Polypharmacy Deprescribing Guide for Older Adults
This guide explains polypharmacy (taking multiple regular medications) and safe deprescribing (carefully stopping unnecessary medications) for older adults and their caregivers, to reduce side effects, falls, and medication errors and improve quality of life.
Polypharmacy (taking 5+ regular medications) is common in older adults and increases risk of side effects, falls, and medication errors. Deprescribing is a safe, collaborative process with your healthcare provider to stop medications that are no longer needed or cause more harm than good. Never adjust or stop medications on your own without provider guidance.
Overview
Polypharmacy refers to the regular use of 5 or more prescription or over-the-counter medications, and it affects roughly 1 in 3 adults aged 65 and older in the United States. As people age, they are more likely to develop multiple chronic health conditions, which often leads to taking multiple medications. Deprescribing is the safe, supervised process of reducing or stopping medications that are no longer needed, cause more harm than good, or were only intended for short-term use. This guide will help you and your caregiver understand how to safely manage polypharmacy and work with your healthcare team to reduce unnecessary medication risks.
Signs & Symptoms of Problematic Polypharmacy
The symptoms of problematic polypharmacy are often vague and can be mistaken for normal signs of aging. Common warning signs include frequent falls or balance problems, new or worsening confusion or memory issues, dizziness, excessive drowsiness, stomach pain or digestive issues, new health problems that have no clear other cause, difficulty remembering to take medications, or accidentally taking extra doses of your medications. If you notice any of these symptoms, talk to your provider right away—they may be caused by a medication interaction or side effect.
Never stop, reduce, or change the dose of any medication on your own without first talking to your healthcare provider. Suddenly stopping some medications (such as blood pressure drugs, antidepressants, or seizure medications) can cause dangerous withdrawal symptoms or severe worsening of your underlying health condition.
Causes & Risk Factors
Polypharmacy is most often caused by having multiple chronic health conditions (such as high blood pressure, type 2 diabetes, osteoarthritis, or chronic pain) that require separate medications. Other common risk factors include seeing multiple healthcare providers who may not have full access to your complete medication list, using over-the-counter drugs, vitamins, or herbal supplements without telling your provider, medications prescribed for short-term use that are continued long-term by mistake, and age-related changes in liver and kidney function that slow down how your body processes medications, leading to higher levels of the drug in your system and increased side effect risk.
Diagnosis
There is no single test for problematic polypharmacy. Your provider will diagnose it by completing a full medication review: they will ask you to bring all your prescription medications, OTC drugs, supplements, and vitamins to your appointment, and go through each one to confirm what it is for, the dose you take, and how often you take it. They will also ask about any side effects you’ve experienced, review your medical history, and check for potential interactions between your medications. Many providers use the American Geriatrics Society Beers Criteria, a list of medications that pose higher risks for older adults, to guide their review.
Treatment & Management: Safe Deprescribing
Deprescribing is a collaborative, step-by-step process between you, your caregiver, and your healthcare team. The goal is to reduce harm from unnecessary medications while keeping all medications that are still providing clear benefits for your health. Your provider will prioritize stopping or reducing medications that have the highest risk of side effects first, and will monitor you closely for any changes in your symptoms or health after any adjustments.
- Bring a complete list of all your medications (including OTC drugs, supplements, and vitamins) to every appointment
- Tell your provider about every side effect you experience, even if you think it is minor or unrelated to your medications
- Work with your provider to create a simple, easy-to-follow medication schedule to avoid missed or double doses
- Ask your provider to explain the purpose of each medication, and ask if any can be safely stopped or reduced
- Attend all scheduled follow-up appointments after medication changes to check for side effects or worsening of your conditions
Living With Safe Medication Management
Ongoing medication management can help reduce your risk of polypharmacy-related side effects. Use a weekly pill organizer sorted by day and time of day to avoid dosing errors, keep an updated copy of your medication list in your wallet and share it with every new healthcare provider you see, ask your pharmacist to review your medications annually for interactions, and avoid starting any new OTC medications, vitamins, or supplements without first asking your provider if they are safe to take with your current medications.
