undergo adequate testing among senior populations.

Unsurprisingly, seniors take a lot of medications. In fact, 42% of seniors (people 65+ years old) take five or more prescription medications every day – a 300% increase over the past two decades. And almost 20% take 10 or more a day. And these numbers only represent prescription medications. When including over-the-counter medications and supplements, 67% of seniors take 5+ medications daily.

Note – when I refer to “seniors” in this post, I am referring to people aged 65+ years.

Adverse drug events and reactions harm seniors.

Although medications can provide great benefits, they can also cause harm, including life-threatening complications.

When an injury occurs as the result of a drug, it is called an Adverse Drug Event (ADE). ADEs include adverse drug reactions, medication errors, allergic reactions, and overdoses.

Adverse drug reactions.

An adverse drug reaction (ADR) occurs when patients have unexpected or dangerous reactions to medications. You can develop an ADR from a single dose of a medication, after prolonged use of a drug, or from a negative interaction between 2 or more medications.

The American Society of Health-System Pharmacists (ASHP) defines an ADR as “any unexpected, unintended, undesired, or excessive response to a drug” that leads to any of the following:

Requires stopping the drug.
Requires a change in the drug therapy.
Leads to a modification of dose (except for minor dosage adjustments).
Requires a hospital admission.
Prolongs a stay in a healthcare facility.
Requires supportive treatment.
Significantly complicates the diagnosis.
Negatively impacts the prognosis.
Leads to temporary or permanent harm or disability, or death.

What kind of health issues can ADRs lead to?

ADRs can develop into serious medication-related issues for seniors. For instance, adverse drug reactions can cause a variety of health issues, ranging from mild to life-threatening, including:

Drowsiness.
Nausea.
Incontinence.
Delirium, and the persistent cognitive changes often associated with it.
Falls.
Serious bleeding, including in the brain.
Death.

A few ADR examples.

Here are 3 examples how seniors could experience medication-related issues:

1. You can have a dose-related ADR if your body overreacts to the medication’s intended effects. For instance, if your blood pressure medication reduces your blood pressure too much, you may feel dizzy or lightheaded. A dose-related reaction can occur if:

The dose is too high.
You are unusually sensitive to a medication.
One medication (drug A) slows the way you metabolize another medication (drug B), leading to an elevated level of medication (drug B) in your blood.

2. You have an allergic reaction.

3. You develop a drug reaction that is unexplained and unexpected. For instance, you could experience a rash, anemia, jaundice, kidney damage, nerve injury, or other types of harm. Although these reactions tend to be more serious, they rarely occur.

What is the difference between an adverse drug reaction and a side effect?

Although both adverse drug reactions and side effects can lead to medication issues for seniors, there are important differences, as follows:

An adverse event is an unexpected reaction that happens when a medication is taken correctly. Adverse reactions are often completely unpredictable.
Conversely, side effects are more predictable, undesired effects from taking a medication.

Medication overload harms seniors.

Medication overload is the use of multiple medications for which the harm to a patient outweighs the benefits. Although there is no strict cutoff indicating when the number of medications becomes harmful, the more medications taken, the greater their likelihood of patient harm.

When patients are overloaded with medication, the risk of adverse drug interactions, and associated harm, increases. Unsurprisingly, the more medications taken, the higher the risk.

Alarmingly, experts believe the practice prescribing multiple medications to individual patients (called polypharmacy) has reached epidemic proportions. In fact, the proportion of seniors taking 5+ drugs tripled from 13.8% in 1994 to 42.4% in 2014.

Of course, some patients need multiple medications to manage more than one chronic disease. But millions of patients – especially seniors – are overloaded with too many prescription medications, which has devastating effects on the quality and length of senior’s lives.

Medication overload can happen in any of the following scenarios:

A doctor prescribes unnecessary medications.
The side effects from a medication outweigh the potential benefit.
A patient is prescribed a medication for a longer period than needed.
A patient takes unnecessary over-the-counter medications or supplements.

Medication overload increases the risk of harm.

