Macular degeneration — when vision fades and adaptation becomes essential

Reviewed by the How To Help Your Elders Medical Advisory Process

Most older adults take multiple medications prescribed by multiple doctors, and the cumulative effect of those drugs can cause symptoms that get mistaken for new diseases. A comprehensive medication review by a pharmacist or geriatrician can identify unnecessary drugs, harmful interactions, and side effects that are making your parent worse instead of better. You do not need medical training to advocate for this review.

The Medication List Itself Can Become a Health Risk

Your mother takes one medication for her heart, another for blood pressure, another for cholesterol, another for arthritis, another for her thyroid, another for anxiety, another for her stomach. That's seven. Then there's the aspirin for prevention, the vitamins, the over-the-counter sleep aid she takes sometimes, the antihistamine for allergies. That's eleven. When you look at the bottles lined up on the bathroom counter, it's hard not to feel that something is wrong here, even though every single medication was prescribed by a doctor for a legitimate reason.

This is polypharmacy, the phenomenon of taking many medications at once. It's not inherently bad. Some people with multiple conditions genuinely do need multiple medications. But there's a point where the number of medications becomes part of the problem. Each medication has side effects. Each medication interacts with other medications in ways that sometimes aren't predictable. Each medication your parent takes increases the chance that the confusion they're experiencing, or the falls, or the dizzy spells, or the memory difficulty, is actually caused by a medication rather than the disease it was prescribed to treat.

According to the CDC, approximately 40% of adults aged 65 and older take five or more prescription medications, and nearly 20% take ten or more. The American Geriatrics Society reports that adverse drug events are responsible for approximately 30% of hospital admissions in older adults. The NIH's National Institute on Aging identifies polypharmacy as a significant risk factor for falls, cognitive impairment, and functional decline in older adults.

The challenging part is that nobody designs this situation. It sneaks up gradually. A cardiologist adds a medication for the heart. A rheumatologist adds one for arthritis. An endocrinologist adds one for diabetes. Each specialist is solving their part of the problem. Nobody is standing back looking at the full list and saying, "Wait, let's think about whether all of these together are actually making things better or worse." That's where you come in.

The Pill Collection

Start with the reality of what a typical older adult is taking. Not a few medications. Many older adults take ten, fifteen, twenty, or more medications and supplements daily. Some prescription, some over-the-counter, some supplements.

When you ask your parent, "What medications are you taking?" they might list five or six. When you look at the bottles, you find ten. When you get their pharmacy records, you find twelve because they forgot the aspirin and the calcium supplement and the migraine medication they take occasionally. This is normal. Most older adults don't have a clear picture of everything they're taking.

The reasons this happens are understandable. A patient sees a cardiologist for heart problems. The cardiologist prescribes a medication. A few months later, they see a gastroenterologist for acid reflux. That doctor prescribes something. They've been taking ibuprofen for arthritis for years, and now their blood pressure is up, so their primary care doctor discusses stopping the ibuprofen and starting something else. But the patient is still buying ibuprofen over-the-counter, so they're actually taking both. Meanwhile, a family friend recommends a supplement for joint health, so they're taking that too.

Each individual decision makes sense. The problem is that nobody is looking at the aggregate picture. Each doctor is focused on their specialty and the conditions they're treating.

How It Happens

The system is structured in a way that makes this happen almost inevitably. Your parent sees specialists. Each specialist is excellent at what they do. But they're focused on their specialty. They're not coordinating with the other specialists. Your parent's primary care doctor is sometimes in communication with specialists, sometimes not. There's rarely a single person with a complete view of the entire medication list.

As your parent ages and more health issues develop, more medications get added. If something isn't working optimally, the instinct is often to add another medication rather than to step back and reconsider the whole approach. If your parent develops a new symptom, a doctor might prescribe a medication to treat it without initially considering that the symptom might be a side effect of a medication already being taken. This is called a prescribing cascade, and the American Geriatrics Society has identified it as one of the most common and preventable causes of polypharmacy.

