Clinical Management of Polypharmacy in the Elderly Population

Polypharmacy is defined as use of multiple medications (>5) and is common in the elderly adult population. Polypharmacy typically results from the accumulation of treatments for chronic medical conditions such as hypertension, diabetes, coronary artery disease, and psychiatric illnesses. It is associated with problems such as increased risk of falls and adverse medication events. Elderly patients take an average of two to nine medicines per day, and prevalence of polypharmacy in the elderly is 11.5%–62.5%. Elderly patients are at higher risk of adverse drug reactions due to metabolic changes and reduced drug clearance. Evaluation of polypharmacy is an important part of clinical assessment of the elderly population. This process involves performing an adequate medication reconciliation, including supplements, followed by systematic evaluation of medications looking for benefits and harms. It then involves discussing goals of care with the patient and, if necessary, creating a deprescribing plan. Whenprescribing new medications, prescribers should consider starting at the lower end of the dosing range and increasing only after monitoring for benefits and harms.