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For clinicians  ·  For facilities  ·  For families  ·  For staff

Why is my parent on nine medications?

For families of residents

Nobody sat down and decided your father should take nine medications. The list assembled itself, and every step in the assembly was reasonable at the time.

Before you read on

Never stop or change a prescribed medication without speaking to your own prescriber. Several of the classes described on this site rebound, or cause a withdrawal syndrome, when they are stopped abruptly, and some have to be reduced gradually over weeks or months under supervision. Nothing here is advice about your own medication, and nothing here is a reason to change anything on your own.

How it happens

  1. Something was started in a hospital and never stopped. A stomach-acid drug started to protect against a stress ulcer during an intensive care stay is the classic example. In a study of nine intensive care units, 60% of new prescriptions for these drugs had no long-term reason — and 27% of those patients went home still taking them. Being discharged to a nursing home or rehabilitation facility made that more likely, not less.
  2. A side effect was treated as a new problem. One drug causes constipation, dizziness or confusion; that gets treated with a second drug; the second causes something of its own. Doctors call this a prescribing cascade. It is only visible if someone reads the list in the order it was written.
  3. A condition resolved and the treatment did not.
  4. Three prescribers each made a good decision — a hospital doctor, a family doctor, a specialist — and none of them saw the other two.
  5. A preventive medicine kept going past the point where it could help. Some medicines work by preventing something years from now. Statins for prevention take roughly two and a half years before one heart attack or stroke is prevented for every hundred people treated. That is a different proposition for someone with a shorter outlook.

How common this is

It is not unusual and it is not a sign that your parent’s facility is bad. Across 4,023 nursing home residents in 57 facilities in seven European countries and Israel, 74% were taking five or more medications and 24.3% were taking ten or more. Among community-living US adults aged 65 and over, 43.8% were taking five or more prescription medicines.

The starkest single figure is about one class. Among Medicare admissions to 22 US skilled nursing facilities, 79.7% were on a stomach-acid drug and 65.3% of those had no recorded reason for it.

The one worth asking about first

If you ask about one thing, ask whether anything on the list is sedating — and whether anyone has considered that what looks like decline could be a medication.

This is the most consequential question a family can ask, because of what happens when it is not asked. Something sedating is started. Your mother becomes quieter, slower, less engaged. That is recorded as decline. Decline is put down to the dementia progressing. The care plan is adjusted for someone further along than she is. Nothing was prescribed at the last step, and nobody did anything wrong, and she has lost ground she did not have to lose.

What a longer list actually costs

Not simply inconvenience. In a study of 3,075 people aged 70 to 79 living in the community, the combined sedative and anticholinergic load of a medication list was linked to worse physical function — and a one-unit increase in that load was associated with a bigger deficit than having one additional chronic illness.

“Anticholinergic” is a side effect shared by many ordinary medicines — some for bladder problems, some older antihistamines, some antidepressants, some for stomach cramps. Each may be mild. Added together across nine drugs they produce dry mouth, constipation, difficulty passing urine, blurred vision and confusion — and no single prescription looks responsible. More on anticholinergic burden.

What a shorter list will and will not do

It will mean fewer tablets, fewer side effects to have, and fewer drugs treating nothing. The randomized evidence supports that and shows it is safe.

What the evidence does and does not show

Sedating medications impair gait, balance and reaction time, and their labels say so. That part is not in doubt. What has not been shown is that a deprescribing program reduces fall rates — the trials that tested it were small, short, and mostly measured a medication count rather than a fracture. Those are two different questions, and absence of evidence from underpowered trials is not evidence that the drugs do not cause falls. What the evidence actually shows about deprescribing and falls.

It has also not been shown to help people live longer. Being told either of those things as a reason for a review is being told more than the evidence supports — and a review is still worth having.

What to do with this

Ask for a medication review, ask that the list be looked at as a whole and in date order, and ask to be told before a change rather than after it. The questions, in words that work.

Back to the family track.

References

  1. Blackett JW, Faye AS, Phipps M, Li J, Lebwohl B, Freedberg DE. Prevalence and Risk Factors for Inappropriate Continuation of Proton Pump Inhibitors After Discharge From the Intensive Care Unit. Mayo Clinic Proceedings. 2021;96(10):2550–2560. PMID 33308869 · DOI 10.1016/j.mayocp.2020.07.038.
  2. Yourman LC, Cenzer IS, Boscardin WJ, et al. Evaluation of Time to Benefit of Statins for the Primary Prevention of Cardiovascular Events in Adults Aged 50 to 75 Years: A Meta-analysis. JAMA Internal Medicine. 2021;181(2):179–185. PMID 33196766 · DOI 10.1001/jamainternmed.2020.6084.
  3. Onder G, Liperoti R, Fialova D, et al. Polypharmacy in nursing home in Europe: results from the SHELTER study. The Journals of Gerontology Series A. 2012;67(6):698–704. PMID 22219520 · DOI 10.1093/gerona/glr233.
  4. Pan S, Li S, Jiang S, et al. Trends in Number and Appropriateness of Prescription Medication Utilization Among Community-Dwelling Older Adults in the United States: 2011–2020. The Journals of Gerontology Series A. 2024;79(7):glae108. PMID 38644631 · DOI 10.1093/gerona/glae108.
  5. Patterson Burdsall D, Flores HC, Krueger J, et al. Use of proton pump inhibitors with lack of diagnostic indications in 22 Midwestern US skilled nursing facilities. Journal of the American Medical Directors Association. 2013;14(6):429–432. PMID 23583000 · DOI 10.1016/j.jamda.2013.01.021.
  6. Hilmer SN, Mager DE, Simonsick EM, et al. A drug burden index to define the functional burden of medications in older people. Archives of Internal Medicine. 2007;167(8):781–787. PMID 17452540 · DOI 10.1001/archinte.167.8.781.
  7. Lee J, Negm A, Peters R, Wong EKC, Holbrook A. Deprescribing fall-risk increasing drugs (FRIDs) for the prevention of falls and fall-related complications: a systematic review and meta-analysis. BMJ Open. 2021;11(2):e035978. PMID 33568364 · DOI 10.1136/bmjopen-2019-035978.
  8. Persaud N, Workentin A, Rizvi A, et al. Interventions to Address Potentially Inappropriate Prescribing for Older Primary Care Patients: A Systematic Review and Meta-Analysis. JAMA Network Open. 2025;8(6):e2517965. PMID 40577011 · DOI 10.1001/jamanetworkopen.2025.17965.
  9. Quek HW, Page A, Lee K, et al. The effect of deprescribing interventions on mortality and health outcomes in older people: An updated systematic review and meta-analysis. British Journal of Clinical Pharmacology. 2024;90(10):2409–2482. PMID 39164070 · DOI 10.1111/bcp.16200.

Bibliographic records on this page were retrieved from PubMed. Every reference links to its DOI or PubMed record.

Written and medically reviewed by Dr. Gurpreet Singh Padda, MD, MBA, MHP, founder and medical director of DWARAA. Last reviewed . This page is educational. DWARAA does not prescribe, deprescribe, diagnose or treat.