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Dr. Caleb Alexander knows how easily older people can fall into so-called polypharmacy. Perhaps a patient, like most seniors, sees several specialists who write or renew prescriptions.

“A cardiologist puts someone on good, evidence-based medications for his heart,” said Dr. Alexander, co-director of the Johns Hopkins Center for Drug Safety and Effectiveness. “An endocrinologist does the same for his bones.”

And let’s say the patient, like many older adults, also uses an over-the-counter reflux drug and takes a daily aspirin or a zinc supplement and fish oil capsules.

“Pretty soon, you have an 82-year-old man who’s on 14 medications,” Dr. Alexander said, barely exaggerating.

Geriatricians and researchers have warned for years about the potential hazards of polypharmacy, usually defined as taking five or more drugs concurrently. Yet it continues to rise in all age groups, reaching disturbingly high levels among older adults.

“It’s as perennial as the grass,” Dr. Alexander said. “The average senior is taking more medicines than ever before.”

Tracking prescription drug use from 1999 to 2012 through a large national survey, Harvard researchers reported in November that 39 percent of those over age 65 now use five or more medications — a 70 percent increase in polypharmacy over 12 years.

But older people don’t take just prescription drugs. An article published in JAMA Internal Medicine , using a longitudinal national survey of people 62 to 85 years old, may have revealed the fuller picture.

More than a third were taking at least five prescription medications, and almost two-thirds were using dietary supplements, including herbs andvitamins. Nearly 40 percent took over-the-counter drugs.

Not all are imperiled by polypharmacy, of course. But some of those products, even those that sound natural and are available at health food stores, interact with others and can cause dangerous side effects.

How often does that happen? The researchers, analyzing the drugs and supplements taken, calculated that more than 8 percent of older adults in 2005 and 2006 were at risk for a major drug interaction. Five years later, the proportion exceeded 15 percent.

“We’re not paying attention to the interactions and safety of multiple medications,” said Dima Qato, the lead author of the JAMA Internal Medicine article (Dr. Alexander was a co-author) and a pharmacist and epidemiologist at the University of Illinois at Chicago. “This is a major public health problem.”

She was stunned to discover, for instance, that the use of omega-3 fish oil supplements had quadrupled over five years. Her research suggests that almost one in five older adults now takes them.

Users probably believe fish oil helps their hearts. But Dr. Qato pointed out fish oil capsules lacked regulation and evidence of effectiveness, and can cause bleeding in patients taking blood thinners like warfarin(brand name: Coumadin).

Though drug interactions can occur in any age group, older people are more vulnerable, said Dr. Michael A. Steinman, a geriatrician at the University of California, San Francisco, who wrote an accompanying commentary.

Most have multiple chronic diseases, so they take more drugs, putting them at higher risk for threatening interactions.

The consequences can also be more threatening. Say a drug makes older patients dizzy.

“They’re more prone to fall, because they don’t have the same reserves of balance and strength” as the young or middle-aged, Dr. Steinman said. “And if they do fall because they’re dizzy, they’re more likely to get hurt.”

Some common combinations that cropped up in the study and could spell trouble: aspirin and the anti-clotting drug clopidogrel (Plavix), both blood thinners that together increase the risk of bleeding with long-term use; aspirin and naproxen (Aleve), over-the-counter drugs that when combined can cause bleeding, ulceration or perforation of the stomach lining.

Dr. Qato recalled reviewing the medications of a 67-year-old man taking both the cholesterol drug simvastatin (Zocor) and the blood pressuremedication amlodipine (Norvasc) — the most common combination of interacting drugs that emerged in her study.

Statins, along with their cholesterol-lowering properties, can causemuscle pain and weakness; Norvasc heightens that risk. A different blood pressure drug — there are many alternatives — would be a safer choice, Dr. Qato said. Yet almost 4 percent of the older adults in her study took both drugs.

