Geriatric Polypharmacy Interventions: How to Reduce Adverse Drug Events in Older Adults
Jan, 13 2026
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Older adults are taking more medications than ever. By 2025, nearly 41% of Americans aged 65 and older are on five or more prescriptions daily. That’s not just common-it’s dangerous. Each extra pill increases the risk of falls, confusion, kidney damage, and hospitalization. And here’s the hard truth: many of these drugs aren’t helping anymore. They’re just adding risk.
Why Polypharmacy Is a Silent Crisis
Polypharmacy isn’t just about having too many pills. It’s about taking drugs that no longer match a person’s health goals, life expectancy, or actual needs. For someone with advanced dementia, a statin to lower cholesterol might not be worth the risk of muscle pain or liver stress. For a frail 82-year-old with limited mobility, a blood thinner for a past atrial fibrillation episode might be doing more harm than good. The numbers don’t lie. Patients taking more than four medications have a 30-50% higher chance of falling and breaking a bone. Each additional drug bumps that risk up by about 8%. And in the U.S., nearly 28% of hospital admissions among older adults are caused by medication problems-many of them preventable. The problem isn’t just doctors prescribing too much. It’s fragmented care. One doctor treats heart disease. Another handles arthritis. A third manages diabetes. None of them see the full picture. Medication lists get outdated. Side effects get ignored. And patients rarely speak up-68% of older adults are afraid to ask if they can stop a pill.What Actually Works: The Three Levels of Intervention
Not all medication reviews are created equal. Research shows only one type delivers real results: Type III Comprehensive Medication Reviews.- Type I just looks at the list of drugs. No patient talk. No context. Doesn’t work.
- Type II adds a check on whether the patient is taking the meds. Still doesn’t fix the problem.
- Type III includes a face-to-face or video visit where a pharmacist or doctor asks: Why are you on this? Is it still helping? What are you afraid to stop? This is the only approach proven to cut hospital readmissions by 18.3%.
Tools That Guide the Right Decisions
Clinicians don’t guess. They use validated tools. Three stand out:- Beers Criteria (2023)-lists drugs to avoid in older adults, like benzodiazepines and certain anticholinergics. Widely known, but alone, it doesn’t improve outcomes.
- STOPP/START (v3, 2021)-STOPP finds inappropriate drugs. START finds drugs that should be added but aren’t. This is the only tool proven to reduce hospitalizations in clinical trials.
- FORTA List-classifies drugs as A (strongly recommended), B (recommended), C (caution), or D (avoid) based on age and condition. Used heavily in Europe, now gaining ground in the U.S.
Who Should Lead the Charge?
Pharmacists aren’t just dispensers. They’re the frontline in polypharmacy reduction. When pharmacists work under Collaborative Practice Agreements (CPAs)-which let them adjust or stop meds with physician approval-deprescribing rates jump by 37.6% compared to physician-only efforts. But here’s the catch: only 22 U.S. states allow CPAs for pharmacists to manage geriatric meds. In the rest, even the best pharmacist can’t make changes without waiting days for a doctor’s signature. That delay kills momentum. The Veterans Health Administration (VA) got it right. They embedded geriatric pharmacists into every clinic. Result? A 26.8% drop in inappropriate prescriptions. Academic medical centers with similar models report 42.6% more drug-related problems resolved. Primary care? It’s struggling. Most doctors have less than five minutes per patient to review meds. And only 15% of Medicare Advantage plans pay for a full medication review. No reimbursement. No time. No change.The Hidden Danger: Undertreatment
Polypharmacy isn’t just about too many drugs. It’s also about too few. One in three older adults isn’t getting medications they actually need. Think about it: a patient with heart failure might be on five drugs for blood pressure and diabetes-but not on a diuretic or beta-blocker because their doctor forgot. Or someone with osteoporosis isn’t on a bone-strengthening drug because no one checked their fracture risk. Dr. Joseph Hanlon calls this the double-edged sword of geriatric prescribing. You can’t just cut. You have to balance. Deprescribing must be paired with re-prescribing when needed. Ignoring undertreatment leads to preventable strokes, fractures, and infections.