| Medication Type | Common Reason for Deprescribing | Notes |
|---|---|---|
| Benzodiazepines (used for anxiety or sleep) | Increased risk of falls, confusion, and memory problems in older adults | May be replaced with non-medication sleep strategies or lower-risk anxiety treatments |
| Non-steroidal anti-inflammatory drugs (NSAIDs) for chronic pain | Increased risk of stomach bleeding, kidney damage, and high blood pressure | May be replaced with topical pain relievers, physical therapy, or acetaminophen |
| Anticholinergic medications (used for allergies, overactive bladder, or nausea) | Increased risk of confusion, constipation, and urinary retention | May be replaced with newer, lower-risk alternatives |
| Duplicate medications (two drugs in the same medication class) | Unnecessary extra medication increases side effect and interaction risk | Your provider will keep the most effective option and stop the other |
Contact your provider or go to the emergency room immediately if you experience any of the following after a medication change: severe dizziness or confusion that makes it hard to stand or think clearly; trouble breathing, chest pain, or swelling of the face or throat; sudden weakness, numbness, or slurred speech; signs of an allergic reaction (hives, rash, swelling, difficulty swallowing); severe stomach pain, vomiting blood, or black/tarry stools; or sudden falls or injuries.
Medical Review Team
WellAlly Medical Editorial Team
This content is not a replacement for professional medical advice.
Recovery & management timeline
1–2 weeks before your deprescribing appointment
Pre-Appointment Preparation
Gather all prescription medications, OTC drugs, supplements, and vitamins in one place. Write down any side effects you’ve noticed, and list all your healthcare providers. Bring this full list to your appointment.
During your appointment
Collaborative Review & Plan Development
Work with your provider to review each medication, discuss which may be unnecessary or harmful, and create a step-by-step plan to adjust doses or stop medications safely. Ask questions to fully understand any changes.
1–4 weeks after first medication changes
Initial Adjustment Period
Follow your new medication schedule exactly. Track any new symptoms, side effects, or changes in your daily function. Attend all scheduled follow-up appointments so your provider can check how you are adjusting.
Every 3–6 months, ongoing
Ongoing Monitoring
Have your provider review your full medication list regularly to ensure all medications are still needed and doses are appropriate for your current age and health status. Update your medication list any time a new medication is added or stopped.
Self-care steps
1Keep a complete, up-to-date medication list
Write down every medication you take, including prescription drugs, over-the-counter medicines, vitamins, and herbal supplements. Include the dose, how often you take it, and what it’s for. Keep a copy in your wallet and share it with every healthcare provider you see.
2Use a pill organizer and medication schedule
Use a weekly pill organizer sorted by day and time of day to avoid missed or double doses. Ask your provider or pharmacist to print a clear medication schedule if you have trouble reading small print on medication bottles.
3Track side effects and daily symptoms
Keep a small notebook or use a notes app to write down any new symptoms, dizziness, falls, confusion, or stomach issues you have. Share this log with your provider at every appointment to help them identify medications that may need adjustment.
4Ask before taking any new medication or supplement
Never start a new over-the-counter medication, vitamin, or herbal supplement without asking your provider first. Many of these can interact with your prescription medications and cause harmful side effects, even if they are labeled as 'natural'.
5Involve a caregiver in medication management
If you have a family member or paid caregiver, include them in medication reviews and appointments. They can help you keep track of your medication list, notice side effects you may miss, and help you follow your medication schedule correctly.
When to seek medical help
Seek urgent medical care if you experience any of the following after a medication change: severe dizziness or confusion that makes it hard to stand or think clearly; trouble breathing, chest pain, or swelling of the face/throat; sudden weakness, numbness, or slurred speech; signs of an allergic reaction (hives, rash, swelling, difficulty swallowing); severe stomach pain, vomiting blood, or black/tarry stools; or sudden falls or injuries.
Frequently asked questions
Is deprescribing safe for older adults?
Will I need to stop all my medications if I start deprescribing?
What if my medications are working well? Do I still need a deprescribing review?
Can I use over-the-counter medications and supplements while I’m deprescribing?
What if I notice side effects after a medication is stopped?
Sources
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Click any link to access the full source. PubMed Central (PMC) links provide free full-text access.
This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment.
This content is for general informational and educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the guidance of a qualified healthcare provider with any questions you have about a medical condition, and never disregard professional medical advice or delay seeking it because of something you read here.
If you think you may have a medical emergency, call your local emergency number or go to the nearest emergency department immediately.
Medically reviewed by WellAlly Medical Editorial Team · Last reviewed October 9, 2026. · Read our editorial policy