Your Parent Is Taking 12 Pills a Day and Nobody Is Asking Why

By Patrick Mapile, Founder of CarePali Home Care — West Los Angeles

The average American over 65 takes between 5 and 7 prescription medications daily, according to research published in the Journal of the American Geriatrics Society. Among those over 80, the number often climbs to 10 or more. Johns Hopkins Medicine reports that more than 40 percent of older adults are taking five or more prescriptions — a condition clinically defined as polypharmacy — yet a study in the British Journal of Clinical Pharmacology found that in 82 percent of polypharmacy cases, at least one medication interaction risk was present. The question families should be asking is not just what their parent is taking, but whether anyone has recently asked why each medication is still necessary.

How Medication Lists Grow Without Anyone Noticing

The accumulation of prescriptions in older adults follows a well-documented pattern that researchers call the "prescribing cascade." A study published in the BMJ found that approximately 20 percent of new prescriptions in older adults are written to treat side effects of existing medications rather than new conditions. The classic example: a blood pressure medication causes ankle swelling, which leads to a diuretic prescription, which causes potassium loss, which leads to a potassium supplement, which causes stomach upset, which leads to an antacid — five medications stemming from one original prescription.

The problem is compounded by fragmented care. Research in the Annals of Internal Medicine found that older adults with multiple chronic conditions see an average of 7 different physicians, and the Journal of General Internal Medicine reported that only 30 percent of specialists are aware of what other specialists have prescribed for the same patient. Each specialist manages their own piece, and nobody steps back to look at the whole picture. A study in JAMA Network Open found that the risk of an adverse drug event increases by 7 to 10 percent with each additional medication.

The Real Dangers of Overmedication

The consequences of polypharmacy extend far beyond theoretical interaction risks. The Journal of the American Geriatrics Society reports that adverse drug events cause approximately 177,000 emergency department visits among older adults annually in the United States and are responsible for up to 12 percent of all hospital admissions in this population. Research published in JAMA Internal Medicine found that polypharmacy independently increases the risk of falls (by 21 percent for every additional medication beyond four), cognitive impairment, urinary incontinence, and malnutrition.

The AGS Beers Criteria — the most widely used guide to potentially inappropriate medications in older adults — identifies dozens of medications that carry elevated risk in this population. Research applying the Beers Criteria has consistently found that 20 to 40 percent of older adults are taking at least one medication classified as potentially inappropriate, with anticholinergic medications (found in many over-the-counter sleep aids, allergy medications, and bladder drugs) being among the most concerning due to their well-documented association with cognitive decline and falls.

The Science of Deprescribing

Deprescribing — the systematic process of reducing or stopping medications that may no longer be necessary or may be causing more harm than benefit — has emerged as a critical field in geriatric medicine. A meta-analysis published in the British Journal of Clinical Pharmacology found that deprescribing interventions in older adults are safe and effective, reducing the number of medications without increasing adverse health events or mortality. Several studies have shown the opposite: careful medication reduction actually improves outcomes.

Research from the Journal of the American Medical Directors Association found that a structured deprescribing process led to an average reduction of 2.8 medications per patient with no increase in mortality and significant improvement in cognitive function and overall wellbeing. The D-PRESCRIBE trial, published in JAMA Internal Medicine, demonstrated that patient-directed deprescribing interventions successfully reduced the use of potentially inappropriate medications by 43 percent compared to usual care.

What Families Can Do

The first and most important step is creating a complete, accurate medication list. The Institute for Safe Medication Practices recommends including every prescription, over-the-counter medication, vitamin, supplement, and herbal product — then bringing this list to every medical appointment. Ask each prescribing physician a simple but powerful question recommended by the American Geriatrics Society: "Is this medication still necessary, and what would happen if we stopped it?"

Request a comprehensive medication review with your parent's primary care physician or, ideally, a geriatrician or clinical pharmacist who specializes in older adult pharmacotherapy. Medicare covers medication therapy management services for qualifying beneficiaries through Part D plans — a benefit that the CMS reports remains significantly underutilized. Many pharmacies also offer medication review services, and the AARP recommends scheduling one at least annually or whenever a new medication is added.

West Los Angeles Resources

UCLA Health's Division of Geriatric Medicine offers comprehensive medication reviews as part of their geriatric assessment program. Cedars-Sinai's pharmacy services include clinical pharmacist consultations. Many local pharmacies in West LA, including independent pharmacies that often provide more personalized service, offer medication therapy management. The LA County Area Agency on Aging can help connect families with resources for medication management support.

At CarePali, medication management is a core part of how our home care aides support families. From organizing pill boxes and providing medication reminders to observing for side effects and communicating changes to family members and healthcare providers, we help ensure that your parent's medication regimen is working for them rather than against them. If you are looking at your parent's pill bottles and wondering whether all of them are still necessary, that instinct deserves to be followed up on. We are here to help.