Each year, an estimated 1.5 million people in the U.S. are affected by medication errors. Older adults face an even greater risk due to the challenges of juggling multiple daily prescriptions.
As our older population grows, there is a real need for better safety practices and error prevention strategies. Caregivers and healthcare providers serve as vital safeguards against these risks. Despite the challenges, there are effective strategies they can use to help protect this vulnerable population from medication errors.
The Rising Risks of Polypharmacy: How More Medications Increase the Chance of Harm
Over the past two decades, the use of multiple prescription medications among older Americans has nearly doubled. A recent brief published in JAMA highlights this growing trend, known as polypharmacy.
The study found that approximately 40% of adults aged 65 and older took five or more prescription medications within a 30-day period between 2017 and 2020 — a significant increase from approximately 20% reported between 1999 and 2000.
“Managing multiple medications can be challenging for individuals, and especially for older adults,” explains Mbonu Ikezuagu, M.D., chief quality officer at Froedtert ThedaCare Health, a Wisconsin-based nonprofit that helps to organize a patient’s care among multiple healthcare providers. “Each new prescription complicates daily medication routine and increases the risk of harmful errors if not monitored.”
Case Studies: How Medication Mix-Ups Can Harm Older Adults
The impact of medication errors has become increasingly evident through recent cases documented by healthcare professionals.
One such case, reported by the National Council on Aging, involves an 88-year-old woman named Alice Brennan who, in 2022, went to the emergency room seeking treatment for neck and shoulder pain. She was prescribed the muscle relaxant Flexeril, to alleviate her pain, even though it can increase the risk of sedation and falls in geriatric patients. Days later, at a routine appointment with her neurologist, the specialist noted Brennan had been prescribed Flexeril and told her to stop taking it right away, which she did.
Soon after, however, suffering unrelated pain and swelling in her knee, an orthopedist diagnosed Brennan with gout and admitted her to a rehabilitation center. Because she’d been prescribed Flexeril at the ER, the drug had become part of her medical record and the team at the rehab began administering it to her once again.
Brennan suffered a cascade of severe reactions to the drugs including hallucinations and lethargy, lack of appetite and dehydration. Tragically, Alice never recovered from the effects of a drug that proved too strong for her aging body. She died six weeks later.
Unfortunately, this kind of miscommunication between medical providers for geriatric patients on multiple medications is not unique.
The World Health Organization (WHO)’s “Medication Without Harm” series, cites the case of Dora, a 79-year-old woman who developed severe symptoms resembling Parkinson’s disease. After an examination, her doctor suggested the symptoms might be drug-induced, leading her daughter to question her extensive medication list. Once her daughter intervened and discontinued the medications, Dora’s symptoms stopped.
Healthcare advocates see these cases as red flags for a broader crisis, and have called for stricter safety protocols and enhanced monitoring systems to protect vulnerable patients from these dangerous situations involving complex medication regimens.
Why Older Adults Are at Higher Risk of Medication Errors
Our bodies undergo natural changes as we age, making us more vulnerable to medication errors and side effects. “Our organs change over time, and as the liver and kidneys slow down, it becomes harder for our bodies to process medications,” explains Dr. Ikezuagu.
Research supports this, showing that medication metabolism — the process by which the body breaks down drugs — can decline by up to 30% in adults over 75 years of age. This slowdown can cause medications to accumulate in the body, raising the risk of side effects.
The challenges aren’t limited to slower metabolisms. Physical changes that come with aging—such as vision loss, hearing impairment, and arthritis—can make managing medications more difficult. It can make even basic tasks, like reading medication labels or opening pill bottles, much more difficult.
A study published in 2024 sheds further light on these difficulties. While 95.6% of older adults in the study could read prescription labels, only 35% could effectively interpret directions on the drug samples they were given.
Adverse Drug Events: More Medications Equal More Risk
Adverse drug reactions (ADRs) are another challenge older adults can face, due to the fact that they often take multiple medications.
