It is common for older adults to have multiple chronic conditions, including heart failure, coronary disease, atrial fibrillation, COPD, diabetes, hypertension, cognitive impairment, dementia, depression, or anxiety.

Each condition can add one, two, or three medications. Over years, some people end up with 15 to 20 prescriptions, a phenomenon known as polypharmacy.

Recent reviews and commentaries highlight that polypharmacy:

• increases the risk of falls, confusion, cognitive decline, adverse drug events, and hospitalization
• especially in older adults with multimorbidity and dementia

This article explains how 2024 to 2025 thinking around polypharmacy is changing, and how medication review, deprescribing, and personalized formulations can make regimens safer.

Support resources for patients and caregivers: Help Hub

Related condition context pages often involved in polypharmacy:
Heart Failure
Atrial Fibrillation
Dementia
COPD
Hypertension

Why Polypharmacy Happens

Polypharmacy is rarely intentional.

Common drivers:

• each specialist prescribing according to their own guideline (cardiology, pulmonology, neurology, psychiatry)
• medications started years ago that were never re-evaluated
• addition of another pill at each new clinical encounter
• fragmented care or lack of a single coordinating clinician

A widely shared news story described an older woman on 21 medications whose symptoms (fatigue, confusion, agitation) improved dramatically after a team deprescribed her down to eight.

The Risks of Too Many Medications

Evidence shows polypharmacy is associated with:

• increased falls and fractures
• cognitive impairment and delirium
• hospitalizations
• under-recognition of medication side effects (confused as worsening dementia)
• higher mortality in some groups

Medications of particular concern include:

• sedatives and benzodiazepines
• certain anticholinergics
• some antipsychotics and other CNS-active agents in dementia

Condition overlap that often amplifies risk: Dementia | Heart Failure

Deprescribing: A Structured, Evidence-Based Process

Deprescribing is not stopping meds at random. It is:

• a planned, supervised process of identifying and discontinuing medications where harms outweigh benefits
• often guided by tools and frameworks (e.g., Beers criteria, STOPP/START)
• increasingly supported by trials suggesting it is feasible and safe when done carefully

Key steps:

• inventory every medication, including OTC drugs and supplements
• align with current diagnoses, goals of care, and life expectancy
• identify high-risk and low-benefit medications
• plan tapering schedules and monitoring to avoid withdrawal or rebound
• engage patients and caregivers in shared decisions

For caregiver-friendly support and planning: Help Hub

Where Personalized Medication Support Fits In

After deprescribing, remaining medications can still be complex. Personalization and compounding can help.

1. Simplifying administration

• converting some meds to liquids or easy-to-swallow forms for people with dysphagia or advanced dementia
• aligning dosing times, for example once daily where possible

2. Fine-tuning doses

• using intermediate strengths to reduce side effects in very frail patients
• allowing micro-adjustments in antihypertensives, antidepressants, or other agents when standard tablet steps are too large

3. Reducing excipient burden

• in individuals with GI or dermatologic reactions to dyes or certain excipients
• compounding can sometimes provide simpler ingredient profiles

All of this must be:

• guided by the supervising clinician (often geriatrician, primary care, or pharmacist-led clinic)
• documented clearly
• periodically re-evaluated

Condition pages that commonly drive dose sensitivity and complexity:
Hypertension
Atrial Fibrillation
COPD

When to Ask for a Medication Review

Good times to request a formal medication review include:

• after a hospitalization
• when moving between care settings (home to rehab to home)
• after a new diagnosis like dementia or advanced heart failure
• when new symptoms (falls, confusion, stomach upset) appear without clear cause

Questions to ask:

• “Can we review every medication and confirm if I still need it?”
• “Are any of these drugs interacting or duplicating each other?”
• “Could fewer or lower doses achieve similar benefits with less risk?”

Support tools and checklists: Help Hub

Final Thoughts: Individualized Plans for Individual Lives

Polypharmacy in older adults is not inevitable. It is a modifiable risk.

The goals are:

• fewer unnecessary medications
• safer regimens
• improved day-to-day functioning (less dizziness, confusion, agitation)

AllMedRx can support post-deprescribing plans by:

• preparing personalized formulations for the medications that remain truly necessary
• simplifying regimens when possible
• ensuring clarity in dosing and labeling for patients and caregivers

For clinicians planning deprescribing or medication re-design in older adults with multiple conditions, AllMedRx can be reached at:
intake@allmedrx.org