The Stopwatch Problem

A routine primary-care visit in the United States now lasts little more than the time it takes to brew a pot of coffee. In one cross-sectional review of eight million office encounters, researchers found the average appointment hovered around 18 minutes—and every lost minute nudged physicians toward “quick-fix” prescriptions rather than thoughtful medication plans. For each additional minute of visit length, the odds of an inappropriate antibiotic or an opioid-benzodiazepine combination fell measurably, underscoring how ruthless schedules can translate into risky scripts. Healio

A Life Lost to the Cascade

The consequences are not abstract. Alice Brennan, an 88-year-old who entered a hospital on three medications, left this world six weeks later after accumulating twenty-six. Among them was cyclobenzaprine—flagged as high-risk for seniors—which triggered hallucinations, dehydration, and the cascade that ended her life. Her daughter’s crusade, “Team Alice,” now educates health-profession students about polypharmacy’s human toll. University at Buffalo

Forty Percent and Rising

Stories like Alice’s unfold against a backdrop of hard numbers. A 2024 meta-analysis estimates that nearly 40 percent of people over 65 take five or more prescriptions—a figure that climbs in nursing homes and in adults past age 70. PubMed Yet drug development rarely keeps pace with that reality; one federal review found 33 percent of U.S. clinical trials still impose an upper age limit, and one-quarter bar anyone 65 plus, leaving a knowledge void about dosing and side-effects in the very population consuming the most pills. American Geriatrics Society To fill that gap, the American Geriatrics Society’s 2023 Beers Criteria now lists more than three dozen medications most older adults should avoid or use with great caution—a vital compass that busy clinicians sometimes overlook. American Geriatrics Society

When hurried prescribing meets aging physiology, fallout follows. Sedatives, strong antihistamines, opioids, and certain blood-pressure drugs can double or triple fall risk because they amplify dizziness and slow reaction time, a fact the Mayo Clinic warns about explicitly. Mayo Clinic Falls, confusion, and organ strain then ricochet back into emergency departments, creating a costly feedback loop.

Deprescribing Success Stories

Hope, however, often arrives in the form of a second set of eyes. Pharmacist Delon Canterbury watched his grandmother Mildred spiral into cognitive decline after being given ziprasidone—another drug the Beers list discourages for dementia. A community pharmacist caught the mismatch, helped taper the medication, and Mildred “returned to her baseline self,” living to 90. The experience propelled Canterbury to found GeriatRx, a deprescribing service that has trimmed patients from 36 prescriptions to just three, saving both cognition and hundreds of thousands of dollars in projected nursing-home fees. US Deprescribing Research Network

Formal programs echo those victories. In 2024 Cedars-Sinai launched Operation Polypharmacy, a pharmacist-led clinic where the average 80-year-old arrived on 17 drugs and left with 1.4 fewer each visit; the share of patients on potentially inappropriate medications dropped by 28 percent, and anticholinergic burden by more than half. Nature

Your Action Plan: Five Moves to Safer Meds

Even when the clock is ticking, a few deliberate habits can turn a whirlwind appointment into a safety net. Keep this checklist handy—on the fridge, in your purse, or stapled to the front of a loved one’s chart.

• Carry a complete, portable list.
  Slip an AHRQ wallet card in with your driver’s license, or snap a photo of every prescription bottle and vitamin you take. Digital options such as the My Med List PDF let you update doses on a phone before each visit. Bring the actual pill bottles for an occasional “brown-bag” dump on your clinician’s desk; seeing is believing when time is short. AHRQAHRQ
• Ask age-specific questions—out loud.
  “Is this drug on the 2023 Beers Criteria?” or “Could we start at the lowest geriatric dose?” cues the prescriber to consult evidence tailored to older bodies. Don’t hesitate to mention balance issues, kidney numbers, or past confusion—side-effects that sound mild in a 40-year-old can fuel a fall or delirium at 80. Geriatrics Care Online
• Book a dedicated medication review.
  Medicare Part D plans must offer a yearly Medication Therapy Management (MTM) session—often a 30-minute phone or video call with a pharmacist who combs through every pill and supplement, then prints a personalized action plan. Community pharmacies still host traditional “brown-bag” days, while newer telehealth deprescribing clinics drill deeper for complex cases. The payoff: one study trimmed an average of 1.4 drugs per 80-year-old and halved anticholinergic burden. CMSDrug TopicsPubMed
• Bring an advocate.
  A daughter with a notebook, a nurse navigator, or a professional patient advocate can catch the whispered “wait—what was that drug?” and chase down lab results that fall through the cracks. Two listeners double the odds that new symptoms—or dangerous overlaps—get flagged quickly.
• Embrace deprescribing as proactive care.
  Stopping a medication isn’t surrender; it’s therapy in reverse. Research shows that thoughtfully tapering inappropriate drugs improves clarity, steadies gait, and can postpone nursing-home entry by years. Aim for the fewest pills that do the most good—and celebrate every safe subtraction. PubMed

A small stack of questions, a laminated list, and an extra set of ears can’t fix a rushed healthcare system, but they can reclaim precious minutes, sharpen prescribing, and keep older adults upright, alert, and living the lives those pills were meant to protect.

The bottom line

Older adults deserve prescriptions tailored to bodies that have changed, informed by evidence that includes them, and written after conversations that extend beyond a stopwatch. Until healthcare systems grant clinicians that breathing room, patients and families can tip the balance by asking sharp questions, keeping meticulous lists, and welcoming the pharmacists and advocates who know how to turn a perilous pile of pills back into safe, effective care.