Polypharmacy in aging adults, usually defined as regularly taking five or more medications, increases the risk of falls, confusion, drug interactions, kidney injury and hospital admissions. Deprescribing is the careful, supervised process of reducing or stopping medications whose risks now outweigh their benefits. Done well, it often leaves people feeling clearer, steadier and better, while keeping the treatments that truly protect them.
Most medication lists grow one reasonable decision at a time. A blood pressure pill after one visit, a stomach medication during a stressful year, a sleep aid after a hospital stay. Years later, nobody has looked at the whole list together.
Why polypharmacy in aging adults matters
As we age, the body handles medications differently:
- Kidney and liver function decline, so drugs and their metabolites can accumulate.
- Body composition changes, with less water and muscle and more fat, altering how drugs distribute.
- The brain becomes more sensitive to sedating and anticholinergic medications.
- Blood pressure regulation becomes less responsive, raising the risk of dizziness on standing.
Add more prescribers, more pharmacies and more supplements, and the chance of an interaction or duplication rises sharply. I discuss interaction risk in more depth in medication interaction screening: a hidden danger.
The prescribing cascade
One of the most common problems is the prescribing cascade: a side effect of one drug is mistaken for a new condition and treated with another drug. Examples include ankle swelling from a calcium channel blocker treated with a diuretic, or a cough from an ACE inhibitor treated with cough medication. Recognizing the cascade often lets two medications go.
Medications that deserve a second look
Expert tools such as the American Geriatrics Society Beers Criteria and the STOPP/START criteria list medications that are often inappropriate for older adults. Common categories include:
- Sedative-hypnotics, such as benzodiazepines and "Z-drug" sleep aids, linked to falls and cognitive impairment.
- Strongly anticholinergic drugs, including some older antihistamines (diphenhydramine is common in nighttime sleep aids), bladder medications and older antidepressants.
- Long-term proton pump inhibitors without a continuing indication.
- Diabetes medications that cause low blood sugar, especially when targets are tighter than needed.
- NSAIDs, which can affect kidneys, blood pressure and the stomach.
- Duplicate therapy, such as two drugs from the same class prescribed by different doctors.
- Supplements, which can interact with anticoagulants and other drugs.
Being on this list does not mean a medication must stop. It means its use should be justified.
A structured deprescribing strategy
In my practice, deprescribing follows a deliberate process rather than a quick cleanup.
1. Gather everything
The "brown bag review": every prescription bottle, over-the-counter product, vitamin, supplement, cream, eye drop and inhaler. Many problems hide in products patients do not think of as medicine.
2. Match each medication to a reason
For each item: Why was it started? Is that reason still present? Is there evidence it helps at this stage of life? Is the dose still right for current kidney function?
3. Weigh benefit against time and goals
Some preventive medications take years to provide benefit. For a healthy 70-year-old, that may be well worth it. For someone with limited life expectancy or different priorities, it may not be. These are conversations, not formulas.
4. Prioritize
Start with medications most likely to cause harm or with the least benefit. Change one thing at a time so you can tell what helped and what did not.
5. Taper when needed
Many medications should be reduced gradually. Benzodiazepines, antidepressants, beta-blockers, gabapentinoids, opioids and steroids are examples where abrupt stopping can cause withdrawal or rebound effects.
6. Monitor and follow up
Check symptoms, blood pressure, blood sugar or other relevant markers after each change. Sometimes a medication needs to restart, and that is part of the process.
Blood pressure and diabetes in older adults
Two areas deserve special mention. Blood pressure goals sometimes need relaxing in frail older adults who become dizzy or fall, and medication lists often still reflect targets set years earlier. I discuss individualized targets in blood pressure optimization beyond standard targets. Similarly, diabetes goals are often loosened in older adults to avoid hypoglycemia, which can cause falls and confusion.
Why time matters
Medication reviews take time. A 15-minute visit focused on a new complaint rarely allows a careful look at a list of twelve medications, which is part of why I wrote about the problem with 15-minute medicine.
Where optimization fits
Patients interested in longevity sometimes want to add things. In older adults, removing an unnecessary sedative or an over-intensive diabetes drug may do more for energy, cognition and fall risk than any new supplement or peptide. Fewer, better-chosen medications are a real form of optimization.
At Laeeq M.D., comprehensive medication review is part of internal medicine care. Dr. Laeeq coordinates with your other physicians and pharmacists rather than working around them, and family members are welcome to join visits when helpful.
Book a Consultation
If you or a parent take many medications and are not sure each one is still needed, book a consultation with Dr. Laeeq. The 60-minute evaluation is available virtually or in person in Reston, VA, and includes a full review of every medication and supplement.
This article is for educational purposes and is not medical advice. Discuss any treatment with a licensed physician who knows your history.
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Written by Dr. Laeeq Ahmed Butt, M.D., MBA
Board-certified internist practicing peptide and longevity medicine in Reston, VA, with virtual care in seven states. About Dr. Laeeq