Polypharmacy and High-risk Medications in Older Veterans Presenting for Emergency Care

Patients age 60 and older represented 20% of Emergency Department (ED) visits between 2014 and 2017.1 Within the Veterans Affairs Health Care System (VAHCS), 49% of patients presenting to the ED were age 65 and older in 2019.2 Older adults often have more prescription medications and increased medical complexity.3 One study suggests that at least 39% of patients over the age of 65 years are prescribed at least 5 medications, and that overall number of prescribed medications increases with age.4 Although 5 or more medications is the most cited definition, polypharmacy has been described ranging from 2 to 11 or more medications.5 Specific medication classes that increase the risk of harm or falls in older adults include antiarrhythmics, anticholinergics, anticoagulants, anticonvulsants, antidepressants, antihyperglycemics, antihypertensives, antipsychotics, anxiolytics, opioids, sedatives, and skeletal muscle relaxants.6,7 In addition, over 50% of older adults have been prescribed at least one medication that is potentially inappropriate.8