AIMS: Polypharmacy is common in adult patients with inflammatory bowel disease (IBD). This study aims to quantify medication prescriptions and estimate the risk of polypharmacy over time in older adults with IBD. METHODS: In a nationwide cohort of adult incident IBD patients from 1 April 1996, to 31 December 2019, we examined medication prescriptions across calendar years among young adults (18-39 years), adults (40-59 years), older adults (60-79 years) and oldest adults (>/=80 years). The prescriptions (ATC:level-3) were grouped into 0, 1-4, 5-9 (moderate polypharmacy) and >/=10 (excessive polypharmacy) and described 1 year pre-IBD diagnosis, and 1, 2 and 3 years post-IBD diagnosis. We estimated the risk of polypharmacy (moderate and excessive) 1-year post-IBD diagnosis in patients (>/=60 years) using regression models, comparing recent to early years. RESULTS: We included 21 255 young adults, 13 432 adults, 8271 older adults and 933 oldest adults. The prevalence of moderate polypharmacy 1-year post-IBD diagnosis for young adults, adults, older adults and the oldest adults was 15.1, 23.2, 38.1 and 49.4%, respectively. The corresponding proportions for excessive polypharmacy were 1.5, 5.4, 16.6 and 23.4%, respectively. The adjusted odds ratio for polypharmacy among patients ages >/=60 years in 2020 vs. 1997 was 1.02 (95% confidence interval: 0.71-1.47). CONCLUSION: The prevalence of polypharmacy was high and increased with increasing age. In all age groups, the year-by-year level of polypharmacy was stable. For patients aged >/=60 years, there were no signs of a decreasing trend. Polypharmacy seems to be an existing problem and awareness of ensuring appropriate prescribing is warranted.