When something stops being a problem, the medication isn't always stopped. Your parent had acid reflux for a while, took a medication for it, and now the reflux isn't really an issue anymore. But the medication is still there. Nobody removed it from the list. Medications accumulate over time without being re-evaluated. The original medication might no longer be necessary or appropriate. It should have been reviewed and potentially discontinued. But it wasn't.

The Dangers

The risks of polypharmacy are real and significant.

One is the increased chance of side effects being mistaken for new diseases. Your parent develops tremor, and the instinct is to think about Parkinson's disease. They start taking a medication for that. But the tremor is actually a side effect of another medication, and now they're taking an additional medication for something they don't have. Your parent becomes confused, and everyone worries about dementia. But the confusion is from a medication interaction. Your parent develops fatigue, dizziness, or balance problems, and these are attributed to aging or a disease, when they're actually medication side effects.

Drug interactions are the other major risk. When a person is taking ten or more medications, the possible interactions are numerous and often unpredictable. Two medications that are individually safe might interact to increase the effect of one, reduce the effectiveness of another, or create a new and unexpected side effect. The American Geriatrics Society Beers Criteria, updated regularly, identifies specific medications and medication combinations that are potentially inappropriate for older adults because the risks outweigh the benefits.

Medication interactions can increase the risk of falls, which for an older adult can be catastrophic. Multiple medications can cloud thinking and make confusion worse. Some drug interactions can affect the heart, the kidney, the liver. Some can cause dangerous changes in blood pressure.

The compliance problem is real too. When someone is taking ten or fifteen medications at different times of day, some in the morning, some in the evening, some with food, some without, it becomes very difficult to take them correctly. Your parent might miss doses, double doses, or take them at the wrong time.

Then there's the cost. Polypharmacy means your parent might be spending hundreds of dollars a month on medications, some of which might not be necessary.

The Medication Review

The solution involves getting professional attention focused specifically on the medication list as a whole rather than on individual conditions. This can come from a pharmacist or a geriatrician, both of whom are trained to look at medications from the perspective of the total picture.

A pharmacist review, sometimes called medication therapy management (MTM), is a process where a pharmacist reviews all the medications and supplements, looks at doses, interactions, indications, and evaluates whether the current regimen is optimal. The pharmacist can identify medications that might be duplicative, causing side effects, interacting with other drugs, or no longer necessary. Medicare Part D includes MTM programs for beneficiaries who take multiple medications for multiple chronic conditions and whose annual drug costs exceed a certain threshold. This service is free for those who qualify.

A geriatrician is a physician who specializes in the care of older adults and has specific training in managing medications in aging patients. A geriatrician review involves evaluating each medication against established guidelines, including the Beers Criteria, that identify medications that are potentially inappropriate for older adults. Medicare Part B covers geriatric assessment visits.

During this review, the goal isn't necessarily to get your parent off as many medications as possible. The goal is to make sure every medication is necessary, that the dose is appropriate, that it's not interacting harmfully with other medications, and that it's achieving its intended benefit. Sometimes that means stopping a medication. Sometimes it means changing to one with fewer side effects. Sometimes it means adjusting doses. Sometimes it means reorganizing the schedule to make it easier to remember. And sometimes it means the current regimen is actually the right one.

Your Advocacy Role

You don't need to be a medical expert to help with this. You need to be organized and persistent.

The first step is getting the complete list. Ask your parent. Get the list from their pharmacy. Ask their doctor. Every medication needs to be on that list: prescription, over-the-counter, vitamins, supplements, herbs, everything.

Then you need to understand what each medication is for. Your parent takes medication X because they have condition Y. Is that condition still relevant? Is the medication still working? Has anything changed since they started taking it?

