The Hidden Epidemic of Polypharmacy: Holiday Medication Safety
Peace of mind for the holidays: staying connected to what matters most for senior care.
Dr. Justin Mutter, MD, MSc·3 min read
Reviewed for accuracy
What Is Polypharmacy and Why Does It Matter?
Did you know that medication safety issues account for nearly one-third of all hospitalizations in the United States? That’s a staggering percentage, but probably not surprising to older adults or to those who care for them. Physicians and nurses call this problem “polypharmacy” – a precarious state of taking five or more medications. Over 10% of Americans take more than ten medications daily – a situation often referred to as “extreme polypharmacy.” The challenge is so widespread – and yet often underrecognized – that some call this a “ hidden epidemic.” This epidemic exists for many reasons, including:
- Seeing multiple prescribing doctors in a given year
- Having multiple medical problems
- Lack of training for medical providers in deprescribing
- Medical systems that prioritize treating individual medical diagnoses instead of the care of whole persons
The Dangers of Medication Overload
Add to this a byzantine health insurance and pharmacy approval system, and it is easy to see how things can go awry. The Lown Institute estimates that “medication overload” contributes to premature deaths in 150,000 Americans annually.
Why Medication Adherence Is So Difficult
But it’s not just an issue of too many medications. It’s also that – with so many medications from so many prescribers – it’s exceedingly hard to keep up! Only about 50% of us take our medications as prescribed, and yet pharmacists indicate that this number should be above 80% in order for medications to bring us the benefits for which they were created. As the former U.S. Surgeon General C. Everett Koop quipped many years ago, “ Drugs don’t work in patients who don’t take them.”
Building a Better Approach to Medication Management
The team at Alula wants to turn this challenge into an opportunity. Alula is, above all, an opportunity to connect and to communicate. When medication management is complicated, we need a care team to rally around simplified solutions.
Frequently Asked Questions
What is polypharmacy and when does it become dangerous?
Polypharmacy refers to taking five or more medications simultaneously—a threshold that becomes increasingly common as people age and accumulate multiple health conditions managed by multiple specialists. It becomes dangerous when medications interact in harmful ways, when side effects compound each other, or when the overall medication burden exceeds what the body can safely process. More than 10% of Americans take ten or more medications daily.
How many medications is too many for an older adult?
Five or more medications is the clinical threshold for polypharmacy. Ten or more is considered extreme polypharmacy. The right number is the lowest number that safely manages the person's conditions. A geriatrician can perform a formal medication review to identify drugs that are redundant, outdated, interacting, or no longer necessary—a process called deprescribing.
What are the risks of medication overload in older adults?
Medication safety issues account for nearly one-third of all hospitalizations in the United States, and the Lown Institute estimates that medication overload contributes to approximately 150,000 premature deaths annually. Risks include adverse drug interactions, increased fall risk from blood pressure and sedative medications, confusion, and compounding side effects that make it difficult to identify which medication is causing which problem.
How can caregivers help prevent medication overload?
Maintain a complete, current medication list that includes all prescriptions, over-the-counter medications, and supplements. Bring this list to every appointment. Ask each prescriber whether their medications are still appropriate given everything else the person takes. Request a formal medication review from a geriatrician or pharmacist. Ask directly: 'Is there anything on this list we could safely reduce or stop?'
What should I do if I think my parent is on too many medications?
Start by making a complete list of everything they take—prescriptions from every doctor, over-the-counter drugs, and supplements. Then ask their primary care provider or geriatrician for a full medication review. Be direct: ask whether any medications could be safely reduced or eliminated. This process is called deprescribing, and it is a legitimate part of good geriatric care. Simplifying a medication regimen also often improves how consistently medications are actually taken.
Newsletter
Guidance delivered weekly
Expert perspectives on caregiving, delivered to your inbox every Thursday. No spam, just support.
Related Articles
What Dementia Behaviors Are Really Telling You
Behaviors are not the person. They are the disease acting on a brain that can no longer regulate itself. A geriatrician and an eight-year family caregiver share what they have learned from living this.
Sundowning in Dementia: Why It Happens and What Helps
A geriatrician explains sundowning through the lens of cognitive reserve and fatigue — why your loved one changes in the evening, and three practices to help: Anticipate, Observe, Alleviate.
Delirium vs Dementia: How to Tell the Difference
A geriatrician explains why sudden confusion is not the same as dementia — and why the timeline matters.