A 60-year-old man had been managing hypertension for years with medication to keep his blood pressure under control. He was also prone to stress and anxiety. Over time, as stress and sleep disturbances crept in, he started taking antidepressants and occasional sleep aids from a doctor who had no idea about the hypertension pills he was on. So, when the doctor checked his BP, he found it to be normal. But the elderly patient did not confide in him that it was drug-induced or that he had a history of hypertension. Each prescription made sense on its own. But combined, it complicated the patient’s situation.The man began feeling unusually tired. Standing up too quickly made him dizzy. One evening, he lost his balance and fell. What seemed like simple fatigue was, in reality, the combined effect of both the hypertension and anxiety medicines, which were suppressing his blood pressure and pushing it too low. As a result, his heart rate was slower than normal and his brain — now more sensitive to sedative effects — struggled to maintain balance and alertness.When this patient consulted me, I realised he wasn’t suffering from a new disease. He was experiencing the consequences of polypharmacy.What is polypharmacy?Polypharmacy — the use of multiple medications simultaneously — is increasingly becoming common, especially among older adults. In many cases, patients live with co-morbidities such as hypertension, diabetes, anxiety, and chronic pain. Each condition is treated according to standard guidelines, often resulting in a growing list of prescriptions. Individually, these medications are beneficial. Combined, however, they can interact in unpredictable and harmful ways.This is often the result of fragmented healthcare. Seniors often consult multiple specialists who may not communicate with each other. Patients too may not reveal their complete clinical history. This leads to duplicate or conflicting prescriptions. Adverse side effects of one drug are misinterpreted as a new medical condition, leading to the prescription of another drug, creating a vicious cycle. Worst is when older adults use over-the-counter (OTC) drugs, supplements or herbal remedies, which can interact with prescribed medications.Why an ageing body is more vulnerableAs people age, the body’s ability to process drugs changes significantly. Metabolism slows, kidney function declines and physiological reserves, or the body’s “extra” capacity to function beyond baseline needs, diminishes. This means drugs stay in the system longer and may accumulate.At the same time, the brain becomes more sensitive to medications — especially those affecting mood, sleep or blood pressure. The result is an increased risk of dizziness, confusion and falls.Story continues below this adWhen ‘treatment’ becomes harmfulMany treatment goals are designed with ideal outcomes in mind, but in complex patients, they can backfire. For example, tight control of blood sugar in diabetics can lead to hypoglycemia, increasing the risk of sudden weakness and falls. Aggressive blood pressure management may result in hypotension, causing dizziness or fainting. Potassium supplements, if not carefully monitored, can disrupt heart rhythm.The patterns seen in the 60-year-old’s case are not isolated. Similar risks arise in many common scenarios. A patient taking beta blockers for heart conditions may experience a slowed heart rate. If combined with other blood pressure medications or antipsychotics, this can lead to dangerously low blood pressure and falls. Diuretics, often used for hypertension, can cause low sodium levels. This may result in confusion, weakness, or even seizures, especially in older adults.Combining sedatives, antidepressants, anti-allergic medications and painkillers can significantly impair alertness and coordination.In patients with dementia, these effects are even more pronounced. The brain’s reduced resilience makes it harder to compensate for medication-induced changes.Also Read | ‘Is it bad to check your blood pressure a lot?’When routine drugs turn dangerousSometimes, even commonly used medications can have surprising effects. Certain antibiotics, such as norfloxacin (a quinolone), can cause sudden drops in blood sugar in diabetics, leading to fainting or falls. Overuse of medications for anxiety can increase dependence on sedatives, further compounding the risk of imbalance and cognitive impairment.Story continues below this adTreating seniors smartlyAddressing polypharmacy requires a shift in approach. This requires regular review of all medications — not just individual prescriptions. The doctor can then prioritise essential treatments while minimizing unnecessary ones, a process called deprescribing. When initiating new treatments, especially in older adults, the principle of “start low, go slow” should be followed to minimize adverse effects. Both doctor and patient should monitor side effects and subtle changes in function. Simplify regimens and see how non-pharmacological interventions like diet, exercise and physiotherapy can be prioritised. The last usually works.(Dr Tickoo is Director, Internal Medicine, Max Healthcare)