Guide — Geriatrics
Polypharmacy and Medication Safety in Older Adults
Polypharmacy — commonly defined as five or more regular medications — is the norm in older adults, and adverse drug events are a leading cause of their hospitalizations. The nurse who reviews the list well prevents more harm than almost any other single intervention.
9 min read · Geriatrics
Educational use only. Medication changes are prescriber decisions; the nursing role is assessment, monitoring, and bringing findings to the team. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Overview
Aging changes what drugs do and how long they stay. Body fat increases (fat-soluble drugs like diazepam linger), total body water decreases (water-soluble drugs concentrate), albumin falls (protein-bound drugs like warfarin and phenytoin have more free, active fraction), the liver metabolizes more slowly, and renal clearance declines even when creatinine looks normal — because muscle mass is low, a “normal” creatinine can hide a poor GFR.
Layer multiple prescribers, multiple pharmacies, OTC products, and supplements over that physiology, and the risk math is obvious. Each added medication multiplies interaction risk; beyond ten medications, an interaction is essentially guaranteed.
Key Concepts
The prescribing cascade
A drug causes a side effect; the side effect is treated as a new disease with another drug. Classic chains: NSAID → blood pressure rise → antihypertensive; antipsychotic → parkinsonism → levodopa; diuretic → urgency → oxybutynin → confusion. Breaking cascades starts with asking what changed first.
Beers Criteria in practice
A consensus list of medications that are potentially inappropriate for adults 65+ — anticholinergics, benzodiazepines, sliding-scale-only insulin, long-acting sulfonylureas, chronic NSAIDs, and more. Knowing the classes lets nurses flag, monitor, and ask the right questions.
Deprescribing is care, not neglect
Planned, supervised dose reduction or discontinuation of medications whose harm now outweighs benefit. Nurses support it by reporting function, side effects, and what the patient actually takes versus what is charted.
The brown bag review
Have the patient bring every bottle — prescribed, OTC, herbal. Reconcile against the chart. The discrepancies found this way are where the adverse events live.
High-Risk Situations to Watch
| Situation | Risk | Nursing Action |
|---|---|---|
| Care transitions | Duplications and omissions at every handoff | Meticulous medication reconciliation; teach the current list explicitly |
| New confusion or falls | Often medication-induced | Timeline review: what started or changed in the last two weeks? |
| Renal function decline | Accumulation of renally cleared drugs | Watch digoxin, gabapentin, many antibiotics; report rising creatinine |
| OTC self-treatment | Diphenhydramine, NSAIDs, cimetidine — all high-risk | Ask specifically about sleep aids, pain relievers, and heartburn remedies |
| More than one prescriber | No single person sees the whole list | Maintain and share one complete, current list with the patient |
Patient Education
Teach one-list discipline: every medication, dose, and purpose on a single card the patient carries — including OTCs and supplements. If they cannot say why they take a drug, that is a flag for the next provider visit, not a reason to stop it on their own.
Set the expectation that any new symptom after a medication change gets reported. “Started feeling dizzy after the new blood pressure pill” is exactly the sentence that prevents the fall.
NCLEX Pearls
- ✦Normal creatinine does not mean normal kidneys in a frail older adult — low muscle mass hides a low GFR.
- ✦New symptom? Check the medication list before assuming new disease — think cascade.
- ✦Diphenhydramine for sleep, NSAIDs for aches: the OTC choices that hurt older adults most.
- ✦Never advise stopping a medication independently — flag, document, and route to the prescriber.
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with American Geriatrics Society (AGS) · AGS Beers Criteria. It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →