Polypharmacy Crisis: Expert Warns of Over-medication in Elderly Populations

In Spain, three out of every ten people over sixty-five take five or more medications chronically. By the time they reach their mid-eighties, that number climbs to nearly half. These are not people taking pills for fun or out of habit—they are managing real diseases, real conditions that demand pharmaceutical intervention. Yet something has gone quietly wrong in how we've learned to manage medication in aging bodies, and Leocadio Rodríguez-Mañas, head of geriatrics at Madrid's Hospital Universitario de Getafe, has spent his career trying to untangle it.

The problem, he explains, is not simply that older people take too many pills. It is that they often take the wrong pills, at the wrong doses, for the wrong duration, or in combinations that create invisible dangers. A patient arrives complaining of dizziness or confusion, and the doctor's first instinct is to order tests. But Rodríguez-Mañas asks a different question: Has something changed with your medications? More often than not, the answer is yes. The symptom is not a new disease—it is a side effect, an interaction, a dosing miscalculation that could have been prevented.

The stakes are substantial. Research suggests that up to half of all hospitalizations among elderly patients involve problems directly tied to medication use. That figure may be high, Rodríguez-Mañas concedes, but even a fraction of that represents thousands of preventable admissions, thousands of people whose health deteriorated not because they were sick, but because they were medicated incorrectly. The risk does not increase linearly with the number of drugs. It follows a curve shaped like the letter J—flat at first, then suddenly steep. Once a patient crosses the threshold of five medications, the probability of adverse events climbs exponentially. Two drugs that both bind heavily to blood proteins can compete for space, displacing each other and flooding the bloodstream with active drug. A sleeping pill prescribed as a temporary measure becomes permanent. An anti-inflammatory taken casually before breakfast, repeated by one in three elderly patients in ways their doctors never intended, accumulates in tissues and causes damage.

Yet the deeper problem is structural. Elderly patients are dramatically underrepresented in clinical trials. A study of heart failure treatments might enroll people averaging seventy years old, even though the typical heart failure patient is over eighty. When a drug is later prescribed to someone a decade older, effects emerge that were never detected in the trial. Pharmaceutical companies avoid enrolling very old patients with multiple conditions because such trials are considered messy—how do you know which drug caused which benefit? The result is that many medications taken by seniors have never been properly tested in senior bodies.

Medical schools compound the problem. Many do not teach geriatrics as a subject at all. A physician graduates at twenty-eight or twenty-nine, fully credentialed, having read little or nothing about how aging changes drug metabolism, how drug interactions multiply, how the margin between therapeutic and toxic narrows with age. They sit down in their clinic, call the next patient, and that patient is elderly. In Madrid, where geriatric services exist in most hospitals, seventy to seventy-five percent of all healthcare spending and time goes to older people. Yet the training to care for them properly is scarce.

Rodríguez-Mañas identifies three categories of medication error in elderly care: overtreatment, undertreatment, and misuse. A patient might take more drugs than necessary. Another might not receive drugs they would benefit from—an antidepressant started at a low dose and never increased to therapeutic levels, leaving the patient unimproved but committed to a medication that no one ever revisits. A third might take the right drug at the wrong dose for the wrong duration. The solution, he argues, requires time and pedagogy. When he explains to an eighty-three-year-old that cholesterol treatment might show benefit in ten or fifteen years, but their life expectancy is ten or twelve years, the calculation becomes clear. The patient often agrees to stop. But that conversation has to happen. Authority alone—the doctor saying simply, stop taking this—does not work. Commitment to treatment comes from understanding it.

The path forward is not to eliminate medication from aging bodies. It is to be deliberate about which medications stay and which go, to review prescriptions at every visit, to recognize that what is not clearly indicated is clearly contraindicated. It requires geriatricians, primary care physicians trained in aging, nurses and therapists who understand the specific vulnerabilities of older bodies. It requires the difficult work of sitting with a patient and explaining why a medicine that once helped might now harm, and why doing less, sometimes, is doing more.