For those who have read my book and the chapter on Do No Harm, might remember some of the hazards of modern medicine. For example, the urge to do more and more because of various pressures. Pressures from the patients, feeling the need to “do something” rather than reassurance and other insidious incentives.
This article highlights a growing and often overlooked problem in modern medicine: polypharmacy, or the use of multiple medications—especially common in older adults. Many seniors take five or more drugs, and some, like the patient in the story, may be prescribed over a dozen. While each medication may have been started for a valid reason, over time the combined effects can become harmful.
The case of Mary Harrison illustrates this clearly. At one point taking 14 medications, she experienced confusion, sedation, and functional decline—symptoms initially mistaken for worsening dementia. However, after consulting a geriatric specialist, her medication list was carefully reduced. Several drugs known to impair cognition or increase fall risk—such as oxybutynin and tramadol—were discontinued. Over time, her cognitive function and alertness improved dramatically, suggesting that her symptoms were largely medication-induced rather than irreversible disease.
This reflects a broader issue: adverse drug reactions account for 1 in 11 hospitalizations in older adults. Many commonly prescribed drugs—like benzodiazepines, proton pump inhibitors, and certain antidepressants—can be inappropriate or risky in this population. Despite this, the healthcare system is structured to prioritize prescribing rather than reassessing or stopping medications.
This has led to increasing interest in “deprescribing,” a systematic process of reviewing and reducing unnecessary medications. Efforts like the “Drive to Deprescribe” campaign aim to reduce medication use in long-term care settings, while research networks are studying how to implement deprescribing more effectively.
Still, barriers remain. Fragmented care, time constraints, and cultural biases toward “doing more” in medicine all contribute to inertia. Patients themselves may also resist, even while expressing willingness to reduce medications.
Encouragingly, simple interventions—like pharmacist-led education and medication reviews—have shown meaningful success, helping many patients safely discontinue high-risk drugs.
Key Takeaways
- More medication is not always better — polypharmacy can cause cognitive decline, falls, and hospitalizations.
- Deprescribing is powerful medicine — carefully removing unnecessary drugs can significantly improve function and quality of life.
- Patients must advocate — regularly asking “Do I still need this?” may be one of the most important health interventions available.
