Tackling polypharmacy in geriatric patients: Is increasing physicians’ awareness adequate?

Abstract

Polypharmacy among geriatric patients poses significant clinical and economic challenges, including increased risks of adverse drug reactions, cognitive decline, and hospitalizations. While raising physician awareness is necessary, it is insufficient on its own. This narrative review highlights the importance of comprehensive, evidence-based interventions to optimize medication management. Tools such as the Beers Criteria, STOPP/START guidelines, Anticholinergic Cognitive Burden (ACB) scale, and Drug Burden Index (DBI) are essential for identifying potentially inappropriate medications and reducing medication-related harm. The review underscores the need for structured medication reviews, deprescribing protocols, and individualized care planning. Furthermore, clinical decision support tools (CDSS) enhance prescribing safety by identifying drug-drug interactions and recommending safer alternatives. Systemic reforms—like policy incentives for deprescribing, medication reconciliation programs, and telemedicine-enabled interventions—support continuity of care and improve adherence. Interdisciplinary collaboration, involving pharmacists, nurses, and geriatricians, is critical for effective polypharmacy management. In low- and middle-income countries (LMICs), tailored solutions such as task-shifting, simplified prescribing protocols, and culturally sensitive education are emphasized. Overall, the article advocates for a comprehensive approach that combines clinical tools, systemic strategies, and collaborative care to ensure safer, more effective pharmacotherapy for older adults.