Geriatric Polypharmacy Interventions: How to Reduce Adverse Drug Events in Older Adults

More than 4 in 10 adults over 65 are taking five or more medications every day. For many, these drugs are life-saving. For others, they’re a ticking time bomb. Each extra pill increases the risk of falls, confusion, kidney damage, and hospitalization. The problem isn’t just the number of pills-it’s the lack of review. Too often, medications are added over years without ever stepping back to ask: Do we still need all of these?

Why Polypharmacy Is a Silent Crisis in Older Adults

The numbers don’t lie. In the U.S., 19% of older adults take ten or more medications. Each additional drug raises the risk of a serious fall by about 8%. People on five or more drugs are 30-50% more likely to suffer an injurious fall than those on fewer. And it’s not just falls. Medication-related problems cause nearly 28% of all hospital admissions in this age group. Many of these aren’t accidents-they’re preventable.

What Works: The Three Levels of Medication Review

• Type I: A pharmacist looks at the list of meds. That’s it. No patient talk. No checks on how they’re actually taking them. This does almost nothing.
• Type II: Same as Type I, but now they check if the patient is taking the pills as prescribed. Still, no conversation about why they’re on them or what side effects they’re feeling. Still no real impact.
• Type III: This is the only one that works. A pharmacist or doctor sits down with the patient-face-to-face or via video-and asks: What’s your goal? Are you still feeling better on this? Are you dizzy after taking this pill? Are you skipping doses because it’s too much? They look at the full picture: health, function, life expectancy, and values.

Studies show Type III reviews cut hospital readmissions by 18.3%. Types I and II? No difference from usual care. The difference isn’t just in the method-it’s in the relationship. When patients feel heard, they’re more likely to follow through on changes.

The Tools That Actually Help Clinicians

The Beers Criteria (updated in 2023) lists drugs that are risky for older adults-like benzodiazepines, anticholinergics, and certain painkillers. But it’s only a starting point. Just removing a drug from Beers doesn’t mean it’s wrong for that person.

The STOPP/START criteria (version 3, 2021) are more useful. STOPP tells you which drugs to stop because they’re harmful. START tells you which drugs you might be missing-like a statin for someone with heart disease who’s not on one. In trials, using STOPP/START led to real improvements in health outcomes. The FORTA list (Fit for the Aged) goes further by rating drugs based on benefit-risk balance in older adults, with categories like A (strongly recommended) to D (avoid).

But tools alone won’t fix this. A 2025 study found that when pharmacists used these tools in combination with direct patient conversations, deprescribing rates jumped 37.6% compared to doctors working alone. The key isn’t the tool-it’s who’s using it, and how.

Who Should Be Doing This Work?

That’s why pharmacist-led teams are the most effective. In the Veterans Health Administration, embedded clinical pharmacists reduced potentially inappropriate medications by 26.8%. At Duke University, their "Five Tips" approach focused on fixing medication lists in the electronic health record first-something 78% of clinics still get wrong.

But here’s the catch: only 15% of Medicare Advantage plans pay for these comprehensive reviews. Most doctors can’t bill for the time it takes to do this right. And in 28 U.S. states, pharmacists can’t even enter into formal collaborative agreements with doctors to adjust meds independently. Without reimbursement and legal authority, progress stalls.

The Hidden Danger: Stopping the Wrong Things

One study found that 12.8% of deprescribing attempts were inappropriate-meaning they removed a drug that was actually helping. A patient with heart failure was taken off their beta-blocker because it was on Beers. They ended up back in the hospital. Another was taken off their blood thinner after a fall, even though their stroke risk was high. That’s therapeutic abandonment.

Dr. Dan Berlowitz’s team found that 7.3% of patients had disease flare-ups after abrupt discontinuation. The answer isn’t to stop deprescribing-it’s to do it smarter. Taper slowly. Monitor closely. Involve the patient. Don’t remove a drug just because it’s on a list. Remove it because the person’s goals, health, and life expectancy say it’s no longer right for them.

What About Patients Who Don’t Want to Stop?

That fear is real. And it’s not irrational. The solution isn’t to push harder-it’s to listen first. Ask: "What do you think this pill is doing for you?" Many can’t answer. Others say, "It helps me sleep." Then you ask: "What if we tried something safer?"

One 78-year-old woman was on seven medications, including a sleeping pill she’d been taking for 15 years. She didn’t even know what it was called. When her pharmacist explained the fall risk and offered a non-drug sleep plan, she agreed to try cutting it. Within weeks, she was sleeping better-without the pill. She said, "I didn’t know I could feel this good without it."

What’s Next? AI, New Guidelines, and the Future

The American Geriatrics Society is working on Beers Criteria 2026, which will include specific deprescribing algorithms. The National Institute on Aging is funding research into personalized risk calculators that factor in genetics, kidney function, and cognitive status. By 2030, experts believe comprehensive medication reviews will be standard care-not optional.

And the economics are shifting. Medicare is now penalizing providers whose patients are on ten or more medications. Hospitals that reduce preventable drug-related admissions will get paid more. The system is finally starting to reward good stewardship, not just volume.

What You Can Do Today

1. Get a full list of every medication, supplement, and over-the-counter drug. Include creams, patches, and inhalers.
2. Ask the doctor: "Which of these are still necessary? Which ones might be doing more harm than good?"
3. Request a pharmacist-led medication review. Ask if your clinic has one-or if they can refer you to one.
4. Don’t stop anything on your own. But do ask for a plan to taper safely if something is being removed.
5. Track how you feel after changes. Did your dizziness go away? Are you sleeping better? Write it down.

This isn’t about cutting pills. It’s about reclaiming health. Less medication doesn’t mean less care. It means better care-focused on what matters most: living well, not just surviving with a pillbox full of promises.