Too Many Medications? 10 Signs Your Older Loved One May Be Overmedicated

For many older adults, medications are essential. They control blood pressure, prevent strokes, manage pain, treat diabetes, protect the heart and help people live longer and better lives.

But as the medication list grows, so can the risks.

Polypharmacy—commonly defined as taking five or more medications regularly—has become increasingly common among older adults. A recent AAMC review noted that the percentage of Americans age 65 and older taking five or more medications nearly doubled over two decades, rising from about 24% in 2000 to more than 40% by 2020.

The concern is not simply the number of medications.

The real question is:

Does every medication still have a clear purpose, and is the combination still safe for this particular patient today?

For frail, elderly and medically complex patients living at home or in assisted living, medication problems may first appear as something completely different: a fall, new confusion, weakness, poor appetite or excessive sleepiness.

That is why medication review should be an ongoing part of medical care—not something done only when a prescription is first written.

When a New Symptom May Actually Be a Medication Problem

Older adults process medications differently than younger people. Kidney and liver function may change with age, body composition changes, and people are more likely to have multiple medical conditions requiring treatment.

At the same time, medications may be prescribed by several different specialists.

A cardiologist may prescribe one medication. A neurologist another. A psychiatrist another. Then an urgent-care physician or hospital may add something else.

Every individual prescription may have made sense when it was started.

But over time, the entire medication list can become complicated.

This can lead to drug interactions, duplicate therapy, excessive sedation, low blood pressure and what clinicians sometimes call a prescribing cascade—when a side effect from one medication is mistaken for a new disease and treated with yet another medication. Growing attention to these problems has led to increased emphasis on “deprescribing,” or carefully reducing or discontinuing medications when the risks outweigh the benefits.

Here are 10 warning signs families and caregivers should recognize.

1. New or Increasing Falls

A fall may be one of the first signs that a medication regimen needs to be reviewed.

A newly published 2026 population-based study found that polypharmacy was associated with more than twice the risk of injurious falls. Diuretic use and antipsychotic use were also independently associated with substantially higher fall risk. Because the study was observational, it does not prove that these medications directly caused every fall, but it reinforces the importance of routine medication review in older adults who fall.

Medications may contribute to falls through:

• Dizziness

• Sleepiness

• Slower reaction time

• Poor coordination

• Low blood pressure

• Dehydration

• Muscle weakness

• Confusion

  
  

If an older adult begins falling after a medication is started or adjusted, the timing matters.

2. Excessive Sleepiness

“She sleeps most of the day now.”

That statement deserves attention.

Sedating medications may include certain:

• Sleep medications

• Anxiety medications

• Pain medications

• Antihistamines

• Muscle relaxants

• Antipsychotics

• Seizure and nerve-pain medications

  
  

Sometimes several mildly sedating medications are taken together, creating a much stronger combined effect.

Excessive sleepiness can lead to reduced activity, muscle loss, falls, poor nutrition and worsening confusion.

3. New Confusion or Memory Problems

Medication side effects can sometimes look remarkably similar to dementia.

A patient may become:

• Forgetful

• Disoriented

• Agitated

• Hallucinatory

• Less interactive

• More sleepy

• Unsteady

  
  

The American Geriatrics Society's Beers Criteria identifies medications and medication combinations that may pose particular risks to older adults, including medications that can worsen cognitive impairment, delirium or falls. The criteria are intended to guide individualized clinical decisions rather than automatically label every listed drug as inappropriate.

A sudden change in cognition should never automatically be blamed on “getting older.”

Medication effects, infection, dehydration, and other medical conditions should be considered.

4. Dizziness When Standing

When a person stands, the body must quickly maintain enough blood pressure to keep adequate blood flowing to the brain.

Some medications can interfere with this response.

Watch for:

• Dizziness after standing

• Grabbing furniture for support

• Needing to sit back down

• Feeling faint

• Actual fainting

• Falls shortly after getting out of bed

  
  

Blood-pressure medications, diuretics and some medications for prostate symptoms, Parkinson's disease and other conditions can contribute.

This does not mean these medications should automatically be stopped. It means the medication list, blood pressure and patient's overall condition should be reassessed.

5. A Sudden Decline After Hospitalization

Hospitalization is a common time for medication lists to change.

Medications may be:

• Started

• Stopped

• Increased

• Decreased

• Temporarily held

• Replaced with another medication

When the patient returns home or to assisted living, discrepancies may occur between the hospital medication list and what the patient was taking previously.

This is one reason medication reconciliation after hospitalization is so important.

Families should not assume that every bottle remaining in the home should automatically be restarted.

6. Poor Appetite, Nausea or Weight Loss

Medications may affect appetite, taste, stomach function or nausea.

For a younger person, missing a few meals may be inconvenient.

For a frail older adult, decreased intake can quickly contribute to:

• Dehydration

• Weakness

• Low blood pressure

• Kidney problems

• Weight loss

• Falls

  
  

If appetite changes after a new medication or dose adjustment, tell the healthcare team.

7. A Medication for the Side Effect of Another Medication

This is where medication lists can quietly grow.

For example:

A medication causes swelling → another medication is prescribed for swelling.

A medication causes constipation → another medication is added for constipation.

A medication causes insomnia → a sleeping medication is added.

A medication causes dizziness → another treatment may be added without recognizing

the original cause.