ADRs are harmful, unintended, and sometimes unpredictable responses to medication, such as severe allergic reactions or organ damage.
According to a study published in 2023, when someone is juggling two medications, the risk of ADRs is only about 13%. That risk jumps to 58% when someone is taking five medications and skyrockets to 82% when seven or more drugs are involved.
Preventing Medication Errors: A Strategic Approach
While the challenges are significant, healthcare experts stress that error risks can be managed through systematic prevention strategies.
The North Star: A Medication List
Maintaining a comprehensive medication list is the cornerstone of medication safety.
“What’s important is keeping that medication list up to date,” says Eboni Green, Ph.D., a nurse specializing in caregiving education in Omaha. “This list should include any allergies someone may have and all of their hard-to-pronounce medications,” Dr. Green continues. “You’d be amazed at how often people forget their medication names or dosages when they talk to their doctor.”
This list should include all over-the-counter drugs, vitamins, and dietary supplements as well, and the amount of each drug someone takes and the time(s) they’re taken. For prescription medications, it’s a good idea to include the prescribing doctor’s name and the reason for the prescription.
This list can be written on a sheet of paper, or even kept on a phone. Keeping the updated medication list information in multiple formats is recommended. This ensures the information is readily available during healthcare visits, emergencies, or when consulting new providers.
Build a Safety Network with Local Pharmacists
Pharmacists play a crucial role in improving medication safety. They serve as the main checkpoint for preventing potential interactions or unnecessary prescriptions. As medication experts and communicators, they can review complete medication lists, including herbs and supplements, to identify potential risks or opportunities to simplify treatment regimens.
If you’re juggling multiple medications, get to know your local pharmacist and ask them questions if you are ever unsure about what you should be taking and when.
If you are a caregiver, taking time to introduce a local pharmacist to the older adult in your care can help establish a relationship.
Make Medical Visits Count: Don’t Be Afraid To Speak Up
When it comes to medication safety, the more you know, the better. Understanding why a medication is prescribed, how to take it correctly, and what potential side effects to watch for can make a difference. Despite its importance, many patients find it challenging to have discussions about medications with their healthcare providers.
“It’s easy to forget questions or feel unsure of what to ask when you’re in the moment with your doctor,” says Dr. Green. She recommends preparing questions in advance and utilizing follow-up consultations, including virtual appointments, to address concerns that arise later.
A hesitation to engage with healthcare providers can create a significant barrier to medication safety. While many patients worry about questioning their doctors or expressing concerns, open dialogue remains essential for developing safe and effective treatment plans.
Guiding Caregivers: Strategies for Managing Complex Medication Regimens
“Caregiving can be overwhelming. It’s tough to juggle daily life and a loved one’s many medications,” notes Ashley DiMaggio, a registered nurse and founder and CEO of GuideWell Patient Advocates in Maryland. Through her organization, DiMaggio helps caregivers and patient advocates navigate complex medication regimens. Drawing from her experience, DiMaggio shares key strategies to support caregivers in managing a loved one’s care:
- Establish a Routine: Create consistency by ensuring medications are taken simultaneously daily. Set alarms on phones or clocks as reminders to stay on track.
- Placement for Recall: Keep medications in easily remembered locations, such as near a bathroom sink or toothbrush, to integrate them into daily habits.
- Ensure Medication Availability: To prevent treatment gaps, ensure enough medication lasts until the next refill. Plan for reliable pharmacy trips or set up mail-order services.
- Discuss Lifestyle Changes with Physicians: Collaborate with healthcare providers to explore lifestyle modifications that could replace or reduce certain medications. Patient advocates can help guide these discussions for informed decision-making.
- Check for Drug Interactions: To stay vigilant about new medications, consult a pharmacist or use reputable online tools. Patient advocates with medical expertise can help identify risks and ensure safety.
