Call (314) 809-6655

Polypharmacy, falls and deprescribing: what caregivers see first

Pharmacist wearing a turban working at a computer in a pharmacy store with shelves filled with medicine.

Written by

Communicare Elite

in

Medically reviewed by Dr. Gurpreet Singh Padda, MD, MBA, MHP, board-certified in Anesthesiology, Pain Medicine, Interventional Pain Management, Addiction Medicine and Obesity Medicine. Dr. Padda is the owner of Communicare Elite. Last reviewed August 8, 2026. How we produce and review this content.

Read this first. Nothing here is a reason to stop or reduce any medication. Several of the drugs discussed are dangerous to withdraw abruptly, and some must be tapered under supervision. This article exists to help you notice and report — the decision belongs to the prescribing clinician.

Our attendants and the families we work with spend hours a day in the same homes. They are the ones who see someone steady themselves on the door frame getting out of bed, or sit back down halfway through standing up. Almost none of that reaches a clinic, because a blood pressure taken seated in an office after a five-minute rest is a measurement of a situation that never happens at home.

That gap matters, because the medication list is among the most common reversible causes of serious harm in later life — and the earliest signs of it are behavioral, not numerical.

How a medication list grows without anyone deciding to grow it

Polypharmacy — commonly defined as five or more regular medications — is rarely the result of a single bad decision. It is the accumulated residue of many reasonable ones.

A cardiologist starts a blood pressure medication. A year later a hospital adds a second during an admission. A primary care physician adds a statin. A urologist adds an alpha-blocker. Each prescriber is acting correctly within their own remit, each drug was right on the day it was written, and nobody owns the list as a whole. Meanwhile the person taking it has lost fifteen pounds, become less active, and their kidneys clear drugs more slowly than they did at 68.

The dose has not changed. The patient has.

The specific mechanism: orthostatic hypotension

This is the pathway worth understanding properly, because it is the one that ends in a hip fracture.

Orthostatic hypotension is a fall in blood pressure on standing — formally, a drop of at least 20 mmHg systolic or 10 mmHg diastolic within three minutes of standing up. It affects roughly one in five community-dwelling older adults, and reviews of the condition identify medications as the leading contributing factor.

What it looks like in a home is not a number. It is a few seconds of gray-out on standing, a hand reaching for furniture, a complaint of lightheadedness on the way to the bathroom at night. Some people get aching across the neck and shoulders — the so-called coat-hanger distribution — or blurred vision rather than obvious dizziness.

The consequences are not proportionate to how minor it looks. Orthostatic hypotension is associated with a substantial increase in falls, and reviews report up to a 50 percent increase in the relative risk of all-cause mortality. A hip fracture at 80 carries a risk of death and of permanent loss of independence that has nothing to do with blood pressure at all. The medication preventing a stroke can cause the event that ends independent living.

Antihypertensives: named in the guidelines, specifically

This is not a fringe concern raised by sceptics. Two of the most widely used prescribing-safety frameworks in geriatric medicine call out particular blood pressure drug classes by name.

  • The AGS Beers Criteria — the American Geriatrics Society’s expert-consensus list of medications often inappropriate in older adults — identifies a high risk of orthostatic hypotension and related harms with certain antihypertensive classes, and does not recommend them as routine treatment for hypertension in this population.
  • The STOPP/START criteria, updated to their third version in 2023, recommend stopping alpha-blockers and centrally acting agents in people at risk of falls, precisely because the resulting vasodilatation produces postural hypotension.

Neither framework argues that older people should not have their blood pressure treated. Both argue that which drug, at what dose, deserves review as the person changes.

More on blood pressure monitoring in older adults →

Statins: a real trade-off, not a scandal

Statins deserve a place in this discussion for a different reason, and it is one that gets lost between two bad arguments — that they are miracle drugs, or that they are a fraud. Neither is true.

Statins increase the risk of new-onset type 2 diabetes. This is established and uncontested:

  • In February 2012 the FDA added a class-wide safety label change to statins, warning of increases in HbA1c and fasting blood glucose.
  • A collaborative meta-analysis of randomized statin trials published in The Lancet in 2010 found roughly a 9 percent increase in incident diabetes.
  • An individual-participant-data meta-analysis published in 2024 in The Lancet Diabetes & Endocrinology confirmed effects on both new-onset diabetes and worsening glycemic control.

