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A KFF Health News report examines risks associated with older adults taking multiple medications and urges patients concerned about side effects to discuss their full medication list with a health professional. A JAMA Internal Medicine study found the share of Americans over 65 taking five or more medications nearly doubled from 2000 to 2020. Deprescribing should be planned with a clinician; the goal is safety, not stopping as many drugs as possible.
More than a third of older adults in the United States take five or more medications a day, and the share of Americans over 65 doing so nearly doubled from 2000 to 2020, according to a study cited in a KFF Health News report. The report advises people concerned about side effects or medication combinations to keep an up-to-date list and raise their concerns with a doctor or pharmacist, rather than stopping a drug on their own.
The report describes the experience of Jonathan Bledsoe, a Reading, Pennsylvania, resident who took several medications, including prescriptions for mood stabilization and cholesterol. After he noticed that his urine had turned dark, he contacted his doctors. He learned that an interaction between his medications was beginning to damage his liver, the report said. After his medications were changed, his liver and kidney function returned to normal.
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. More drugs can mean more opportunities for interactions and side effects, she said. The report also describes a prescribing cascade: a drug causes a side effect, another medication is prescribed to address it, and the growing combination may lead to further problems.
One example Mixon gave involved a water pill used by some people with heart failure to reduce fluid retention. Frequent urination may contribute to incontinence, which could then be treated with another drug. The report stresses that medicines can provide important benefits; the concern is whether each medication remains necessary and appropriate for the individual patient.
When Medication Lists Keep Growing
Medication combinations can become difficult for patients and clinicians to track, particularly when prescriptions come from multiple providers or health systems with separate records. Pharmacist DeLon Canterbury, who leads a consulting company focused on helping patients reduce unnecessary medications, cautioned that patients should not assume someone else is checking every possible interaction.
The report says bodies can process medications differently with age, potentially raising the risk of unwanted effects such as falls, memory loss, constipation or diarrhea. These outcomes are not inevitable, and the report does not suggest that people should stop prescribed treatment without guidance. It presents a medication review as a way to weigh benefits, risks and the patient’s current health needs.
That discussion matters because patients may notice a new symptom or side effect between appointments. Bringing it to a clinician can help determine whether it is related to a medication, another health issue, or something else. The appropriate response depends on the person and the drug involved.
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Deprescribing Enters More Discussions
Deprescribing means intentionally reducing or stopping a medication when a clinician and patient determine it is appropriate. KFF Health News reports that the practice has gained momentum over the past decade, alongside rising polypharmacy and concern about medication-related harms. Canterbury said the science on safe tapering is newer and is not yet widely taught in medical schools.
The report also notes a policy development: the Centers for Medicare & Medicaid Services issued guidance this year clarifying how physicians and pharmacists can be paid for medication reviews and for helping patients taper drugs when appropriate. Clinicians had previously reported uncertainty about payment for the work, which can take time.
Separately, the report says Health and Human Services Secretary Robert F. Kennedy Jr. has advocated weaning Americans off psychiatric medications he says are overused. That position has polarized the medical community, according to the report. The broader issue of reviewing a person’s prescriptions is distinct from any blanket claim that a particular class of medication is unnecessary.
““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 Medication Reviews Can Establish
The cited study describes a change in the share of older Americans taking five or more medications, but the report does not provide enough detail here to determine how much of that change reflects particular conditions, prescribing practices or other factors. A count of medicines alone also does not show whether an individual’s treatment is inappropriate: some people need several drugs for separate health needs.
The report does not identify a single medication or combination that explains all adverse effects, nor does it give a universal schedule for tapering. Whether a drug should be changed, and how, depends on the patient and medication. The report’s examples are not a diagnosis of any reader’s symptoms. It also does not establish how widely the new federal payment guidance will change access to medication reviews.
Bring the Full List to a Clinician
People worried about their prescriptions can make an up-to-date list of medications, vitamins and supplements and bring it to a primary care clinician, specialist or pharmacist. The report notes that a paper list may be enough; a tracking app or QR-code bracelet is not required. Patients can ask whether each item is still needed, whether any symptoms could be medication-related, and whether a change or taper is appropriate.
Any reduction should be discussed with a qualified health professional, rather than attempted abruptly or without advice. Clinicians and pharmacists can review the full list and decide whether monitoring or a gradual taper is needed. The report does not set a timeline for future policy changes or for wider adoption of deprescribing practices.
Key Questions
What does deprescribing mean?
Deprescribing is the planned reduction or discontinuation of a medication when a patient and clinician decide it is appropriate. It is not a general instruction to stop treatment.
What is polypharmacy?
In the report, polypharmacy refers to taking five or more medications. The cited study found that the share of Americans over 65 taking that many nearly doubled between 2000 and 2020.
Should I stop a medication if I suspect a side effect?
Do not change or stop a prescribed medication without discussing it with a qualified health professional. Contact your clinician or pharmacist to review the symptom and your full medication list.
What should I include on a medication list?
List prescription drugs, over-the-counter medicines, vitamins and supplements. Keep the list current and bring it to appointments so health professionals can review the full combination.
Source: rss
