If you’re like a lot of people in their 60s and beyond, you may have developed a particular weekly ritual: doling out your prescription medications into a pill organizer. They’re handy devices. Without them, the task of remembering to take all of your medications, at the right time, every day, would be much more challenging.

But have you ever gazed at your neatly arranged collection of pills, tablets, and capsules and wondered if they’re all really necessary? If so, that’s a good thing. While prescription medications can be vital, even lifesaving, there’s also such a thing as being on too many, or on the wrong ones. 

“Polypharmacy” is the medical term for using multiple medications simultaneously, and it’s practically a way of life for older Americans. According to the Centers for Disease Control and Prevention, 83 percent of Americans ages 60 to 79 are using at least one prescription, and over one-third take at least five. (People in their 40s and 50s typically use fewer prescriptions, but 60 percent are on at least one.)

It’s easy to see how this happens: Older adults often have multiple health conditions, and some of the most common ones—such as high blood pressure, diabetes, arthritis, and heart disease—may each be managed with one or more medications. The concern is that, as prescriptions pile up, so do the potential risks. There’s a greater chance of medication side effects, including serious ones such as falls, impaired driving, and cognitive decline.

And the more medications a person takes, the higher the odds of drug interactions—where two or more drugs interfere with one another, which can affect how a drug works or create unexpected side effects. Polypharmacy can also lead to a “drug-disease” interaction, which means that a medication prescribed to treat one health condition either worsens another or spurs a new one.

Those are some sobering thoughts, but I’m not suggesting you dump the contents of that pill organizer. Instead, we should all—healthcare providers and patients—try to strike the right balance, where we get the most benefit from medications, while minimizing the risks. Here’s how:

• Avoid inappropriate prescriptions. In some situations, a medication is likely to do more harm than good, and just shouldn’t be prescribed. One good resource on this is the Beers Criteria list, which is maintained by the American Geriatrics Society. It includes medications that the AGS considers to be “potentially inappropriate” for adults ages 65 and up, or at least for those with certain medical conditions or existing prescriptions. The list is fairly hefty, and it cites many common antihistamines, diabetes drugs, painkillers, sedatives, blood pressure medications, and more.It’s not that those medications should never be prescribed to older adults. But ideally, healthcare providers should consult the Beers Criteria list any time they’re prescribing to someone who is 65 or older, and carefully consider the benefit/risk picture. You could also have a look at the list, and if you’re already on a cited medication, talk to your doctor about why you’re taking it and whether you should continue.
• Make your own list. It’s critical that all of your healthcare providers have up-to-date information on your medical conditions and current medications—including any over-the-counter drugs or supplements, which can potentially interact with prescription drugs. This is key in avoiding inappropriate prescriptions, or making sure you take new medications safely: You might, for example, need to stop a particular supplement while using a new prescription. Consider creating a list of your medications and supplements (the National Institute on Aging has a great template for this) and bringing it to all your medical appointments.
• Have a regular medication review. New prescriptions are only one part of the story. It’s also important to regularly take stock of old ones: Is a medication that was prescribed to you 10 years ago still needed? Are there newer alternatives that might be better? You can do this by having a medication review with your healthcare providers at each appointment. Go over that handy list you’ve made, and discuss whether any medications should be stopped or have the dosage adjusted. This is especially important if you suspect you’re having medication side effects or if you think a prescription is no longer working well. Even if you’ve been taking something for a long time, its effects (and side effects) can start to shift—either because the health condition is progressing or because your body’s metabolism of the medication is changing.
• Consider seeing a geriatrician. Depending on your age and health status, you might consider finding a geriatrician—a primary care provider who specializes in caring for older adults. They are adept in coordinating care for people with multiple health conditions and can help you figure out which medications are needed and which ones can be safely skipped. Finding a geriatrician is not necessarily easy, as they are, unfortunately, in short supply. But if you have access to that type of care, you might want to take advantage of it.
  

A common thread here: Be proactive. Even if medical information is shared across electronic medical records, don’t assume all of your providers know which medications you’re already taking. Don’t be afraid to ask questions about prescriptions, new and old. And if you suspect you’re having medication side effects, tell either the provider who prescribed it or (if you’re not sure which medication is the culprit) your primary care physician. Medications can help us live longer, healthier lives, but only if we’re using them wisely.