Managing Multiple Medication Complexity in Aging Adults

For millions of older Americans, taking their daily medications can be a complicated task and lead to preventable safety issues or non-adherence. As the population of the United States ages, this challenge will only become more urgent. The number of adults 65 and older is expected to increase by 42% between 2022 and 2050, rising from 58 million to 82 million. 

While modern medicine has allowed us to live longer lives, aging comes with physiological changes, greater disease burden and increasingly complex medication needs. The question becomes: how can we support older adults in managing these medications safely so they can maintain optimal health?

In this article, we’ll examine today’s healthcare landscape, often characterized by fragmented care and polypharmacy, and highlight three strategies that can reduce medication-related risk.

The Risk of Too Many Medications

One of the most significant drivers of medication management complexity is polypharmacy, defined as the regular use of multiple medications. For seniors with several chronic conditions, such as heart disease, diabetes, and hypertension, polypharmacy is practically unavoidable. 

What we know: 

• • Polypharmacy is widespread: Between 2021 and 2022, nearly 87% of adults aged 65+ took at least one prescription medication in the past year. Additionally, according to the Centers for Disease Control (CDC), about 1 in 3 adults in their 60s and 70s take five or more prescription drugs regularly.
  • Risk increases sharply with each added medication: Patients taking 5–9 medications have a 50% chance of an adverse drug event, and polypharmacy contributes to nearly 30% of all hospital admissions.

These numbers highlight how rapidly medication use can become both unsafe and unmanageable, and why addressing polypharmacy must be a priority in senior care.

The Safety Crisis of Adverse Drug Events (ADEs)

An adverse drug event is any patient injury associated with a medication. Unfortunately, ADEs are a common and often preventable source of morbidity and mortality among U.S. seniors. The sheer volume of medications many older adults take, combined with age-related changes in the body’s ability to process drugs (pharmacokinetics and pharmacodynamics), puts them at significantly higher risk.

What we know:

• • Hospitalization risk increases: Older adults are hospitalized for ADEs 4–7 times more often than younger adults.
  • Emergency visits are more common: Each year, older adults visit U.S. emergency departments for ADEs significantly more often than younger people.
  • Certain medications drive the most harm: The leading causes of ADE-related emergency visits in seniors are widely used, high-risk drugs—anticoagulants, diabetes medications like insulin, opioid pain relievers, and antibiotics. 

Many of these adverse events are preventable and stem from issues such as drug-drug interactions, inappropriate dosing, inadequate monitoring, and nonadherence.

By the Numbers

Key statistics that highlight the scope of medication use and safety risks among older adults.

• 88.6% of U.S. seniors take at least one prescription medication.
• 1 in 3 adults in their 60s and 70s take five or more medications regularly.
• Taking 5-9 medications raises the risk of drug interaction to 50%.
• 30% of all hospital admissions are linked to polypharmacy.
• 4–7× higher hospitalization rates for medication-related harm in older adults compared to younger adults.
• 3.4%–20%+ of seniors skip or alter medications due to cost, depending on the survey.

The Barriers to Medication Adherence in Older Adults

Taking medicine exactly as prescribed is essential for managing chronic conditions. However, for older adults, adherence can break down for three core reasons: patient-level challenges, financial barriers, and system-level gaps. These issues make it harder for seniors to take medications safely and consistently, increasing the risk of preventable harm.

1. Complex Regimens and Patient-Level Challenges

As noted above, many older adults manage multiple medications with different dosing schedules, instructions, and side effects. These complex regimens alone can make adherence difficult. In some cases, patients may also question the need for certain medications, particularly if they don’t feel immediate benefit. 

In addition, age-related cognitive decline, such as forgetfulness or difficulty following complex instructions, may result in missed doses or incorrect use. Physical limitations, including arthritis, reduced grip strength, vision loss, or trouble opening pill bottles, can also interfere with a senior’s ability to take medications independently. 

2. Financial Barriers and Cost-Related Nonadherence (CRN)

Despite Medicare coverage, prescription drug costs are a hardship for many older adults on fixed incomes. As a result, some skip doses, delay refills, or reduce their prescribed amount to save money. Indeed, CDC data shows that 3.4% of seniors reported cost-related nonadherence in 2021–2022, while broader national surveys place the number over 20%.

3. System-Level Fragmentation and Communication Gaps

Older adults often see multiple specialists who may each prescribe medications. This can increase the risk of drug-drug interactions, duplicate prescriptions, and inconsistent instructions. Poor communication with healthcare providers, particularly during care transitions like hospital discharge, further raises the risk of medication errors and adverse drug events.

The Strategies for Safer Medication Management

What does making a meaningful reduction in medication-related risk look like in practical terms? It requires shifting from a reactive approach—fixing medication problems only after they occur—to a proactive one that prevents those problems in the first place. That means better oversight of patients’ medications, stronger pharmacy involvement, and clearer guidance for patients and caregivers.

1. Deprescribe and Reconcile Medications

The data above shows that many older adults take a large number of medications, which increases the likelihood of harmful interactions or errors. Addressing polypharmacy is critical. Medication reconciliation, a formal process of creating the most accurate and complete list of a patient’s current medications, is essential to minimizing this risk.

Equally important is deprescribing, the supervised tapering or discontinuation of medications when potential harms outweigh potential benefits.

2. Leverage Pharmacist Expertise

Pharmacists play a vital role and are often underutilized partners in medication safety. Expanding their role, such as through Medication Therapy Management (MTM), can make a meaningful difference. 

In MTM, pharmacists take a closer look at all of a patient’s medications, check for risks, and adjust the regimen when needed. They also ensure patients understand how and when to take each drug. This can improve adherence and safety by providing comprehensive reviews and counseling to address potential issues like drug interactions and complexity. 

3. Strengthen Patient and Caregiver Education

Low health literacy is often a barrier to adherence. It’s important for providers to use clear, accessible communication to ensure patients and their caregivers understand each medication’s purpose, dosing, timing, and potential side effects. This kind of education is one of the most effective safeguards against misuse and preventable harm.

Looking Forward

If left unaddressed, medication complexity will only intensify as the population ages. By simplifying regimens, strengthening communication, and improving coordination across care teams, we can give older adults the support they need to manage their medications safely and maintain their health for as long as possible.

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