Polypharmacy in Elderly Patients and Deprescribing in Geriatric Medicine

General
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Introduction

When I review medications for patients above 65, I often pause at the prescription list. Five, seven, sometimes ten drugs. Each was started with good intent. Yet together, they may be doing harm. Polypharmacy in Elderly Patients and Deprescribing in Geriatric Medicine is not just a prescribing issue. It is a safety issue.

We know that polypharmacy, commonly defined as more than five medications, is linked to falls, frailty, cognitive decline, and Adverse drug reactions elderly hospitalisation. The ageing body metabolizes drugs differently. Renal clearance declines. Hepatic function changes. What was once safe at 55 may not be safe at 75.

Evidence Linking Polypharmacy to Harm

A large cohort study published in The BMJ found that increasing medication burden in adults over 65 was significantly associated with higher hospital admission rates and mortality.
Further reading: https://www.bmj.com
WHO medication safety overview: https://www.who.int/teams/integrated-health-services/patient-safety

In care homes, the risk is even greater. Studies on Medication review care home residents show that regular structured reviews reduce inappropriate prescribing and prevent avoidable admissions.

Case Study

A randomized trial conducted by the University College Cork group that developed the STOPP START criteria geriatric prescribing demonstrated that applying these tools significantly reduced potentially inappropriate medications and adverse events in hospitalized older adults.

This framework prompts us to stop high risk drugs and start evidence based therapies that are missing. It moves deprescribing from opinion to structured clinical reasoning.

Deprescribing as a Clinical Skill

Deprescribing is not withdrawal. It is thoughtful reduction. I see it as active clinical management. The Clinical pharmacist role in deprescribing is crucial here. Pharmacists bring pharmacokinetic expertise, while physicians contribute diagnostic context. Together, we protect patients.

A live example comes from Australian primary care programs where collaborative deprescribing reduced sedative use and improved fall outcomes in older adults.

Polypharmacy risks
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Conclusion

We must normalize medication review as routine care, not crisis response. If we truly aim to improve geriatric outcomes, deprescribing must become a core competency.

For more discussions on safe prescribing, visit medboundhub.com or connect with us to collaborate on geriatric medication safety initiatives.

Reflection

  1. When did you last conduct a structured medication review for an elderly patient?

  2. Are we prescribing with equal commitment to stopping when needed?

MBH/PS

2 Likes
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Honestly, we are often quick to prescribe but not equally committed to stopping medications when they are no longer needed. Regular medication reviews in elderly patients are essential to avoid unnecessary polypharmacy.

3

This article provides an insight into polypharmacy. We all would have had the experience of helping our grandparents with their medications. Minimum 4 to 5 medicines at one time. They would say tablets are more than the food. Physicians should consider the structured administration and termination of a drug when needed.

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Thank you for highlighting this important concern. Polypharmacy in older adults is indeed a growing safety issue, and regular medication reviews are essential to balance therapeutic benefits with potential risks. Integrating structured tools like STOPP/START and encouraging collaboration between physicians and pharmacists can make deprescribing a proactive and patient-centered part of geriatric care.