Sometimes these additional medications are appropriate. Sometimes the better solution is reconsidering the medication that started the problem.

This is why reviewing the entire medication list together is more useful than evaluating each medication in isolation.

8. Several Doctors Prescribing Without One Person Reviewing Everything

Specialists appropriately focus on their areas of expertise.

But someone needs to periodically look at the complete picture.

That includes:

• Prescription medications

• Over-the-counter medications

• Vitamins

• Supplements

• As-needed medications

• Eye drops

• Inhalers

• Topical medications

• Medications from previous hospitalizations

  
  

According to the American Geriatrics Society, more than 88% of older adults use at least one prescription medication and more than two-thirds use three or more during a typical month.

The more complicated the medication regimen becomes, the more important coordinated medication management becomes.

9. Kidney Function Has Changed

Kidneys remove many medications from the body.

As kidney function declines, a dose that was previously appropriate may become too high.

The Beers Criteria specifically identifies medications that may require dose adjustment or avoidance in older adults with reduced kidney function.

This is especially important after:

• Dehydration

• Infection

• Hospitalization

• Acute kidney injury

• Significant weight loss

• Changes in heart failure or diuretic therapy

  
  

Medication dosing should reflect the patient's current condition—not simply what was prescribed years ago.

10. Nobody Can Explain Why a Medication Is Still Being Taken

This is one of the simplest and most useful questions:

Why is this patient taking this medication?

If nobody knows, it deserves review.

Some medications were intended for short-term use but remain on the list for months or years.

Others may have been started for a condition that has changed.

The goal of deprescribing is not to eliminate necessary medications. It is to systematically determine whether each medication still provides more benefit than risk for the individual patient.

What Is the Beers Criteria?

The American Geriatrics Society Beers Criteria is one of the most widely used clinical tools for identifying medications that may pose increased risks to adults age 65 and older.

It includes medications that may:

• Be inappropriate for many older adults

• Be problematic with particular diseases

• Require additional caution

• Interact dangerously with other medications

• Need adjustment because of kidney function

  
  

The current criteria include more than three dozen medications or medication classes that should generally be avoided in many older adults and more than 40 medications or classes requiring special caution depending on a patient's conditions.

Importantly, appearing on the Beers Criteria does not automatically mean a medication should be stopped.

There may be very good reasons for an individual patient to take it.

The criteria are a tool for asking better questions and weighing benefits against risks.

Never Stop Medications on Your Own

This is extremely important.

Some medications can cause serious problems if they are suddenly discontinued.

Examples may include certain:

• Blood-pressure medications

• Steroids

• Antidepressants

• Anxiety medications

• Seizure medications

• Heart medications

  
  

Medication reduction should be planned with the healthcare team.

The safest approach is usually review, prioritize, simplify and monitor.

A Simple Medication Checklist for Families

At least periodically—and especially after a fall, hospitalization or major change in health—ask:

• What is each medication treating?

• Is it still necessary?

• Has the dose been adjusted for kidney function and current weight?

• Could it be contributing to dizziness, confusion or falls?

• Are there duplicate medications?

• Are several medications causing sedation?

• Are over-the-counter products or supplements interacting with prescriptions?

• Can the medication schedule be simplified?

• Has anything been added by another doctor or hospital?

• Could any medication be safely reduced or discontinued?

  
  

Bring the actual medication bottles when possible.

A printed medication list may not always reflect what the patient is truly taking.

Medication Safety Where the Patient Actually Lives

For homebound and assisted-living patients, seeing the patient where they live can provide information that is difficult to obtain in a traditional office visit.

A healthcare team may discover:

• Old prescriptions that are still being taken

• Duplicate bottles

• Medications from several pharmacies

• Incorrect pillbox organization

• Confusion between morning and evening medications

• Over-the-counter sleep aids

• Supplements not listed in the medical record

• Medications that should have been stopped after hospitalization

• Blood pressure that is too low

• New weakness or balance problems

  
  

For medically complex older adults, medication management is not simply about generating prescriptions.

It is about making sure the entire regimen still makes sense.

Call Us First

At Mobile Physician Associates, our patients are often elderly, frail, homebound or living in assisted-living communities—and many take multiple medications for several chronic medical conditions.

When a patient develops a fall, dizziness, excessive sleepiness, new confusion, weakness, poor appetite or another sudden change, Call Us First.

Our clinical team can help determine whether the problem may be related to medications or another medical condition and whether the patient can be evaluated where they live.

When appropriate, Mobile Physician Associates can provide:

• Comprehensive medication reconciliation

• Review for medication interactions and duplication

• Evaluation of potentially inappropriate medications

• Blood-pressure and orthostatic assessment

• Evaluation of kidney function and other laboratory testing

• Fall and balance-risk assessment

• Coordination with specialists, pharmacies and assisted-living staff

• Follow-up after hospitalization or medication changes

• A personalized plan to simplify and improve medication safety when appropriate

  
  

The goal is not fewer medications simply for the sake of having fewer medications.

The goal is the right medications, at the right doses, for the right reasons, for the patient as they are today.

Mobile Physician Associates

Call Us First: (310) 256-2426

Available 24 hours a day, 7 days a week

www.MyMobilePhysician.com

Never stop or change a prescription medication without discussing it with the prescribing healthcare professional. Call 911 immediately for a medical emergency.