Moreover, though her patient wasn’t experiencing problems, he was also taking garlic and omega-3 supplements, which can interact with prescription medications.

“Did you tell your doctor you were on them?’” Dr. Qato recalled asking. “He said, ‘No, why should I? If it was important, why didn’t he ask me?’”

A reasonable question. A recent study in JAMA Internal Medicine, however, found that more than 42 percent of adults didn’t tell their primary care doctors about their most commonly used complementary and alternative medicines, including a quarter of those who relied most on herbs and supplements.

Usually, that was because the physicians didn’t ask and the patients didn’t think they needed to know; in a few cases, doctors had previously discouraged alternative therapies, or patients thought they would.

And they might, especially for older patients with complex regimens. “I’m not a big fan of supplements,” Dr. Alexander tells patients taking lots of vitamins, supplements and herbal remedies.

“I think the vast majority of evidence raises serious questions about their effectiveness or, in some cases, their safety. They’re less well regulated than prescription medications. I think you’d be better off stopping them.”

Patients often resist, he said, and “they’re the captain of their own ship.” So he explains the risks and benefits, and negotiations ensue.

Often, though, patients don’t know that a daily aspirin, Prilosec OTC or fish oil can interact with other drugs. Or they’re confused about what they’re actually taking.

Dr. Steinman recalled asking a patient to bring in every pill he took for a so-called brown bag review. He learned that the man had accumulated four or five bottles of the same drug without realizing it, and was ingesting several times the recommended dose.

Ultimately, the best way to reduce polypharmacy is to overhaul our fragmented approach to health care. “The system is not geared to look at a person as a whole, to see how the patterns fit together,” Dr. Steinman said.

In the meantime, though, patients and families can ask their physicians for brown bag reviews, including every supplement, and discuss whether to continue or change their regimens. Pharmacists, often underused as information sources, can help coordinate medications, and some patients qualify for medication reviews through Medicare.

“We spend an awful lot of money and effort trying to figure out when to start medications,” Dr. Alexander said, “and shockingly little on when to stop.”

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Maybe you have seen television ads starring the beefy, affable comedian and actor known as Larry the Cable Guy.

In his sleeveless shirt and gimme cap, he’s driving a monster truck or streaking along on a jet ski, pausing to chomp on a turkey drumstick or a barbecued rib, all the while proclaiming his love for America and for Prilosec OTC to fight “frequent heartburn.”The caution that the drug should be taken for no more than 14 days, and not more often than every four months, appears briefly on-screen. If you blink or go fetch your glasses, you’ll miss it.

Todd Semla has noticed the ads, too, and he’s not a fan. “I don’t see Larry the Cable Guy saying, ‘If you take this drug often, your kidneys may be affected or you could break a hip,’” said Dr. Semla, a pharmacist at the Feinberg School of Medicine at Northwestern University, and past president of the American Geriatrics Society.

Since their introduction in 1990, the drugs collectively known as proton pump inhibitors (common brand names: Nexium, Prevacid, Prilosec) have become among the most frequently prescribed in the country; as the Cable Guy points out, they are also available over the counter. They suppress stomach acid more effectively than a previous class of drugs called H₂ blockers (Zantac, Tagamet, Pepcid).

They have also given users reason to be wary. In recent years, scores of studies have reported associations between prescription P.P.I. use and an array of health problems, including bone fractures, low magnesium levels, kidney injuries and possibly cardiovascular drug interactions.

They are also linked to infections, like the stubborn Clostridium difficile and pneumonia. Reducing the acidity of the stomach, researchers believe, allows bacteria to thrive and then spread to other organs like the lungs and intestines.

The latest findings, published in JAMA Internal Medicine, point to increased risk of chronic kidney disease among users, which is particularly worrisome.

“You can treat and hopefully cure infections,” said Dr. Adam Schoenfeld, an internal medicine resident at the University of California, San Francisco, and an author of an accompanying editorial on the drugs’ adverse effects. “Fractures can heal, though they can be catastrophic events for older people. But chronic kidney disease doesn’t go away.”