With medication overload, the risk of medication-related issues for seniors increases as follows:

For every drug added, the risk of an adverse drug event increases by 7-10%.
Seniors taking 6+ drugs while in the hospital are more than 2x as likely to experience delirium, as compared to patients taking fewer than 6 medications.
Taking 4+ drugs is associated with an 18% increased risk of falling. And taking 10+ drugs is associated with a 50% higher chance of falling.
Taking 6-9 medications is associated with a 59% greater chance of death, compared to taking no medications. Taking 10+ medications is associated with a 96% higher chance of death.

Medication overload makes it harder to take medications as prescribed.

Unsurprisingly, the more medications you take, the harder it is to keep track of what medications you took, how you’re supposed to take them, and what each one is for.

Seniors on multiple medications may find it overwhelming and confusing, making it hard to follow doctor’s orders for each medication. Concerningly, research shows that patients taking a large number of prescriptions may neglect vitally important drugs, which can lead to worsening health and a decline in quality of life.

Medication overload can cause financial strain.

Certainly, taking multiple drugs is expensive, even with insurance. When medication causes financial strain, patients may skip or ration their medications, leading to a worsening of their health.

How common are medication issues for seniors?

Unfortunately, medication issues are common for seniors.

For instance, research shows that hospitalization rates due to adverse drug reactions are 4 times higher for seniors, as compared to adults under 65. In fact, research shows that although only 14% of the US population is over 65, they account for 56% of hospitalizations for adverse drug events.

Additionally, according to a Lown Institute report, in a recent 10-year period, an estimated 35 million seniors visited an emergency room for an adverse drug event. Moreover, every day in the US, 750 seniors are hospitalized due to serious side effects from one or more medications, leading to well over 2 million admissions in a 10 year period.

Of course, there are many seniors who experience adverse drug events but are not hospitalized, instead receiving care in outpatient settings.

Finally, experts believe less than 50% of people who experience an adverse drug event recognize it as such and thereby seek medical treatment. Importantly, this means that about 20% of seniors suffer from an adverse drug event every year – many without even realizing it!

Biologically, seniors have an increased risk of adverse drug reactions.

Importantly, there are significant biological differences between younger and older patients, often not realized by doctors or patients.

For instance, seniors are more likely to experience an ADR due to the following biological differences:

In general, seniors weigh less and have different body composition than younger people, impacting the concentration of medication in their bodies, and how long medications stay in their bodies.
It’s harder for the livers of seniors to process drugs as well as in younger people.
Kidneys of seniors can’t clear drugs out of the body as well as in younger people.
Seniors have increased sensitivities to many medications.
It’s harder for seniors to maintain their blood pressure, making them more vulnerable to dizziness, falls, etc.
Medications can make it even harder for seniors to modulate their temperatures, potentially causing life-threatening, or fatal, changes in body temperatures.
Seniors are more likely to have at least one disease that alters their body’s response to medications.

Which drugs are most likely to cause medication issues for seniors?

Research shows the following 3 classes of drugs contribute to 60% of emergency room visits for adverse drug reactions among seniors:

Blood thinners – which can cause severe, life-threatening bleeding.
Diabetes medications – which can cause low blood sugar, increasing the risk for falls, factures, confusion, seizures, and hospitalizations.
Opioids – which can lead to sedation, falls, and cognitive impairment.

Some medications can cause memory and cognition issues.

Unfortunately, many commonly prescribed drugs can interfere with memory and cognition. According to AARP, these seven are the most likely to cause memory issues:

Antianxiety drugs (benzodiazepines)
Antiseizure drugs
Tricyclic antidepressants
Narcotic painkillers (opioids)
Sleeping aids (nonbenzodiazepine sedative-hypnotics)
Incontinence drugs (anticholinergics)
Antihistamines (first generation)

Additionally, the article notes the following medications may also interfere with memory and cognition:

Beta-blockers
Corticosteroids.
Heartburn medications.
Cannabinoids (cannabis/marijuana).

If you take any of these types of medications, I strongly suggest you read their article. You can learn how each medication can impact your memory, the brand and generic names of drugs in each category, and alternatives.

Special concerns for dementia patients.

