An 82-year-old woman lay on her kitchen floor for nearly two days after a fall, too weak and dizzy to stand. Rescuers found no fracture or head injury—just dehydration and exhaustion.
At the hospital, she initially stabilized. Then she suddenly became agitated, pulling at her gown and trying to climb out of bed. A doctor considered haloperidol, an antipsychotic often used when older patients become acutely confused.
But she kept reaching toward her lower abdomen.
A bladder scan found the problem: Her bladder was dangerously full. After drainage by a catheter, her agitation faded within minutes.
The culprit was a scopolamine patch she had been using for months to treat chronic dizziness, a drug that can interfere with bladder function in older adults.
Had the link been missed, she would have left the hospital with yet another prescription—to treat a problem the first drug had caused.
Doctors call this scenario a prescribing cascade: when the side effect of one medication is mistaken for a new illness and treated with another prescription.
Polypharmacy—taking five or more medications—has grown increasingly common for nearly half of Americans aged 65 and older. Medication-related harm sends hundreds of thousands of Americans to emergency departments each year. Some estimates suggest that these complications may contribute to more than 250,000 deaths annually, making them one of the leading causes of death in the United States.
“These episodes are far more common than most people realize,” Dr. Nimit Agarwal, a geriatrician at the University of Arizona who cared for the patient, told The Epoch Times.
Many medications are necessary, even lifesaving. However, warning signs that a medication may be causing harm are often easy to miss.
Recognizing when a drug may be doing more harm than good is an increasingly important skill amid rising overprescription. One place to start is understanding which occasions are most likely to result in unnecessary medications being added.
Occasion 1: When a Side Effect Looks Like a New Problem
The first—and often most overlooked—occasion is when a side effect is mistaken for something new.
Many prescribing cascades begin when a new symptom appears after a medication is started, and no one connects the two.
“In many cases, symptoms that show up after starting a drug may actually be side effects,” Agarwal said. However, those symptoms often resemble new conditions or flare-ups of existing ones, allowing the original medication to escape notice.
Older adults often live with several chronic diseases, with more than 90 percent of Americans older than 65 having at least one, and many manage several. When dizziness, fatigue, or confusion appear, it is easy to assume that a condition is worsening or simply that “this is what aging looks like.”
Timing can make that connection harder to see. Patients and clinicians expect side effects within days or weeks, but Aaron Tejani, a clinical pharmacist, said they can surface months later—after a dose increase, a new supplement, or another drug shifts the balance. By then, the link to the original medication may no longer be obvious.
“Clinicians are usually trying to solve the most immediate problem in front of them,” Tejani told The Epoch Times.
“Prescribing another medication can feel like helping the patient in the moment,” he said, even when the underlying cause is a drug started months earlier.
Judith Beizer, a clinical pharmacist and professor at St. John’s University, pointed to a common example. The blood pressure drug amlodipine can cause swelling in the legs and feet. Instead of adjusting the medication, doctors sometimes prescribe a diuretic to reduce the swelling—treating a side effect as if it were a new medical problem.
At first, it seems to work—the swelling recedes—but the diuretic creates a new problem: increased urination. Older adults may find themselves getting up repeatedly to use the bathroom. At night, when they may already be unsteady or half-awake, the risk of falling rises.
Similar chains unfold with many medications. Gabapentin, often prescribed for nerve pain, can cause leg swelling, prompting another prescription. Anticholinergic medications used for bladder problems, allergies, or motion sickness can interfere with bladder function, prompting additional drugs to manage urinary symptoms or memory problems.
A 2025 study in the Journal of the American Geriatrics Society found that among more than 23,500 U.S. nursing home residents who newly started a gabapentinoid, almost 1,000 received a new prescription for a loop diuretic within weeks, often because the drug caused leg and foot swelling that was mistaken for a separate heart or kidney issue.
“You can end up treating the side effect rather than recognizing the medication as the cause,” Beizer told The Epoch Times.
When medication lists grow beyond five or seven drugs, problems often emerge, Dr. George Hennawi, a geriatrician who directs the Center for Successful Aging at MedStar Good Samaritan Hospital in Baltimore, told The Epoch Times. The earliest clues may be small changes in balance or thinking. Patients may feel slightly dizzy, unsteady, or more confused than usual.
“Even if a medication seems benign, we have to be suspicious when new symptoms appear after starting it,” he said.
The same principle extends beyond prescriptions. Over-the-counter medications, vitamins, and herbal products can also contribute.
“Whatever you’re ingesting for any health-related reason, it has the potential to contribute to the problem,” Tejani said.
