About 4 in 10 Americans aged 65 and older now take five or more prescription drugs, up from about 2 in 10 at the turn of the century, according to a research letter from Memorial Sloan Kettering Cancer Center published this week in JAMA Network Open.
If you or a parent is on a long medication list, this finding does not mean any one of those drugs is wrong. It is a good reason to bring every bottle to your next appointment and ask two questions: which of these do I still need, and is any of them treating a side effect of another? Do not stop or cut back a prescription on your own. Some drugs cause harm when stopped suddenly, and that decision belongs with your doctor.
Key takeaways
- Among adults 65 and older, taking five or more prescription drugs rose from 21.9% to 40.7% between 1999-2000 and 2017-2020.
- Across all US adults, any prescription drug use rose from 46.7% to 56.4%, and five-plus drug use more than doubled, from 7.8% to 16.7%.
- The biggest jumps were in cholesterol, blood pressure, diabetes and antidepressant drugs.
What the study found
The researchers used the National Health and Nutrition Examination Survey (NHANES), a federal survey of US adults, covering 58,201 participants. People reported the prescription drugs they had taken in the previous 30 days during household interviews. The team compared 1999-2000 with 2017-2020.
Overall, the share of adults taking at least one prescription drug went from 46.7% to 56.4%. The share taking five or more, called polypharmacy, rose from 7.8% to 16.7%. The largest increase in polypharmacy was in adults 65 or older, from 21.9% to 40.7%.
Several drug classes grew sharply across all adults:
- Cholesterol-lowering drugs: 7.5% to 20.3%
- Blood pressure drugs: 18.3% to 30.0%
- Antidepressants: 6.8% to 14.2%
- Diabetes drugs: 4.6% to 11.1%
- Blood thinners and other drugs that affect clotting: 2.0% to 4.7%
The authors note that the rise in drugs for heart and metabolic disease was consistent with changing clinical guidelines. Over-the-counter medicines were not fully captured, so the true number of pills people take is likely higher.
Dr. Kumar’s take
This is a snapshot survey, not a trial. It tells us how many people take these drugs. It does not tell us whether they are healthier for it, or which prescriptions were appropriate.
Some of the increase reflects real progress: better diabetes and blood pressure treatment, more people treated for depression. But a lot of it reflects guidelines that widened who counts as “needing” a drug. Cholesterol drugs nearly tripled across all adults. Lower treatment thresholds put more people without heart disease on lifelong medication, and the case for that is far weaker than for people who already have it. More drugs is not the same as better care.
The bigger risk sits in the combinations. Each added drug brings its own side effects and new chances for interactions. One common trap is the prescribing cascade: a drug causes a side effect, the side effect gets mistaken for a new problem, and a second drug gets added to treat it. A blood pressure pill that causes ankle swelling can lead to a water pill. A drug that causes dizziness can lead to a drug for dizziness. Each step looks reasonable on its own, which is why cascades build up over years and several doctors.
The good news is that cascades are often fixable. Someone has to look at the whole list at once, and that often does not happen when care is split among specialists.
What it means for you
- Bring everything. Put every prescription, over-the-counter drug and supplement in a bag and take it to your next visit, or ask your pharmacist for a full medication review.
- Ask the two questions. Is each drug still needed? Did any of them start after a new symptom that appeared soon after another drug began?
- Tell your doctor about new symptoms that started after a medication change, before anything new gets added.
- Do not stop anything on your own. Blood pressure drugs, antidepressants, blood thinners and others can cause problems if stopped abruptly. Any reduction should be planned with your doctor.
- Non-drug options count. For some conditions, such as mild depression, exercise has real evidence in older adults. Ask whether that fits your situation.
A shorter list is not automatically a better one. The point is that every pill on it should have a current reason to be there.