An analysis of Medicare claims found that almost 14% of people with dementia who lived outside nursing homes had overlapping prescriptions for 3 or more drugs that act on the central nervous system. Unfortunately, taking 3 or more drugs like these can increase the risk for impaired cognition, fall-related injury, and even death.

The drugs of concern are antidepressants, antipsychotics, anti-epileptics, benzodiazepines, non-benzodiazepine receptor agonist hypnotics, and opioids.

Why do seniors take so many medications?

Importantly, most patients, families, and policymakers – as well as many healthcare providers – don’t understand the enormity of medication overload.

Unfortunately, prescribing too much medication is ingrained in America’s healthcare systems. Experts believe the culture, structure, and practices of the US healthcare system make it easy for providers to prescribe medications and hard for them to reduce a dosage or stop a prescription altogether.

The Lown Institute identifies three aspects of the US healthcare system that contributes to medication overloading:

A culture of prescribing – Patients and healthcare providers strongly believe there is a “pill for every ill”.

Information and knowledge gaps – Healthcare providers and patients don’t have the critical information and skills needed to evaluate the evidence and make informed decisions regarding medications.

A highly fragmented system of care – Patients see multiple health care providers in a variety of settings, with providers not communicating with each other to discuss patient care. This fragmentation leads to more medications and an increase in inappropriate prescribing.

What’s the doctors’ role in medication overload?

Certainly, some providers try to reduce their patients’ medication overload. However, many do not. And there is no healthcare professional group, public organization, or government agency formally responsible for addressing this issue.

Furthermore, most patients do not have a healthcare provider taking on the responsibility of reducing medication overload. And even if providers were willing, most healthcare providers don’t have the time, training, or resources to address medication overload, which would require them to:

Coordinate care among the patient’s medical team.
Track medications prescribed by everyone on a patient’s medical team.
Undertake efforts to reduce the number and dosages of medications.

Importantly, doctors generally don’t have access to the information needed to reduce medication overload among their senior patients.

Firstly, fragmented care means providers may not know all the medications a patient takes, making it hard for any provider to consider if a patient is experiencing medication overload.

Secondly, and alarmingly, providers often prescribe drugs to treat what they think is a new medical condition or the worsening of an existing condition. However, in reality, they are adding a drug to manage the side effect of another drug. Then if the newest drug causes a new side effect, another provider may prescribe yet another drug to manage the latest symptoms. This is called “prescribing cascade” and it can cause serious harm and even death.

Thirdly, there is little information available about drug interactions among seniors or how to reduce the number of medications used.

Fourthly, doctors use treatment guidelines based on studies of younger, healthier patients. And available guidelines rarely provide information on how to evaluate the total number of drugs seniors take, or how to lower dosages or stop medications for seniors.

Finally, time-squeezed appointments put pressure on doctors, encouraging them to quickly write a prescription and move on.

What’s the pharmaceutical industry’s role in medication overload?

As you may know, pharmaceutical companies pay for most clinical drug trials. Their desire for positive outcomes contributes to a lack of reliable information. And these companies often fund studies they design to prove their drugs work for common ailments.

Pharma companies work hard to spin trial results to highlight the benefits and downplay any negative effects. Additionally, they aggressively market their drugs to healthcare providers, with marketing materials and published papers reporting their drugs are safer, more effective and appropriate for a larger population of patients than they actually are.

Moreover, pharmaceutical companies spend billions of dollars every year marketing to doctors. They pay doctors consulting fees and provide gifts, including lavish vacations, to influence doctors’ recommendations. This practice is common, despite widely accepted studies demonstrating that drug industry’s marketing activities influence doctors’ behavior in ways that are detrimental to patients and the public.

Upsettingly, many of the professional medical societies that publish treatment guidelines used by doctors rely heavily on pharma funding, giving them less incentive to promote a culture with less prescribing.

What’s the patients’ role in medication overload?

Many patients ask their doctors for medication, even if there is a non-medication option, such as lifestyle changes. We all want to feel better – quickly and easily. And it doesn’t help that we see countless ads touting the benefits of medications. If you insist on getting a new medication even though your doctor advises you against it, you increase your risk of harm from medication overload and adverse drug reactions.

