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Polypharmacy in the Elderly

Concurrent use of multiple medications and its consequences

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Dahiliye (İç Hastalıkları) department. Book Appointment →

What is Polypharmacy in the Elderly?

Polypharmacy is the concurrent use of five or more medications, while severe polypharmacy refers to ten or more.

It is common in older adults: about 30–40 percent of community-dwelling adults over 65 take five or more medications daily, with even higher rates in long-term care.

Drivers include multimorbidity, single-disease guideline application without holistic review, prescribing cascades and patient/family expectations.

Older adults are particularly vulnerable due to age-related changes in pharmacokinetics (reduced renal clearance, altered hepatic metabolism) and pharmacodynamics (increased sensitivity to CNS drugs and anticoagulants).

Inappropriate polypharmacy increases risk of adverse drug events, falls, cognitive impairment, hospitalization and mortality.

Symptoms

New or worsening confusion, sedation or cognitive decline
Falls, dizziness, orthostatic hypotension or balance problems
Fatigue, weakness, anorexia or unintentional weight loss
Constipation, urinary retention, dry mouth or other anticholinergic symptoms
Bleeding, bruising or signs of drug accumulation due to drug interactions
Symptoms suggesting a prescribing cascade (treating side effects of one drug with another)
Difficulty managing complex medication regimens (missed doses, duplicate doses)

Risk Factors

Multimorbidity with several chronic conditions managed by multiple specialists
Advanced age (over 75)
Frailty and functional decline
Multiple prescribers and lack of care coordination
Recent hospitalization or transitions of care
Cognitive impairment with reduced ability to manage medications
Living in long-term care facilities
Use of high-risk medications (anticholinergics, benzodiazepines, opioids, NSAIDs)

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Use of five or more daily medications, especially in adults over 65
  • New or worsening cognitive symptoms in patients on multiple medications
  • Falls, dizziness or orthostatic symptoms in elderly patients
  • Difficulty understanding or managing medications
  • Multiple specialists prescribing without coordination
  • Hospitalization with possible drug-related causes
  • Patient or caregiver concerns about medication burden, side effects or cost

Treatment Methods

01
Conduct comprehensive medication review including all prescription, over-the-counter, herbal and supplement use
02
Apply explicit criteria (Beers Criteria, STOPP/START) to identify potentially inappropriate medications in older adults
03
Use deprescribing frameworks systematically: assess indication, weigh benefits versus harms, identify candidates for discontinuation, plan tapering schedule, monitor outcomes
04
Prioritize deprescribing of highest-risk drugs: long-acting benzodiazepines, anticholinergics with cognitive risk, antipsychotics in dementia, NSAIDs in CKD/heart failure, proton pump inhibitors used long-term without indication
05
Address prescribing cascades by treating root cause rather than adding medications
06
Simplify regimens with combination products, once-daily dosing, pill organizers and reminder systems where appropriate
07
Engage patients and caregivers in shared decision-making — understanding goals of care guides what to keep and what to stop
08
Coordinate among specialists, pharmacists and primary care to ensure unified medication strategy
09
Reassess at every transition of care (admission, discharge, level of care change)
10
Document deprescribing decisions with clear rationale and follow-up plan

Which Department to Visit?

You can visit our Dahiliye (İç Hastalıkları) department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.