Longevity and Medication: How to Avoid the Trap of Polypharmacy as We Age
Every morning, Francisco, 78 years old, sets out on the table a small collection of pills of different colors and sizes. Antidiabetics, pills for heart failure, tablets for uric acid or cholesterol, a dose for benign prostatic hyperplasia… The doses are spaced throughout the day, and at night comes the time for benzodiazepines to help him sleep.
This is a real and far from exceptional case. Many older adults follow a similar medication routine. According to Spain’s Ministry of Health, more than 50% of people over 65 regularly take five or more medications. And 20% take ten or more different active substances daily. Although medications are often necessary (and in some cases essential), this accumulation of prescriptions can multiply the risks of drug interactions, adverse effects, falls, cognitive decline, and preventable hospitalizations, as some health guidelines and studies describe. “Most studies agree in showing the existence of excessive drug consumption, with a daily average ranging between 4.5 and 8 medications per person per day. These studies demonstrate, on the one hand, that this consumption leads to a high rate of adverse effects and mortality, and on the other hand, that there is poor prescribing in most cases. The loss of a global approach to the patient and the misuse of health resources are at the root of this situation. Each medication is the result of isolated medical actions, leading to the development of iatrogenesis (harm or disease caused by medical care, whether through treatment, diagnosis, or healthcare in general),” states the report The Elderly Polymedicated Patient: Effects on Their Health and on the Healthcare System.
Polypharmacy is defined as the habitual use of five or more medications simultaneously. Although sometimes necessary, its uncontrolled proliferation can bring serious problems. Medicine has allowed us to live longer, but it has also created a dependency on treatments that, at times, end up complicating more than helping. In the era of longevity, polypharmacy has become a worrying phenomenon. What consequences does it have? And how can we imagine an aging process where health does not depend exclusively on an endless list of prescriptions?
Why Does It Happen? Multiple Factors
Polypharmacy has its roots in how we conceive of and manage health in older age. First, there is medical fragmentation, as many older patients visit several specialists (cardiologists, rheumatologists, neurologists…), each prescribing medications often without a comprehensive view of the patient’s overall health—in many cases, though of course it is not a universal problem for all patients.
Second, as many specialists point out, the healthcare system has prioritized treating specific symptoms rather than promoting preventive strategies and healthy living. Another factor to consider is what is called therapeutic inertia: once a treatment is started, it often continues without reassessing its real need over time. “There are many cholesterol medications prescribed to prevent risk, and at a certain point for some patients, this indication no longer makes sense; in people aged 98, for example, it might no longer be appropriate to keep them on a statin, especially since that medication can cause muscle weakness,” family doctor Jordi Mestres told me.
And beyond all that, cultural pressure also plays a role; there is a strong social belief that more medication equals better care and more attention from the prescribing doctor. As a result, many older adults continue on treatments that may have been useful at one time but should now be reviewed, adjusted, or even discontinued.
The Consequences
Taking multiple medications not only carries physical risks. It also has emotional and life-related costs. The side effects from drug interactions—and from the drugs themselves—are a problem: dizziness, confusion, drowsiness, or digestive disorders are common and often go unnoticed as “just part of aging.” Dependence on strict medication schedules can limit daily activities or travel, leading to a loss of autonomy. Moreover, these drug cocktails can affect self-perception of health; managing a daily routine based around medications can diminish self-esteem, mood, and the sense of vitality.
Toward Smarter Prescribing
In recent years, movements have emerged in Spain and many other countries to address this situation. One key concept is rational deprescription—that is, the process of reducing or discontinuing medications that no longer offer real benefit. Polimedicado.org is a platform promoting the “Just the Right Pills” campaign, aimed at raising awareness about rational medication use. In Madrid, there is the Polymedicated Senior Care Program, for example, and in Catalonia, the Department of Health launched the Pills, Only the Necessary Ones campaign in 2024 to reduce the inappropriate use of certain medications, particularly among people taking 10 or more medications simultaneously and showing signs of frailty. These are just a few examples.
Smart prescribing in older age means periodically reviewing all medications, evaluating current risks and benefits; prioritizing treatments that have a real impact on quality of life, not just on clinical parameters; and including the patient in decision-making, respecting their autonomy and life goals.
Longevity should be an opportunity to live more fully, not just to accumulate more years of medical dependence. It’s not about demonizing medication—many times it is essential—but about returning the spotlight to the person, not the drug. Living longer should not mean living more medicated, but living more freely, with a body and mind as unburdened as possible by unnecessary treatments.