Importantly, most patients don’t understand the potential harm of any given medication, nor do they understand the dangers of medication overload.

For instance, in a recent poll of seniors and family caregivers of seniors, many respondents were not knowledgeable about the risks and side effects of medicines. Importantly, almost 40% did not know that certain prescription drugs can increase cognitive impairment or confusion. And only 50% knew seniors should avoid certain drugs. Unfortunately, about 50% of patients and family caregivers reported they have never talked with their healthcare providers about stopping unneeded or inappropriate medications.

What can seniors do to reduce the risk of medication issues?

In order to reduce your risk of harm, you must share your questions and concerns with your healthcare provider. Plus, you should play an active role in the decision-making process when discussing medications, as well as other treatment options.

Importantly, speak with your healthcare providers if you think you are taking too many medications or if you are experiencing adverse effects.

Reduce your risk of medication overload and/or an adverse drug reaction.

First and foremost, at least once a year, ask your primary care doctor for a “prescription checkup”. Bring a complete list of all medications, including over-the-counter drugs, for your doctor to review. Importantly, ask if any medications can be eliminated, or if any dosages can be reduced. And ask if any of the medications you take can negatively interact.

You can also ask your pharmacist to review your list of medications, including over-the-counter and supplements, to identify possible issues.

Additionally, don’t push your doctor to prescribe medication. Push aside the temptation to get “a pill for every ill”. And just because you saw an ad for a medication on TV, or a friend told you how much it helps her, it doesn’t mean you need it.

Additionally, consider these steps to minimize your risk:

Make sure each of your doctors knows ALL the medications you take, including over-the-counter medications and herbal supplements. At every appointment, your doctor (or a staff member) should ask you to confirm your medications. Listen carefully, check the doctor’s list against your own list, and make any corrections needed. Do NOT assume that each of your doctors has access to your medication list via your Electronic Health Records (EHR). Many EHRs do not connect to each other.
Always carry your list of medications with you. You can keep a piece of paper in your wallet, make a note on your phone, or use a medication tracking app.
Use the same pharmacy for all your medications – the pharmacist, or their computer system, may spot potential problems. But don’t rely on this – it’s not foolproof.
Ask your doctor if any of your medications require blood testing. If so, follow the blood testing schedule. And pay extra attention to make sure you take these medications exactly as prescribed.
Make sure you properly understand when and how to take each medication (see the section below for tips).

Make sure you understand when and how to take each medication.

When you get a new prescription, ask your doctor these questions:

When should I take this medication, specifically? For example, does 3 times/day mean at meals or every 8 hours?
How should I take this medication? With or without food?
Any particular food or beverages to avoid while taking this medication?
How long will it take to work? How will I know if it is working?
What should I do if I experience side effects?
Can I crush pills? Split pills?
What should I do if I miss a dose?
How should I store it?

You should also ask your doctor the questions above if you don’t feel certain about how to take any of your existing medications.

Make it simpler to take your medications correctly.

Since medication mistakes are common and easy to make, set up a system to make it easier.

Use a pill sorter. Make sure you focus on the task when you fill it up each week. Many pills look similar!
Use an alarm system, on your cell phone, watch, or other timer to help you remember to take each medication on time.
For complicated medication regimens, keep track with the ZaggoCare Daily Medication Chart (scroll down to the footer for our free, downloadable chart).

Do you know if any of your medications are considered “risky”?

Some medications are riskier than others, so it’s worth taking a few moments to see if you take any medications in the “risky” category.

Check your medications on WorstPills.org to see if you take medications considered risky. Discuss any findings with your doctor. Importantly, do not stop taking medications without talking to your doctor.
Review the American Geriatric Society’s Beers Criteria list of medications deemed potentially dangerous for seniors. Again, discuss your findings with your doctor.
If your loved one has dementia, talk to his/her doctor about reducing central nervous system drugs if he/she takes 3 or more from the list above.

Don’t accept new medications without a conversation with your doctor.

