TL;DR
More than a third of Americans over 65 take at least five medications, a pattern associated with greater risk of drug interactions and side effects. Health professionals say patients concerned about their medication mix should bring an up-to-date list to a clinician and ask whether any medicines can be safely tapered; they should not stop prescriptions on their own.
A growing share of older Americans take five or more medications, raising the potential for drug interactions and side effects, according to a KFF Health News report. Clinicians and pharmacists cited in the report encourage people worried about their prescriptions to bring a current medication list to a doctor or pharmacist and ask whether any drugs can be safely reduced or stopped.
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The percentage of Americans age 65 and older taking at least five medications nearly doubled between 2000 and 2020, according to a study published in JAMA Internal Medicine cited by KFF Health News. The report says more than one-third of older adults now take five or more medications each day. Amanda Mixon, a hospitalist and associate professor of bioinformatics at Vanderbilt University, said she sees older patients taking an average of 16 medications, often prescribed by multiple clinicians and filled at different pharmacies.
The report describes how a medication may trigger a prescribing cascade: a side effect is treated with another drug, which can then contribute to further symptoms or prescriptions. Mixon gave the example of a water pill prescribed for heart failure that increases urination; in some cases, incontinence may then be treated with another medication. The report does not suggest that every multi-drug regimen is inappropriate. The question is whether each medicine remains necessary and safe for the individual patient.
Jonathan Bledsoe, a Marine veteran from Reading, Pennsylvania, told the report that a medication interaction was beginning to damage his liver after he had taken several medicines for nearly three years. He said he noticed that his urine had turned dark and brought the symptoms to his doctors. After his medications were changed, the report says, his liver and kidney function returned to normal. His experience illustrates why new symptoms merit prompt medical attention, but it does not establish how common such outcomes are.
Why Medication Reviews Matter
Taking several prescriptions can make it harder for patients and clinicians to spot which drug may be causing a new symptom, particularly when different prescribers use separate health records. Pharmacist DeLon Canterbury told KFF Health News that patients should not assume someone is checking every medication interaction behind the scenes. That does not mean pharmacies and clinicians provide no medication checks; it means patients should share a complete, updated list and raise concerns directly.
Deprescribing means intentionally reducing or stopping a medication when a clinician determines it is appropriate, often with a gradual taper. The goal, Canterbury said, is patient safety, not reducing the number of medicines at any cost. Age can change how the body processes medications, and the report lists possible side effects including constipation, diarrhea, falls and memory problems. An individualized review can help weigh those risks against the benefits of each prescription.
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How Deprescribing Is Developing
The report says interest in deprescribing has grown over the past decade alongside increased use of multiple medications. But Canterbury said the science on how to taper medicines safely is newer and deprescribing is not yet widely taught in medical schools. Stopping some drugs suddenly can be unsafe; any change should be planned with the clinician responsible for the medication.
Policy has also begun to address the time required for medication reviews. According to the report, the Centers for Medicare & Medicaid Services released guidance this year clarifying how physicians and pharmacists can be paid for reviewing medicines and helping patients taper them when appropriate. The report says some clinicians had previously been uncertain about payment for this work. Separately, it notes that Health and Human Services Secretary Robert F. Kennedy Jr. has advocated reducing psychiatric medication use, a position that has divided members of the medical community. That policy debate is distinct from an individual clinical decision about a patient’s treatment.
“As you accumulate more and more medications, the chance of them interacting with each other and having bad interactions increases.”
— Amanda Mixon, hospitalist and associate professor of bioinformatics at Vanderbilt University
What a Medication Review Can Establish
The report does not identify a single medication or combination responsible for risk across all older adults, and the figures it cites do not show that every person taking five or more drugs will experience an interaction. Individual risk depends on the medicines, doses, health conditions and patient circumstances. The report also does not provide details of the study’s methods or a breakdown of which drug combinations were most often involved.
It is not clear from the report how widely clinicians will use the CMS payment guidance, or whether it will lead to more medication reviews. Patients should not interpret general concerns about polypharmacy as advice to stop a prescription. The appropriate next step depends on a clinician’s review of the full medication list and the reason each medicine was prescribed.
Bring a List to Your Clinician
People concerned about side effects, a new symptom or the number of medicines they take can ask a primary care provider, specialist or pharmacist for a medication review. The list should include prescriptions, over-the-counter drugs, vitamins and supplements, with doses when possible. A paper list is sufficient; the report notes that apps and tracking devices are optional tools, not requirements.
Patients can ask whether each medication is still needed, whether any could be contributing to symptoms, and whether a dose change or supervised taper is appropriate. Any plan to reduce or stop a medicine should be made with a qualified clinician, who can explain how to do it safely and monitor for changes. The report provides no timetable for further policy action following the CMS guidance.
Key Questions
What does polypharmacy mean in this report?
Here, polypharmacy refers to taking five or more medications. The report says more than one-third of Americans age 65 and older take at least that many each day.
What is deprescribing?
Deprescribing is the planned reduction or discontinuation of a medication when a clinician decides it is appropriate. Some medicines need to be tapered rather than stopped abruptly.
Should I stop a medication if I am worried about side effects?
No. Do not stop or change a prescription without discussing it with a clinician. Contact your care team about new or concerning symptoms and ask for guidance on whether the medicine should be reviewed.
What should I bring to a medication review?
Bring an up-to-date list of prescriptions, over-the-counter medicines, vitamins and supplements, including doses if known. A printed or handwritten list can work.
Does taking five or more medicines mean a person is being overtreated?
No. The number alone does not establish that treatment is inappropriate. A clinician should review why each medicine is being used, its benefits and risks, and whether it remains suitable for that person.
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