Polypharmacy in older people: what it is, risks and how to reduce them

Taking many medicines at once is common in older people and often necessary, but it raises the risk of interactions and mistakes: reviewing the treatment regularly is the best protection.

Polypharmacy means taking five or more different medicines on an ongoing basis. In older people with several long term conditions it is very common and often justified. Problems arise when a medicine is no longer needed, duplicates another or interacts with the rest, or when the person cannot manage so many doses without mistakes.

We explain what the official data say, what the real risks are and what you can do as a family member to reduce them.

What exactly is polypharmacy?

Polypharmacy is when a person takes five or more medicines long term. There is no single universal definition, but five is the threshold most commonly used in Spain.

In its report on people aged 65 and over with polypharmacy, Spain’s Ministry of Health counts someone as having polypharmacy if they are on long term treatment with five or more different active ingredients in the same year, and defines a long term medicine as one whose yearly dispensing equals about six months or more of treatment.

The World Health Organization (WHO) lists polypharmacy as one of the three priority areas of its global challenge “Medication Without Harm”, because as populations age more people live with several long term conditions and several treatments at once.

How many older people in Spain have polypharmacy?

Almost three in ten people aged 65 or over. The Ministry of Health report published in January 2026, using 2023 data from the Primary Care Clinical Database (BDCAP), puts polypharmacy at 29.7% in this group, slightly higher in women (30.9%) than in men (28.3%).

The same report notes that the most frequent medicine groups among people with polypharmacy are stomach protectors and blood pressure medicines, and that polypharmacy is much more common in people with heart failure, coronary heart disease or diabetes.

What are the risks of taking many medicines at once?

The more medicines, the greater the chance of interactions, side effects and mistakes with doses. With age the body also changes the way it absorbs and clears medicines, which makes older people more sensitive to their effects.

• Interactions: one medicine can increase or reduce the effect of another.
• Duplicates: two medicines of the same class prescribed by different doctors, or the same substance under two brand names.
• Side effects: dizziness, drowsiness or confusion that can make falls more likely.
• Dosing mistakes: missed doses, repeated doses or confusion between similar boxes, which we explain in the most common mistakes when organising medication.
• Errors when moving between care settings: according to Spanish studies gathered by the Ministry of Health, up to 63% of people may have a reconciliation error at hospital discharge, and the risk grows with the number of medicines.

How can inappropriate polypharmacy be reduced?

The main tool is a structured medication review: the doctor, supported by the pharmacist, checks that each medicine is still needed, that the dose is right and that there are no relevant duplicates or interactions. When a medicine no longer brings benefit it can be withdrawn in a planned way, which is known as deprescribing.

Professionals rely on recognised criteria such as the STOPP/START criteria or the Beers criteria. For example, the Valencian regional government’s guide to appropriate prescribing in older people with polypharmacy suggests reviewing any medicine without an evidence based clinical indication and any simultaneous prescription of two medicines of the same class.

As a family member, you can help like this:

1. Gather all the medicines, including those bought without a prescription, creams, drops and supplements, and take them to the appointment.
2. Ask for a full medication review at least once a year or after any hospital stay.
3. Ask what each medicine is for and how long it should be taken; our list of questions for your doctor will help.
4. Do not stop or change any medicine on your own: some need to be reduced gradually.

A practical example: Antonio and his eleven medicines

Take the case of Antonio, 79, who has high blood pressure, diabetes, osteoarthritis and atrial fibrillation. He sees his GP, a cardiologist and an endocrinologist, and between them he takes eleven medicines. His son notices that lately he feels dizzy when standing up and keeps boxes of old treatments in a drawer.

The sensible step would be to book an appointment with the GP, take all the packs and a list of what he actually takes, and mention the dizziness. At the review, doses could be adjusted or medicines that are no longer needed could be withdrawn. Afterwards, it is worth removing packs of stopped treatments from the house (the pharmacy can tell you how to dispose of them) and organising the remaining doses by day and time to avoid confusion.

How can IMA Health help you?

When someone takes many medicines, keeping them well organised reduces the risk of missed and repeated doses. With IMA Health, a specialised pharmacy prepares the medication by the day and time of each dose in a personalised dosage system, and IMA coordinates with the pharmacy, handles home delivery and provides personalised follow-up. To find out how this system works, read what an SPD is.

Sources

• Spanish Ministry of Health: polypharmacy reaches 45% of people aged 85 to 94 (January 2026, in Spanish)
• WHO: Medication Safety in Polypharmacy (2019)
• Spanish Ministry of Health: safe practice recommendations for medication reconciliation at hospital discharge (2019, in Spanish)
• Portal del Medicamento, Castile and León regional government: guide to appropriate prescribing in older people with polypharmacy (in Spanish)

This article is for information only and does not replace advice from your doctor or pharmacist.