Bring the full list to your parent's primary care doctor or to a geriatrician, and ask: "Are all of these medications still necessary? Are any of these interacting with each other in ways we should be concerned about? Are any of these causing side effects we've been attributing to something else? Are there any that could be stopped?" Be specific about any symptoms your parent is having that might be medication-related.

Ask about a pharmacist review if that hasn't been done. Call the insurance company and ask if medication therapy management is available. Ask if your parent can see a geriatrician, either as a specialist or as a second opinion on medication management.

Be willing to bring this up repeatedly. The first conversation might result in no changes. The second conversation might. Medication issues aren't usually resolved in a single appointment. It takes persistence, but the rewards in terms of your parent's quality of life and safety can be substantial.

Watch for symptoms that might be medication-related. If your parent becomes confused, dizzy, falls, has new fatigue, develops tremor, experiences nausea or appetite changes, these should prompt a conversation about whether medications might be responsible. Keep a log of when symptoms started and which medications were started around that same time.

The goal is for your parent to be taking the medications they actually need, in doses that work for them, with attention to the interactions and side effects, and without unnecessary medications that add burden and risk. That's achievable with attention and advocacy. It requires someone to step back and look at the whole picture rather than just individual conditions. That someone can be you.

Frequently Asked Questions

How many medications is too many?
There is no fixed number that defines "too many." Polypharmacy is generally defined as taking five or more medications, and excessive polypharmacy as ten or more. But the real question is whether each medication is still necessary, whether the combination is causing problems, and whether the total regimen is being monitored as a whole. Some people genuinely need ten medications. Others are taking ten because nobody has reviewed the list in years. The number matters less than whether each medication earns its place.

What is the Beers Criteria?
The American Geriatrics Society Beers Criteria is a regularly updated evidence-based list of medications that are potentially inappropriate for older adults. It identifies drugs where the risks typically outweigh the benefits in people 65 and older, including certain sedatives, muscle relaxants, first-generation antihistamines, and some diabetes medications. The Beers Criteria is not a prohibition list; some medications on it are appropriate in specific situations. But it's a tool that doctors and pharmacists use to flag medications that deserve extra scrutiny in older patients.

Does Medicare cover medication reviews?
Yes. Medicare Part D includes medication therapy management (MTM) programs for eligible beneficiaries. To qualify, you typically need to take multiple medications for multiple chronic conditions and have annual drug costs above a certain threshold (which changes annually). The MTM review is free and can be conducted by a pharmacist in person, by phone, or by video. Medicare Part B also covers the geriatric assessment visit, which includes medication review. Ask your parent's pharmacy or Medicare plan about eligibility.

My parent's doctor prescribed all these medications. Isn't it rude to question them?
No. Questioning a medication regimen is not questioning the doctor's competence. It's acknowledging the reality that multiple doctors prescribing independently, over years, without a unified review creates risk. Doctors expect and welcome these conversations. Asking "is this medication still necessary?" or "could any of these be causing the dizziness?" is appropriate patient advocacy. If a doctor is dismissive of these questions, that itself is useful information about whether your parent needs a different doctor or a geriatrician's input.

How do I keep track of my parent's medications?
Create a single, complete written list that includes the medication name, dose, frequency, prescribing doctor, the condition it treats, and when it was started. Update this list whenever anything changes. Bring it to every doctor's appointment and every pharmacy visit. Some pharmacies offer medication synchronization services that align refill dates, making management easier. Pill organizers (daily or weekly) reduce the chance of missed or double doses. There are also apps that track medications and send reminders, though these require your parent to be comfortable with a smartphone.

Can stopping a medication be dangerous?
Yes. Some medications should never be stopped abruptly because withdrawal effects can be serious. Beta-blockers, corticosteroids, benzodiazepines, and certain antidepressants all require gradual tapering under medical supervision. Never stop or change a medication without consulting the prescribing doctor. The goal of a medication review is not to stop everything at once but to identify medications that can be safely reduced or eliminated, one at a time, with monitoring.