Firstly, you must involve yourself in the decision-making process! If your doctor wants you to start a new medication, make sure he/she understands your preferences and values. For instance, is quality of life more important to you than longevity? And make sure you fully understand the benefits and harms. Don’t be afraid to ask as many questions as you need.

Before agreeing to a new medication, ask these questions:

What is the medication for?
Is the medication absolutely necessary?
What are the expected side effects?
Are there lifestyle changes I can try first?
Am I getting the lowest dose possible for my condition? Or, can I start at a low dose and see how it goes?
What will happen if I don’t take it?
How will we know if it’s working or not working? How long will that process take?
Is there a chance I’m getting a new medication to treat side effects from other medications I currently take? If so, are there other options?
Will this new medication interact negatively with other medications I already take?
Will it impact other medical conditions I have?
Will a time come when I could stop this medication or go on a lower dosage? How will that be decided?

Importantly, before starting a new medication, take notes regarding your health. This will help you determine if a new medication is making you feel worse.

Speak up if you suspect a medication issue.

Importantly, if you recognize a change in your own, or your loved one’s, abilities or health, speak up. Although your doctor may dismiss your concerns, persist until you feel your doctor takes your concerns seriously.

Need more help than your doctor can provide?

Most doctors and pharmacists do not have specialized training and experience relating to the special considerations for seniors’ medication. Therefore, you may want to hire an expert to discuss your medication regimen, side effects, and possible medication overload and adverse drug reactions.

Importantly, hiring an expert pharmacist or pharmacologist may involve fees that your insurance will not cover. Ask about charges before hiring an expert to help you.

Senior care pharmacists.

Did you know there are “senior care pharmacists” who specialize in the unique medication-related needs of seniors? There are many ways a senior care pharmacist can help you. They can:

Reduce medication-related problems and improve therapeutic outcomes.
Minimize the health risks of medications that may be inappropriate and recommend more appropriate choices, including stopping unnecessary medications.
Identify untreated or undertreated health concerns and make treatment recommendations, taking into account potential side effects and drug/food/disease interactions.
Carefully review your entire medication regimen, including supplements and over-the-counter medications, to determine whether each product is necessary, dosed correctly, safe for you, and affordable.
Educate other members of your medical team regarding medication management.

To find a senior care pharmacist in your area, use the directory at the American Society of Consultant Pharmacists.

Clinical pharmacologists.

Pharmacologists focus on medications and how they affect the people and organisms that consume them. Some pharmacologists work in labs and develop drugs, while others work with patients to address medication-related issues.

As the title suggests, geriatric clinical pharmacologists are medical doctors who specialize in medication use and issues for seniors. They can provide similar evaluations and recommendations as those listed above for senior care pharmacists.

Unfortunately, there are not many geriatric pharmacologists, so you might have a hard time finding one to help you. I suggest you search online using the terms “geriatric pharmacologist” and your state. Don’t worry if the doctor’s office is far from you – you may be able to have phone or video appointments.

One senior’s tale of getting help for medication issues.

Isabella, an 88-year-old friend of mine, was taking 10 medications – a combination of drugs to treat chronic conditions such as high blood pressure, and others to manage a recent serious illness. After months and months of feeling terrible, unable to spend much time of out bed, she turned to a geriatric pharmacologist for help.

Isabella is pleased to see her life improving. She appreciates the pharmacologist’s expertise and the time the doctor spends on her case. The pharmacologist evaluated each drug, determined potential adverse interactions, and discovered that Isabella didn’t need all the medications she was taking. In cooperation with Isabella’s other doctors, the pharmacologist developed new protocols that improved Isabella’s quality of life.

Geriatrics doctor.

Geriatrics doctors specialize in the care of seniors, including addressing medication-related issues. If you’re interested in using a geriatrics doctor, you can look for one in your area using the search tool on HealthAging.org.

A very important warning.

Although medication issues can cause harm to seniors, NEVER stop a medication without talking with your doctor.

Learn more…

Every medication carries a degree of risk. In addition to the medication-related issues for seniors discussed in this post, read these posts to learn more:

Medication Issues for Seniors