The new study, by a Johns Hopkins team, compiled years of data from two sources: a community sample of 10,482 adults in four communities in North Carolina, Mississippi, Minnesota and Maryland (average age: 63) and a cohort of nearly 250,000 patients in a rural Pennsylvania health care system. Those who took prescription proton pump inhibitors were 20 percent to 50 percent more likely to develop chronic kidney disease than nonusers, said the senior author, Dr. Morgan Grams, a nephrologist and epidemiologist at Johns Hopkins.

Like the rest of these drug studies, this one demonstrated an association, not a direct cause. But in the Pennsylvania sample, the researchers documented a dose effect: The risk of chronic kidney disease rose 15 percent among those taking the drug once a day, but 46 percent in those taking it twice daily, compared with nonusers. “That leads us to believe there’s a causal effect,” Dr. Grams said.

Relative risk statistics sometimes seem to exaggerate the dangers of a drug or an illness, if they were low to begin with. But “kidney disease is quite common, particularly among older adults,” Dr. Grams pointed out. And the P.P.I.-using population is vast, she added. “When you have 15 million people using these drugs, even relatively rare adverse effects can affect a lot of people.”

Older people should probably pay special heed. They are more likely to have reflux, Dr. Semla said, in part because the muscle that prevents stomach acid from rising into the esophagus weakens with age. Older adults are therefore more likely to take these drugs, and also more vulnerable to the diseases and disorders associated with them, especially with long-term use.

All of this led an American Geriatrics Society panel last year to add proton pump inhibitors to the list called the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults, citing the risk of bone loss and fractures and C. diff infection.

The Food and Drug Administration has also issued several safety announcements about these drugs’ association with C. diff, fracture riskand low magnesium, linked to kidney disease and other ailments.

So you’d think use of proton pump inhibitors would be declining. It’s not.

“Despite this information, those drugs are extremely overprescribed,” Dr. Schoenfeld said.

From 1999 to 2002, 9 percent of people ages 55 to 64 reported using a prescription gastric reflux drug (including non-P.P.I.s) in the previous 30 days, the Centers for Disease Control and Prevention has reported.

Ten years later, the proportion had risen to 16 percent. Among prescription medications, only cardiac and cholesterol drugs were more commonly used by adults ages 55 to 64.

Proton pump inhibitors can be crucial medications, doctors hasten to point out, for those with peptic ulcers or for intensive care patients, among others. They’re also the most effective option for severe reflux. But whether over the counter or prescribed (prescriptions can involve higher doses), they are usually recommended for short-term use.

Yet “there are definitely older people who’ve been on these for 10 or 20 years,” Dr. Schoenfeld said. Perhaps the medication was prescribed during a hospital stay, then never discontinued. Or a patient took a nonprescription version for a bout of indigestion, felt better and therefore kept taking it, though the initial problem may have long ago disappeared. Doctors, too, often fail to question extended use, Dr. Schoenfeld said.

Regularly reviewing all medications, prescription and over the counter, at office visits might help reduce this overuse. Dr. Schoenfeld recommends tapering off a proton pump inhibitor to see if it’s still needed, or switching to one of the less potent H₂ blockers, which don’t appear to entail the same risks.

Better yet, nonpharmacological approaches can often reduce heartburn and other reflux-related problems. Losing weight helps; so does limiting certain medications, like aspirin. Dr. Semla suggests raising the head of your bed so stomach acid has a harder time climbing.

Moreover, “if people eat a lot of fatty, greasy foods or drink a lot of alcohol or caffeine, those are all triggers for heartburn,” Dr. Schoenfeld said. It probably also helps — “people are going to hate me” — to cut back on chocolate.

“With time or with dietary changes,” he said, “a lot of these symptoms would go away on their own.”

Listen up, Cable Guy.