Occasion 2: After a Hospital Stay
Hospitalization is one of the most common times when medication lists grow, Agarwal said.
During a hospital stay, doctors often tweak doses or swap existing pills for hospital-preferred versions. By the time patients go home, those changes can stick. A patient who arrived on a single blood pressure drug might leave with a different one listed—and then resume the original at home, sometimes unaware that the two do essentially the same job.
Other medications started during the admission—such as sleep aids, acid reducers, or stool softeners—can also remain on the list long after the problem they were meant to treat has resolved. The additions rarely happen all at once. A pill for insomnia. Another for heartburn caused by the first. A third to ease the constipation resulting from the pain medication.
Medication lists at discharge are often less reliable than patients assume.
“I’d rather have no medication list than an outdated one,” Beizer said.
The problem is compounded during other transitions of care—when patients move from hospital to home or from one doctor to another. Each handoff is an opportunity for a medication to slip through unchecked.
Occasion 3: When Multiple Doctors Are Prescribing
Medication lists can also grow when patients see several specialists, each treating a different condition.
Someone might see a cardiologist for heart disease, an endocrinologist for diabetes, and a primary care doctor for managing blood pressure and other chronic illnesses. Each prescribes medications based on guidelines for that particular disease.
“Almost all clinical guidelines are designed around a single disease,” Dr. Nancy Schoenborn, a geriatrician at Johns Hopkins University School of Medicine, said. However, many older adults live with several diseases at once. Following every guideline simultaneously can mean adding one medication after another.
A single diagnosis, such as heart failure, can lead to seven or eight medications when guideline-based treatments are followed, Schoenborn told The Epoch Times. Each prescription may be appropriate on its own, but together, they add up quickly.
“Patients with multiple chronic conditions are often managed by several specialists,” Dr. Milta Little, a geriatrician at Duke University, told The Epoch Times. “Each medication may have a legitimate reason for being prescribed.”
However, over time, the combined effects can become difficult to untangle.
There is also a natural tendency to trust earlier decisions, Tejani said.
“Once we’ve prescribed something we thought would help, it can be hard to step back and consider it might now be causing harm,” he said.
Without periodic review of the entire medication list, drugs that once served a purpose can remain in place indefinitely.
Occasion 4: When ‘Temporary’ Medications Stick Around
Sometimes medication lists grow simply because drugs meant to be temporary are never stopped. A sleep aid during a stressful period, a stomach medication after an illness, or a laxative after surgery. The immediate issue improves, but the prescription remains.
Part of the problem is training. Clinicians are taught extensively how to start medications, but they are less often taught how to revisit them later.
“Prescribing is deeply built into medical training,” Schoenborn said. “Deprescribing is a much newer concept.”
In practice, reviewing a full medication list can take far more time than most appointments allow.
“It often requires a dedicated visit,” Dr. Amelia Gennari, a geriatrician at the University of Vermont Medical Center, told The Epoch Times. “It’s difficult to do at the end of a routine appointment.”
Patients often assume that if a drug is still on the list, it must still be needed—but physicians frequently inherit prescriptions from others and may not revisit them.
“Pharmacists hear this all the time,” Tejani said. “A doctor will say, ‘A specialist started that medication, so I’m not going to touch it.’”
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What Patients Can Do
The goal is not to avoid medications altogether. Many drugs are essential and lifesaving. Experts say a few simple habits can help prevent medication lists from quietly expanding over time.
One of the most effective steps is to periodically review medications with a clinician. Gennari recommends asking for a dedicated appointment to review each medication and determine whether it is still needed. Patients can make that process easier by bringing all of their medications to the visit, including prescriptions, over-the-counter drugs, vitamins, and supplements.
Experts also recommend keeping a single, up-to-date medication list. That record should include every drug, supplement, and vitamin, along with the reason each was started. Bringing the same list to every appointment can help ensure that each doctor is working from the same information.
Transitions in care deserve particular attention. After hospitalizations or specialist visits, review the updated medication list with your primary care doctor. Ask which additions were meant to be temporary and whether anything can be stopped. Medication reconciliation is most valuable when lists are most likely to grow.
Finally, experts say it is important to stay alert to new symptoms that appear after medications are added or adjusted.
“If you’re having what you think is a medical problem, always question the drugs you’re taking first as the source of that problem,” Tejani said.
Sometimes the newest symptom is not indicative of a new disease at all—but a sign that something you’re already taking may be causing harm.
What’s Next: Many medication cascades begin with a single prescription. In the next article, we explore how to decide whether to start a medication.