The Biggest Medication Mistakes Older Adults Make

Polypharmacy and the Medication Mistake Risk Older Adults Face Daily

Polypharmacy — the simultaneous use of multiple medications — has become a defining feature of older adult health in the United States. According to a brief published in the Journal of the American Medical Association, the use of multiple prescription medications among older Americans has nearly doubled over the past two decades. The most commonly referenced clinical threshold for polypharmacy is five or more medications, while use of ten or more is often classified as excessive polypharmacy. Among adults aged 65 and older, data from the Centers for Disease Control and Prevention indicates that the percentage taking five or more prescriptions tripled over three decades, rising from 14 percent to 42 percent.

The risks that accumulate with each added drug are not linear. Research published in 2023 and cited by MedShadow Foundation found that when a person is managing two medications, the risk of an adverse drug reaction is approximately 13 percent. That figure rises sharply to 58 percent when five medications are involved, and reaches 82 percent when seven or more drugs are taken concurrently. These are not rare edge cases — they describe the daily reality for a substantial portion of the senior population.

The National Institute on Aging further notes that inappropriate polypharmacy — meaning the use of excessive or unnecessary medications — specifically elevates risk for falls, cognitive impairment, harmful drug-drug interactions, and drug-disease interactions, where a medication prescribed for one condition worsens another entirely. This systemic vulnerability makes medication management one of the most critical safety priorities in geriatric care.

Skipping Doses and Inconsistent Medication Adherence in Seniors

One of the most frequently reported medication mistakes among older adults is non-adherence — taking medications inconsistently, skipping doses, or stopping a course of treatment without informing a physician. A study focused on identifying common medication errors among elderly individuals found that approximately 50 percent of respondents reported skipping dosages, taking them incorrectly, or not following the frequency their doctors directed. Research published in 2024 and indexed in PubMed identified the most prevalent self-administration errors as forgetting doses, taking medications with or without food incorrectly, improper timing, taking an incorrect dosage, and failing to follow physician instructions.

Non-adherence is rarely a matter of carelessness alone. Older adults often manage complex schedules involving morning, afternoon, and evening doses, sometimes from medications prescribed by multiple specialists who may not be fully coordinating with one another. Vision changes that make label reading difficult, cognitive changes that affect memory, and the sheer volume of pills involved all contribute to errors that may go unrecognized for extended periods. A 2024 study found that while 95.6 percent of older adults could read prescription labels, only 35 percent could effectively interpret the actual dosing directions provided with their medications.

Dangerous Drug Interactions and the Hidden Risk of OTC Medications

A persistent and widely underappreciated medication mistake involves the role of over-the-counter products and dietary supplements in creating dangerous drug interactions. Adults aged 65 and older account for approximately 30 percent of all over-the-counter medication use in the United States, despite representing a smaller proportion of the population, according to the University of Utah Health poison control program. Research published in PMC found that nearly half of all older adults use an OTC medication daily or weekly. Despite this prevalence, many seniors and their physicians do not discuss OTC use in the same detail as prescription regimens.

A study from the University of Chicago Medicine found that 68 percent of adults who took prescription drugs were also using over-the-counter medicines or dietary supplements — yet only 35 percent of those individuals had actually discussed this with a medical professional, according to research cited by the Lanier Law Firm. A comprehensive review published in a peer-reviewed journal and indexed on PubMed found that concurrent use of supplements and prescription medications ranged from 23 to 82.5 percent in studies of older adult populations, significantly increasing the risk of adverse interactions, particularly involving anticoagulants and absorption-disrupting minerals such as calcium interfering with levothyroxine uptake.

The FDA has identified grapefruit juice as a notable food-drug interaction risk, noting that consuming it while taking certain cholesterol-lowering statins can cause too much of the drug to remain in the body, raising the risk of liver and muscle damage that can progress to kidney failure. Grapefruit juice also interacts with select medications prescribed for high blood pressure, Crohn’s disease, ulcerative colitis, and abnormal heart rhythms. Loop diuretics, commonly prescribed for heart failure and kidney disease, carry documented interactions with non-steroidal anti-inflammatory drugs such as ibuprofen — a class of OTC pain relievers many older adults reach for without a second thought.

The StatPearls entry on polypharmacy, maintained by the National Library of Medicine, notes that fewer than half of patients discuss the use of herbal supplements or complementary medicine with their medical providers — a communication failure the review describes as a significant systemic gap. A review synthesizing evidence from 16 international studies called for standardized supplement screening during clinical visits as a foundational step toward reducing preventable interactions in older populations.

