In recent years, with the acceleration of population aging, it has become increasingly common for older adults to live with multiple chronic conditions. Diseases such as hypertension, diabetes mellitus, coronary artery disease, osteoarthritis, and chronic kidney disease often require long-term combination therapy. Against this backdrop, polypharmacy has become a major focus in geriatric medicine. Internationally, the long-term concurrent use of five or more medications is generally defined as polypharmacy, while the use of ten or more medications is referred to as hyperpolypharmacy.

Although appropriate combination therapy can improve disease control and enhance quality of life, increasing numbers of medications are also associated with higher risks of drug-drug interactions, adverse drug reactions, falls, and poor medication adherence. Therefore, scientifically assessing the risks associated with polypharmacy in older adults has become an essential component of precision medicine and geriatric pharmaceutical care.

I. Why Are Older Adults More Likely to Experience Polypharmacy?

Older adults often live with multiple chronic diseases rather than a single medical condition.

For example, a patient in their seventies may simultaneously have hypertension, type 2 diabetes, coronary artery disease, hyperlipidemia, and osteoporosis, requiring antihypertensive medications, glucose-lowering agents, statins, antiplatelet therapy, and calcium supplements. As the number of chronic conditions increases, medication regimens inevitably become more complex.

In addition, older adults may require medications to manage sleep disorders, anxiety, constipation, chronic pain, and other age-related conditions, further increasing both the number of medications and daily dosing frequency.

Furthermore, prescriptions from different specialists, along with self-purchased dietary supplements and over-the-counter (OTC) medications, may further contribute to overall medication burden, making polypharmacy increasingly common.

II. What Does Taking Five or More Medications Mean?

It is important to emphasize that taking five or more medications does not necessarily indicate inappropriate prescribing.

For many patients, combination pharmacotherapy is recommended by clinical guidelines and is essential for controlling disease and reducing the risk of complications. For example, patients with cardiovascular disease often require antihypertensive agents, lipid-lowering medications, antiplatelet drugs, and glucose-lowering therapies, all of which are supported by robust evidence-based medicine.

The real concern is inappropriate polypharmacy, which refers to situations where:

• There is unnecessary duplication of medications;
• Clinically significant drug-drug interactions are present;
• The potential risks of a medication outweigh its expected benefits;
• High-risk medications are prescribed for older adults without appropriate justification;
• Medications are continued despite no longer having a clear clinical indication.

Therefore, the key issue in polypharmacy is not simply the number of medications, but whether every medication is necessary, safe, and provides meaningful clinical benefit.

III. What Are the Potential Risks of Polypharmacy in Older Adults?

1. Increased Risk of Drug-Drug Interactions

As the number of medications increases, the likelihood of drug-drug interactions rises substantially.

These interactions may alter drug absorption, metabolism, or elimination, leading to either reduced efficacy or excessive pharmacological effects. For example, combining multiple anticoagulant or antithrombotic agents may increase bleeding risk, while certain drug combinations may affect cardiac rhythm or place additional stress on the liver and kidneys.

Therefore, whenever a new medication is introduced, potential interactions with the patient's existing treatment regimen should be carefully evaluated.

2. Higher Incidence of Adverse Drug Reactions

Older adults generally experience age-related declines in liver function, kidney function, and physiological reserve, making them more susceptible to medication-related adverse effects.

Common adverse reactions include:

• Hypotension
• Hypoglycemia
• Dizziness
• Drowsiness
• Electrolyte disturbances
• Gastrointestinal discomfort
• Increased bleeding risk

Studies have consistently shown that polypharmacy is associated with higher rates of adverse drug events, emergency department visits, and hospitalizations.

3. Increased Risk of Falls and Fractures

Falls are a leading cause of disability among older adults, and polypharmacy is recognized as one of the major contributing risk factors.

Certain medications—including sedative-hypnotics, some antidepressants, opioid analgesics, and certain antihypertensive agents—may cause dizziness, orthostatic hypotension, delayed reaction time, or impaired balance, thereby increasing the risk of falls and fractures.

For frail older adults, medications affecting the central nervous system or blood pressure should be carefully reviewed, and treatment plans adjusted when appropriate.

4. Reduced Medication Adherence

As medication regimens become more complicated, patients are more likely to miss doses, accidentally duplicate medications, or make dosing errors.

Older adults may also experience memory impairment, reduced vision, or swallowing difficulties, all of which can further compromise long-term medication adherence.

Poor adherence not only reduces treatment effectiveness but may also lead to inadequate disease control and increased healthcare utilization.

5. Increased Burden on Liver and Kidney Function

Most medications undergo hepatic metabolism or renal excretion.

With aging, hepatic blood flow declines and glomerular filtration rate (GFR) decreases, allowing medications to remain in the body longer and increasing the risk of drug accumulation and toxicity.

Therefore, for older adults with chronic kidney disease or impaired liver function, medication dosages should be adjusted according to organ function, with regular monitoring of relevant laboratory parameters.

IV. How Do Physicians Assess the Risks of Polypharmacy in Older Adults?

Today, geriatric medicine and clinical pharmacy have established comprehensive approaches to evaluating polypharmacy.

Common assessment criteria include:

• Whether every medication has a clear clinical indication;
• Whether there is unnecessary therapeutic duplication or overlapping effects;
• Whether clinically significant drug-drug interactions are present;
• Whether any high-risk medications are being prescribed;
• Whether dosage adjustments are needed based on age or hepatic and renal function;
• Whether medications with limited benefit or excessive risk can be discontinued through deprescribing.

In clinical practice, healthcare professionals also use validated tools such as the American Geriatrics Society (AGS) Beers Criteria and the STOPP/START Criteria to systematically evaluate medication regimens in older adults, helping optimize therapy while minimizing adverse drug events.

V. How Can Older Adults Reduce the Risks Associated with Polypharmacy?

Optimizing medication management is more important than simply reducing the number of medications.

Older adults and their caregivers are encouraged to:

• Regularly organize all prescription medications, over-the-counter drugs, and dietary supplements, and provide healthcare professionals with a complete medication list;
• Ask at every follow-up visit whether long-term medications remain necessary;
• Avoid discontinuing, changing, or duplicating medications without medical advice;
• Seek prompt medical attention if symptoms such as dizziness, falls, altered consciousness, recurrent hypoglycemia, or abnormal bleeding occur;
• Whenever possible, have chronic diseases managed by the same healthcare institution or coordinated medical team to reduce duplicate prescribing and improve continuity of care.

For patients taking multiple long-term medications, a comprehensive medication review should ideally be performed at least once a year to optimize treatment based on changes in health status.

Conclusion

As an increasing number of innovative medicines become available worldwide, older adults have access to a broader range of treatment options than ever before. However, because drug approval timelines vary across countries and regions, many innovative therapies approved overseas may not yet be available locally. As a result, patients are paying increasing attention to reliable information on innovative medicines and compliant pathways for accessing them.

As a platform dedicated to global innovative medicines, Dengyue Pharmaceuticalclosely follows advances in cardiovascular diseases, diabetes, oncology, rare diseases, and other therapeutic areas. Supported by a professional pharmaceutical service team, the company provides innovative drug information, overseas medicine consultation, verification of medicine sources, and guidance on compliant access channels, helping patients gain comprehensive and reliable access to global treatment developments while supporting informed clinical decision-making.