Polypharmacy Risk Assessment Tool
Assess Your Medication Safety
Your Medication Safety Assessment
Important: This tool is for informational purposes only. Always consult your healthcare provider before making any medication changes.
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, theyâre a ticking time bomb. Each extra pill increases the risk of falls, confusion, kidney damage, and hospitalization. The problem isnât just the number of pills-itâs 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
Polypharmacy isnât a diagnosis. Itâs a symptom of a system that treats each disease in isolation, not the whole person. A patient with heart failure gets a beta-blocker. Then they develop atrial fibrillation and get a blood thinner. Arthritis brings in an NSAID. Sleep trouble adds a benzodiazepine. Depression? Another antidepressant. Before long, someoneâs on ten pills a day. And no one ever looked at the whole list together.The numbers donât 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 itâs not just falls. Medication-related problems cause nearly 28% of all hospital admissions in this age group. Many of these arenât accidents-theyâre preventable.
What Works: The Three Levels of Medication Review
Not all reviews are created equal. There are three types, and only one moves the needle.- Type I: A pharmacist looks at the list of meds. Thatâs it. No patient talk. No checks on how theyâre 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 theyâre on them or what side effects theyâre 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: Whatâs your goal? Are you still feeling better on this? Are you dizzy after taking this pill? Are you skipping doses because itâs 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 isnât just in the method-itâs in the relationship. When patients feel heard, theyâre more likely to follow through on changes.
The Tools That Actually Help Clinicians
Doctors arenât trying to harm patients. Theyâre overwhelmed. Thatâs why tools matter-not as checklists to tick off, but as conversation starters.The Beers Criteria (updated in 2023) lists drugs that are risky for older adults-like benzodiazepines, anticholinergics, and certain painkillers. But itâs only a starting point. Just removing a drug from Beers doesnât mean itâs wrong for that person.
The STOPP/START criteria (version 3, 2021) are more useful. STOPP tells you which drugs to stop because theyâre harmful. START tells you which drugs you might be missing-like a statin for someone with heart disease whoâs 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 wonât 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 isnât the tool-itâs whoâs using it, and how.
Who Should Be Doing This Work?
Primary care doctors are stretched thin. The average visit is 15 minutes. A full medication review takes 45 to 60 minutes. Thatâs not realistic.Thatâs 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 hereâs the catch: only 15% of Medicare Advantage plans pay for these comprehensive reviews. Most doctors canât bill for the time it takes to do this right. And in 28 U.S. states, pharmacists canât 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
Itâs not just about cutting pills. Itâs about cutting the right ones.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. Thatâs therapeutic abandonment.
Dr. Dan Berlowitzâs team found that 7.3% of patients had disease flare-ups after abrupt discontinuation. The answer isnât to stop deprescribing-itâs to do it smarter. Taper slowly. Monitor closely. Involve the patient. Donât remove a drug just because itâs on a list. Remove it because the personâs goals, health, and life expectancy say itâs no longer right for them.
What About Patients Who Donât Want to Stop?
Sixty-eight percent of older adults are afraid to stop their medications. Theyâve been told these pills are keeping them alive. Theyâve seen friends die after quitting something. They worry: "What if I get worse?"That fear is real. And itâs not irrational. The solution isnât to push harder-itâs to listen first. Ask: "What do you think this pill is doing for you?" Many canât 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 sheâd been taking for 15 years. She didnât 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 didnât know I could feel this good without it."
Whatâs Next? AI, New Guidelines, and the Future
Technology is catching up. In April 2024, Epic Systems rolled out a new tool called the "Polypharmacy Risk Score." It uses AI to analyze electronic records and predict whoâs most likely to have an adverse event. In testing, it was 87.3% accurate. Thatâs not perfect-but itâs a powerful flag for clinicians to dig deeper.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
If youâre caring for an older adult-or if youâre one-hereâs what to do now:- Get a full list of every medication, supplement, and over-the-counter drug. Include creams, patches, and inhalers.
- Ask the doctor: "Which of these are still necessary? Which ones might be doing more harm than good?"
- Request a pharmacist-led medication review. Ask if your clinic has one-or if they can refer you to one.
- Donât stop anything on your own. But do ask for a plan to taper safely if something is being removed.
- Track how you feel after changes. Did your dizziness go away? Are you sleeping better? Write it down.
This isnât about cutting pills. Itâs about reclaiming health. Less medication doesnât mean less care. It means better care-focused on what matters most: living well, not just surviving with a pillbox full of promises.
What is considered polypharmacy in older adults?
Polypharmacy is generally defined as taking five or more medications regularly. This includes prescription drugs, over-the-counter medicines, vitamins, and supplements. While thereâs no single official definition, most clinical guidelines and research use this threshold because the risk of adverse drug events rises sharply beyond this point. About 41% of adults aged 65 and older in the U.S. take five or more medications, and nearly 20% take ten or more.
Can deprescribing cause harm?