Stopping Prescribed Medications Without Medical Guidance

Another common and potentially hazardous error involves older adults independently deciding to stop taking a prescribed medication — often because they feel better, are concerned about side effects, find the medication too expensive, or simply forget the reason it was prescribed. The National Institute on Aging explicitly cautions that no medication should ever be stopped without first consulting a healthcare provider, as abrupt discontinuation of certain drugs can trigger rebound effects, withdrawal symptoms, or dangerous instability in the conditions the drug was managing.

This error is compounded by a tendency, documented in research, for older patients to continue filling prescriptions for decades without revisiting whether those medications are still necessary or appropriate. Some drugs, including certain sleep aids and acid-reducing medications, can become riskier with prolonged use or as a person ages, according to reporting from AARP that cites clinical pharmacists and researchers. The aging body processes drugs differently than it did in younger years — reduced kidney and liver function can slow drug metabolism, causing medications to accumulate to higher concentrations than intended even at unchanged doses.

Healthcare providers increasingly rely on the American Geriatrics Society’s Beers Criteria — a regularly updated list of potentially inappropriate medications for older adults — to identify drugs that should be avoided or used with heightened caution in seniors. The criteria categorizes medications across five risk tiers, including those that are generally inappropriate for older adults, those to avoid in patients with specific conditions, drugs to use with caution, known drug-drug interactions, and dose adjustments based on kidney function. Despite its clinical utility, awareness of this guidance among patients themselves remains limited.

Medication Mistakes Rooted in Poor Communication with Healthcare Providers

Many of the most consequential medication errors experienced by older adults are not the result of intentional choices or individual carelessness — they stem from fragmented communication across the healthcare system. Older adults with multiple chronic conditions frequently see several specialists in addition to a primary care physician, each of whom may prescribe medications independently and without full visibility into what the others have prescribed. This environment creates conditions in which duplicate prescriptions, conflicting drug regimens, and unchecked interactions can persist undetected.

Transitions in care — particularly the movement between hospital settings and home — have been identified by the National Library of Medicine’s StatPearls resources as a common source of medication errors. Discharge summaries may contain discrepancies, medications started during a hospital stay may not be communicated clearly to outpatient providers, and newly prescribed drugs may not be reconciled against those the patient was already taking. Research published in BMC Geriatrics examining elderly patients with high medication burdens found that medication discrepancies in discharge summaries were significantly more frequent when patients were managing a large number of drugs.

Pharmacists represent an underutilized resource in this landscape. Using a single pharmacy for all prescriptions allows the pharmacist to maintain a complete medication profile and flag potential interactions before they cause harm. The American Medical Compliance organization, in its guidance for healthcare personnel on elder medication management, specifically recommends that clinical teams ask patients about herbal supplements, vitamins, and OTC products — not just prescription drugs — at every relevant encounter.

How Age-Related Physiological Changes Amplify Medication Risk

Beyond behavioral and systemic errors, the aging body itself introduces a layer of biological complexity that can turn standard medication regimens into sources of unexpected risk. The clinical literature consistently documents that older adults experience meaningful changes in pharmacokinetics — the way the body absorbs, distributes, metabolizes, and excretes drugs. Kidney function declines with age, which is significant because many medications rely on the kidneys for clearance. When kidney function is reduced, drugs can accumulate to higher concentrations than intended, increasing the likelihood of toxicity even when doses have not changed.

Body composition also shifts with age — decreased muscle mass and increased body fat alter how certain drugs are distributed throughout the system. The central nervous system becomes more sensitive to medications that affect it, including sedatives, sleep aids, pain medications, and some antidepressants. The National Institute on Aging has noted that prescribing three or more central nervous system-active drugs to older adults — a pattern it calls CNS-active polypharmacy — may increase the risk of falls, overdoses, memory problems, and death, based on data from a study covering more than 1.2 million people with dementia enrolled in Medicare.

The StatPearls resource on polypharmacy reduction strategies, updated in August 2024, lists cognitive impairment, falls, hospitalizations, and increased mortality among the clinical outcomes most strongly associated with polypharmacy in older adults — outcomes that are directly influenced by age-related physiological changes interacting with complex drug regimens. These biological realities make it especially important that physicians conduct comprehensive medication reviews and consider the concept of deprescribing: the deliberate, supervised reduction or elimination of medications that are no longer necessary, no longer effective, or whose risks have come to outweigh their benefits.

Frequently Asked Questions About Senior Medication Safety