Open the cabinet above the bathroom sink and count. A blood pressure pill. Something for cholesterol. A blood thinner, maybe. A daily aspirin, a vitamin D, the allergy tablet from the pharmacy aisle, the fish oil your neighbor swears by.
Each one made sense when it was added. Together, they are a system nobody has looked at in a while. And according to the CDC, that system sends a remarkable number of people to the emergency room every year.
The Numbers
Harm from medicines, what doctors call adverse drug events, causes more than 1.5 million emergency department visits in the United States each year, and nearly 500,000 of those end in a hospital stay. Adults 65 and older account for more than 600,000 of those visits, which the CDC says is more than twice the rate of younger adults.
When CDC researchers looked closely at the data in a 2021 study published in JAMA, the picture sharpened. Among people 75 and older who arrived at the emergency room because of a medicine, nearly half were admitted to the hospital.
The Surprise Is Which Medicines
You might expect the culprits to be unusual or risky drugs. The same study found that among adults 65 and older, the medicines most often behind an emergency visit were some of the most familiar ones in the country.
Warfarin, the blood thinner sold as Coumadin and Jantoven, accounted for about one in five of those visits on its own. Insulin was next. Then clopidogrel (Plavix), another medicine that keeps blood from clotting, and apixaban (Eliquis), a newer blood thinner. Across all ages, the CDC reports that blood thinners are involved in about one in five emergency visits for medicine-related harm, and diabetes medicines in about one in seven.
Here is the detail that should change how you think about this. In the warfarin cases, almost every single visit (99.8 percent) involved people taking the drug exactly as prescribed. These are medicines that do their jobs well and have a narrow margin between enough and too much. A blood thinner that works a little too hard causes bleeding. Insulin that works a little too hard drops blood sugar too low. The same medicine that protects you can, on a bad week, hurt you.
Why the Margin Narrows With Age
The FDA explains the mechanics plainly. As the years go by, the liver and kidneys may work more slowly, which changes how a drug breaks down and leaves the body. Circulation can slow, affecting how quickly a medicine reaches those organs. Changes in weight can change how much of a drug you need and how long it stays in your system. The result, in the FDA’s words, is a bigger risk of drug interactions.
Then there is the arithmetic. The National Institute on Aging reports that about one third of adults in their 60s and 70s take five or more prescription drugs. The institute lists falls and confusion among the risks when medicines pile up, along with interactions between drugs and between a drug and a condition you already have.
None of this means the medicines are wrong. It means the dose that was right at 62 may need a second look at 72, and that the fourth prescription may interact with the first in a way nobody planned.
The One-Hour Fix
There is a simple, well-tested answer, and the Agency for Healthcare Research and Quality has a name for it. A brown bag medicine review.
The instructions fit on an index card. Before your next appointment, gather every medicine you take and bring all of it. The AHRQ handout is specific: prescription medicines, over-the-counter medicines, herbal products, vitamins and supplements, creams, liquids, inhalers, anything you inject, and all pills in the bottles they came in, plus any pill organizers you use.
Your doctor or pharmacist then goes through the bag with you to do three things: confirm exactly what you are taking, check that you are taking each one safely, and find out whether you could take fewer.
That last part is the one people forget to ask about. The FDA suggests asking, for any medicine you take regularly, whether it is still working, whether you still need it, and whether there is anything you can do to cut back.
Four Questions Worth Asking
Whether you do the full bag review or just bring a list, these questions, drawn from FDA and National Library of Medicine guidance, get the most out of the visit.
Do I still need every one of these? Prescriptions outlive the problems they were written for more often than you would think.
Could any dose be lowered? Especially for medicines that have been at the same dose for years.
Does the new one interact with anything I already take? Include the vitamins and the herbal products. They count.
What should I avoid while on this? The FDA notes that foods, drinks, and other medicines can all change how a drug behaves.
Two more habits help. The FDA recommends buying your medicines at one pharmacy and telling that pharmacist about everything you take, prescriptions and otherwise, so one person can watch for interactions. And the CDC adds a quiet but important one: keep up with any blood tests your doctor orders. For blood thinners and diabetes medicines, those tests are how the dose stays in the safe zone.
One rule above all. Do not stop or change a medicine on your own. Always bring the question to your doctor and decide together.
The Bottom Line
The medicines most likely to land people our age in the emergency room are the blood thinners and diabetes drugs that millions of us take every morning, working exactly as designed, with a margin that gets narrower over time.
One bag, one appointment, four questions. It is the cheapest health insurance you will buy this year.