- Use technology: Modern technology makes medication management more manageable and safer. Smart pill dispensers and apps can ensure medications are taken on time. Tools like MedMinder or the Hero automatic pill dispenser and apps like Medisafe can help remind patients and caregivers when to take their next dose. Traditional tools like pillboxes remain effective, particularly for patients with complex regimens.
Why Caregivers Can, and Should, Advocate for Deprescribing
Deprescribing — a careful process of reviewing and reducing or stopping unnecessary medications to improve safety and quality of life — is something caregivers should advocate for, especially if they’re concerned about the number of medications their loved one is taking.
For older adults on multiple medications, research shows that deprescribing can significantly lower the risk of adverse effects, dangerous drug interactions, and possibly even cognitive decline.
A strong advocate for deprescribing, DeLon Canterbury, PharmD, a geriatric pharmacist and CEO of GeriatRx, is at the forefront of this movement. He works closely with prescribing physicians, social workers, and healthcare teams to streamline medication regimens for older adults, prioritizing safety and effectiveness.
Canterbury’s journey into deprescribing is deeply personal. “I’ve seen lives transformed by empowering patients and caregivers with the knowledge and tools to reduce unnecessary medications safely. Deprescribing aims to cut risks and keep care centered on the patient,” he explains.
For caregivers who want to advocate for a loved one, Canterbury emphasizes that the process should begin with compassion: “Find a quiet moment to check in,” he notes. Then consider saying something like: “‘You mentioned [specific symptom] started after taking [medication name]. Would you feel comfortable if we asked Dr. [name] about other possible options?’”
The next step? Contact your loved one’s prescribing doctor. Canterbury suggests approaching these conversations as collaborative discussions. Key questions to ask include:
- “Is this medication still necessary?”
- “Are there safer alternatives?”
- “Could any side effects be affecting daily activities?”
“Doctors appreciate these questions,” Canterbury notes. “It offers an opportunity to have that dialog and reassess every medication at each visit. That’s where caregivers play a vital role in starting the conversation.”
Canterbury also recommends enlisting the support of a pharmacist. “Pharmacists are medication experts and can give you the confidence to ask the right questions before you even step into the doctor’s office,” he explains. Whether at a local pharmacy, hospital, or care facility, in collaboration with your doctor, pharmacists should always be available and can:
- Spot potential drug interactions
- Suggest safer alternatives
- Help craft a streamlined medication plan
“The goal isn’t to stop all medications; it’s to ensure every medication is truly necessary and safe.”
Canterbury wants caregivers to remember a key message: “You’re not questioning the doctor’s expertise. You’re collaborating to ensure the best care for your loved one.” This approach transforms medication use from a source of anxiety into an opportunity for better care outcomes. “By taking an active role, you help shape a safer, more personalized care plan for your loved one.”
The Next Frontier: AI and Medication Safety
Artificial intelligence (AI) offers another potential way to reduce errors and enhance medication safety. And with an aging generation representing about 20% of the general population and 50% of healthcare costs in 2030, the demand for smarter and safer prescribing solutions is more urgent than ever.
A recent review revealed that AI tools helped reduce medication errors in 71% of the analyzed studies. These errors ranged from overprescribing and dosing mistakes to drug interactions. By identifying high-risk scenarios, AI offers critical support to physicians and pharmacists.
Meanwhile, researchers at Duke University are developing machine-learning models to provide personalized medication recommendations, such as selecting the safest sedating drugs for older adults dealing with pain, anxiety, or mood disturbances.
While AI has great potential, there are limitations. For example, researchers from Mass General Brigham using AI to manage medications found that AI chatbots provided inconsistent recommendations for the same scenario in different chat sessions.
Even with ongoing concerns about privacy and accurate information from AI, researchers believe that with more training, AI could help doctors reduce medication risks for older adults and provide better care.
Preventing medication errors in older adults requires a collaborative, multi-faceted approach. Regular medication reviews, clear provider communication, patient education, and the careful use of updated medical lists and technology all play a role. Prioritizing medication safety today can help save lives and safeguard the health of older adults in the future.