Yes, if done carelessly. Stopping a medication too quickly or without monitoring can lead to withdrawal symptoms, disease flare-ups, or rebound effects. For example, abruptly stopping a blood pressure or antidepressant medication can cause dizziness, anxiety, or heart rhythm problems. The key is to taper slowly, monitor closely, and only discontinue drugs that are no longer providing benefit or are causing harm. Always work with a healthcare provider-never stop on your own.
Which tools do doctors use to decide what to stop?
The most widely used tools are the Beers Criteria, STOPP/START (version 3, 2021), and the FORTA list. Beers identifies potentially inappropriate medications for older adults. STOPP tells you which drugs to stop because theyâre risky. START tells you which essential drugs might be missing. FORTA rates drugs by benefit-risk balance in older people. Among these, STOPP/START and FORTA have shown the strongest results in clinical trials for improving health outcomes.
Why donât more doctors do medication reviews?
Time and money. Most primary care visits last less than 15 minutes. A full medication review takes 45-60 minutes. Few clinics have the staff or funding to support it. Only 15% of Medicare Advantage plans pay for comprehensive medication reviews. Also, many doctors arenât trained in deprescribing, and electronic health records often donât make it easy to see the full medication picture. Pharmacists are often the best fit for this work-but they need legal authority and reimbursement to do it.
Are there any new technologies helping with this problem?
Yes. In 2024, Epic Systems launched a tool called the Polypharmacy Risk Score, which uses artificial intelligence to predict which patients are most likely to have an adverse drug event. It analyzed data from millions of patient records and was 87.3% accurate in testing. Other systems are starting to integrate clinical decision support that flags high-risk combinations or missing essential medications. These tools donât replace human judgment-they help clinicians make better decisions faster.
How can families help with polypharmacy management?
Families can be critical allies. Bring a full list of all medications to appointments-including supplements and OTC drugs. Ask questions: "Why is this prescribed?" "What happens if we stop it?" "Are there side effects we should watch for?" Keep track of changes in mood, balance, appetite, or sleep after a medication change. Many older adults donât remember what theyâre taking or why. A family member who asks, listens, and documents can prevent dangerous mistakes.
Nicole Ziegler
November 19, 2025 AT 20:48OMG I legit cried reading this đ my grandma was on 12 meds and no one ever asked if she actually needed them. She stopped one sleep pill and started sleeping BETTER. Like, actually slept. Not just passed out. đ
Bharat Alasandi
November 21, 2025 AT 11:16Bro this is the exact same issue in India. Elderly folks on 8+ drugs because every specialist adds their own thing - cardiology, neuro, ortho, endo - no one talks. I got my dad off a benzo and an NSAID after a pharmacist audit. Heâs walking without a cane now. Tools like STOPP/START? Absolute game changers. Pharma reps donât wanna talk about this tho đ
Kristi Bennardo
November 22, 2025 AT 23:18This is an outrage. The medical establishment has normalized iatrogenic harm as âstandard care.â We are systematically poisoning our elderly with bureaucratic polypharmacy while ignoring the root cause: fragmented, profit-driven healthcare. This isnât a âproblemâ-itâs a crime. And the fact that pharmacists canât even prescribe adjustments in 28 states? Thatâs malpractice by legislation.
Shiv Karan Singh
November 23, 2025 AT 18:47Typical. Another article pretending deprescribing is magic. What about the 12% who got worse? You think your grandmaâs âbetter sleepâ means the pill was useless? Maybe it was preventing seizures. Or anxiety-induced arrhythmias. Beers Criteria? Thatâs just a list of drugs doctors are too lazy to titrate. Real medicine isnât about cutting pills-itâs about knowing when NOT to cut.
Ravi boy
November 24, 2025 AT 12:24my uncle in delhi on 9 pills and no one ever checked if they work. doc just gave more. pharmacist said stop one but doc said no. now he dizzy all day. i think this is global problem. no one talk. just give more. also typo sorry english not my first
Matthew Karrs
November 25, 2025 AT 15:09AI risk score? Epic? Please. This is all a cover for insurance companies to cut costs. They donât care if grandma lives well-they care if sheâs not in the hospital. Theyâll deprescribe everything except the expensive biologics. Mark my words: this âsafe taperingâ is just the first step to rationing care. Wait till the algorithm says âlow life expectancyâ and auto-removes everything.
Matthew Peters
November 25, 2025 AT 18:52That 78-year-old woman who stopped the sleeping pill and felt better? Thatâs the moment everything changes. Not the Beers Criteria. Not the AI. Not the new guidelines. That moment-when someone realizes theyâve been living in fog for 15 years and suddenly, they can breathe again? Thatâs the revolution. Iâve seen it. Iâve cried watching it. This isnât about drugs. Itâs about dignity. And weâre so close to making it standard.
Liam Strachan
November 26, 2025 AT 01:27Really well put. Iâve worked in UK primary care for 15 years and this is the biggest gap. Doctors want to do right thing but time and admin crushes them. Pharmacist-led reviews? Brilliant. Shame we donât fund them properly. Iâve seen patients come in on 10 meds and leave on 4-with better mobility, clearer head, and way less anxiety. Itâs not about taking less-itâs about taking what matters. Simple, really.