The risk is higher with intensive dosing and concentrated in people already near the diabetes threshold — which describes a large share of the older population. Cardiology bodies including the American College of Cardiology hold that for patients at meaningful cardiovascular risk the benefit still outweighs this harm, and that remains the mainstream position.

But “outweighs” describes a trade-off, not an absence of harm. A person taking a statin for primary prevention at 84, with a limited life expectancy and a fasting glucose creeping upward, is in a genuinely different position from a 58-year-old who has already had a heart attack. Both may be prescribed the same drug.

More on cholesterol in older adults →

Deprescribing is a discipline with formal tools

Deprescribing — the planned, supervised reduction or withdrawal of medication that no longer earns its place — is not the absence of treatment. It is a recognized part of good geriatric practice, with published instruments behind it.

  • AGS Beers Criteria. Medications often inappropriate in older adults because harms outweigh benefits at that age.
  • STOPP/START, version 3 (2023). A systems-based review covering both potentially inappropriate medications and potential prescribing omissions — it flags what is missing as readily as what should stop.
  • STOPPFrail. Aimed at people with limited life expectancy, where a preventive medication’s time to benefit may exceed the time available.

That last concept is the one families find most clarifying. A drug that prevents events over ten years offers little to someone whose prognosis is two — while its side effects, including falls, arrive immediately. Weighing that is a clinical judgment, but it is a legitimate one, not a form of giving up.

What to watch for, and report

This is the part that belongs to whoever is in the house. None of it requires clinical training — it requires being present and paying attention.

Report promptly

  • Dizziness or gray-out on standing
  • Grabbing furniture or walls to steady up
  • Any fall, or near-fall — including ones dismissed as clumsiness
  • Fainting, however briefly
  • New confusion or unusual drowsiness
  • Increasing thirst or urination

Also worth mentioning

  • Symptoms that started after a dose change
  • Falls clustered in the morning or after naps
  • Doses skipped because they “make me feel funny”
  • Two prescribers who may not know about each other
  • Pills left in the organizer at the end of the week
  • A list nobody has reviewed in years

Timing is diagnostic information. “She gets dizzy” is a symptom. “She gets dizzy standing up from the edge of the bed, most mornings, and it started about three weeks after the new tablet” is close to a diagnosis. Write down what you saw and when — memory compresses and reshapes this kind of detail within days.

Ask for a medication review

Families are often unsure whether they are allowed to raise this. They are. A structured medication review is ordinary care, not a challenge to the prescriber.

  1. Gather everything into one bag — prescriptions, over-the-counter medicines, supplements, eye drops, creams, and anything prescribed by a specialist the primary physician may not know about. Supplements matter; they interact.
  2. Take the bag to the appointment rather than a list from memory. What is in the cupboard and what is on the record are frequently different.
  3. Bring your written observations — dates, times of day, what happened.
  4. Ask three questions: what is each of these still for; which of them could be contributing to the dizziness or falls; and is there anything here we could reduce or stop.
  5. Ask what to expect if something is changed, and what should prompt a call back.

What not to do

Never stop or reduce a medication on your own, and never advise someone you care for to do so. Stopping an antihypertensive abruptly can cause rebound hypertension. Several classes must be tapered. Stopping a statin after a cardiac event is a different and far riskier proposition than never starting one. Personal care attendants do not advise on medication at all — if the person you care for raises doubts, the right response is to encourage them to take it to their clinician, and to report what you have observed.

What this means for day-to-day care. Attendants are frequently the only person who sees the same individual every morning for months. That vantage point is genuinely rare in healthcare, and it is why the observation above is worth taking seriously rather than filing as complaining. A pattern noticed in a hallway in February and reported plainly is worth more to a prescriber than another office blood pressure reading.

Sources

This article is general information, not medical advice. It describes published research; it is not a recommendation for you or the person you care for. Never start, stop or change a prescribed medication because of something you read here — talk to the prescribing clinician first. Communicare Elite provides non-medical personal care through Missouri’s Consumer Directed Services program and does not provide medical advice or treatment.

More posts