Technology Is Changing the Game
In 2024, Epic Systems rolled out a new tool: the Polypharmacy Risk Score. It uses AI to scan electronic health records and flag patients at high risk for adverse events. In testing, it predicted drug-related hospitalizations with 87.3% accuracy. This isn’t sci-fi. It’s now in use in hospitals across the country. The system looks at age, kidney function, drug interactions, recent hospital stays, and even pharmacy refill patterns. It doesn’t decide-but it points the way. The American Geriatrics Society is also working on Beers Criteria v2026, which will include automated deprescribing algorithms. By 2026, EHRs may auto-suggest: “Patient on 8 meds. Gabapentin and amitriptyline both for neuropathy. Consider stopping one. Risk of dizziness: high.”What Gets in the Way?
Even with the right tools and people, barriers remain:- Fragmented care-78% of older adults see five or more providers a year. No one has the full list.
- Poor documentation-only 33% of EHRs track whether patients are actually taking their meds.
- Patient fear-many think stopping a pill means their condition is worsening. They don’t know deprescribing can improve quality of life.
- Wrong speed-rushing to stop meds causes 12.4% of patients to have withdrawal symptoms or disease flare-ups. Tapering matters.
- Starting with a full medication reconciliation (takes about 23 minutes per patient).
- Using STOPP/START to identify problems.
- Engaging the patient: “What’s your biggest concern right now? Let’s see if we can make that better.”
- Building a team: pharmacist, nurse, social worker, and primary doctor-all talking to each other.
What’s Next?
By 2030, comprehensive medication reviews won’t be optional. They’ll be standard. Medicare is already moving that way. Starting in 2024, providers get penalized if more than 30% of their Medicare patients are on ten or more drugs. Early adopters are seeing results: 19.3% higher patient satisfaction and 27.6% lower total care costs. That’s not just good medicine. It’s smart economics. The goal isn’t to reduce pill count. It’s to reduce harm. To help older adults live better, not just longer. To make sure every drug has a reason to be there-and that no one is left behind because no one asked.What is considered polypharmacy in older adults?
Polypharmacy is generally defined as taking five or more medications regularly. This threshold is used by major organizations like the American Geriatrics Society and the American Academy of Family Physicians. It’s not just about the number-it’s about whether each drug is still appropriate for the person’s current health, goals, and life expectancy.
Can stopping medications really improve health in older adults?
Yes, when done carefully. Studies show that appropriate deprescribing reduces falls, confusion, kidney stress, and hospital visits. For example, stopping unnecessary sedatives or antipsychotics in dementia patients often improves alertness and mobility. The key is individualization-removing drugs that no longer provide benefit, not all drugs.
Who should lead medication reviews for seniors?
Pharmacists trained in geriatrics are the most effective leaders. They have the time, tools, and expertise to review drug interactions, adherence, and appropriateness. When they work under Collaborative Practice Agreements, they can adjust or stop medications directly, which improves outcomes significantly. Physicians should be involved, but pharmacists should lead the review process.
What tools do clinicians use to decide which drugs to stop?
The most effective tools are STOPP/START (v3, 2021) and the FORTA list. STOPP identifies potentially inappropriate medications, while START finds drugs that should be added but aren’t. The Beers Criteria is useful for flagging dangerous drugs, but alone, it doesn’t improve health outcomes. The best approach combines these tools with patient goals and clinical judgment.
Why don’t more doctors do medication reviews?
Time and money. Most primary care doctors have less than five minutes per patient to review meds. Medicare doesn’t pay for comprehensive reviews in most plans-only 15% of Medicare Advantage plans reimburse for them. Without payment or time, even well-intentioned providers can’t make changes.
Is artificial intelligence being used to reduce polypharmacy?
Yes. Systems like Epic’s Polypharmacy Risk Score use AI to scan patient records and flag high-risk combinations. In testing, it predicted adverse drug events with 87.3% accuracy. These tools don’t make decisions-they help clinicians spot hidden risks faster. By 2026, AI-driven alerts will be built into most major electronic health records.