When the medication list gets too long to manage

It builds up slowly. A cardiologist adds one. A specialist adds another. Something for sleep. Something for the stomach upset the first thing caused. Nobody ever takes anything away, and nobody is looking at the whole list.

This is one of the most common causes of preventable harm in older adults, and it is entirely fixable.

Signs the list needs a review

• Five or more prescription medications
• More than one prescriber and no single person reviewing everything
• New dizziness, falls, confusion or unusual tiredness
• A medication started to treat the side effect of another medication
• Not being sure what one of them is for
• Skipping doses because of cost

How to do it properly

Bring the actual bottles — all of them, in a bag. Not a list, not a photo. Include over-the-counter medicines, vitamins, supplements and anything herbal, because those interact too. Include anything prescribed by a specialist, and anything you have stopped taking on your own.

Then, for each one, the questions worth asking are simple: What is this for? Is it still needed? Is the dose still right for my kidney function and my age? Does it interact with anything else here? Is there a cheaper version that works the same?

Deprescribing is a real thing

Stopping a medication that is no longer helping is legitimate medical care, not neglect. Sleeping tablets, certain acid-reducing medications and some blood pressure combinations frequently outlive the reason they were started, and in older patients they carry real risk of falls and confusion.

Never stop anything on your own — some medications are genuinely dangerous to stop abruptly. Bring the bag, and let someone go through it with you.

If cost is the problem

Say so. It is the most common reason people quietly stop taking something, and it is nearly always solvable — a generic, a different medication in the same class, a manufacturer programme, or a different pharmacy. A prescription you cannot afford is not a treatment.