ByDR. MICHAL BAR-LAHYANI‏, A CLINICAL PHARMACIST

A meta-analysis of 122 studies, which included over 57 million participants worldwide, found that approximately 39.1% of the older population takes five or more medications concurrently. Many assume that as more medications are added the health status is supposed to improve, but in practice among some patients the opposite phenomenon occurs.

Among some patients, and especially in old age, adding medications can lead to fatigue, dizziness, confusion, and a decline in functioning. The reason for this is not always a worsening of the illness – but rather sometimes an effect of the medication therapy itself.

Here are 5 things that are important to know in order to improve the general feeling:

1. The body changes – and so does the reaction to medications. With age, physiological changes occur that affect the way medications are broken down and cleared from the body. In many cases, the body breaks down medications more slowly, and therefore medication levels in the blood can be higher. As a result, dosages that were suitable in the past can in old age cause more side effects, even when dealing with normal dosages.


2. The challenge is the combination between the medications. A systematic review and meta-analysis published in Drugs & Aging found that approximately 29% of patients in the older community are exposed to at least one drug-drug interaction. The problem is not always one specific medication, but rather the cumulative effect of all of them together. Each medication on its own can be correct, but the combination between them can change the body's reaction. Among the possible effects: Fatigue and weakness, dizziness and falls, a drop in blood pressure, confusion or impaired concentration, and a worsening of existing side effects.

Beware of a ''prescribing cascade''. This is a situation in which a side effect of a medication is mistakenly perceived as a new medical problem
Beware of a ''prescribing cascade''. This is a situation in which a side effect of a medication is mistakenly perceived as a new medical problem (credit: SHUTTERSTOCK)

3. Beware of a "prescribing cascade".
This is a situation in which a side effect of a medication is mistakenly perceived as a new medical problem, and as a result an additional medication is added instead of identifying the source. A systematic review of 9 studies published between the years 2015-2025 found that the prevalence of adverse drug events as a cause for hospitalization ranges across a wide spectrum, and can reach up to over 20% of cases. Over time, the treatment becomes more complex and includes medications that are not necessary. Early identification of the phenomenon makes it possible to reduce unnecessary treatment and significantly improve the feeling.


4. Dietary supplements are also part of the picture. Many patients do not report dietary supplements or medicinal herbs because they are not perceived as "medications". However, they too can have an effect on the activity of prescription medications, and significant interactions can develop that affect the overall treatment.


5. A periodic review is the key. The current approach recommends a periodic review of all medications. The review includes a re-examination of the need for each medication, stopping medications that are no longer necessary, and examining safer alternatives. The goal is using the lowest effective dosage, while adapting to kidney and liver function and also considering over-the-counter medications.


The bottom line: More medications do not necessarily mean better health. Sometimes it is precisely a fresh look at the overall medication therapy – and not adding additional medications – that leads to an improvement in the feeling and in the quality of life.

The author is Dr. Michal Bar-Lahyani, a clinical pharmacist in the Jerusalem and Shfela District at Maccabi, an expert in polypharmacy and chronic diseases in the third age.