Polypharmacy

Polypharmacy is an imprecise label that usually describes the accumulation of 5, and often more, medications. ^[1] In a systematic review of 110 articles yielding 138 definitions, the most commonly reported definition of polypharmacy was the numerical definition of five or more medications daily, though definitions are variable and did not account for the appropriateness of therapy. ^[2] Assessing whether polypharmacy is appropriate or inappropriate for an individual is more informative than relying on a simple pill count. ^[3]

Patient-related risk factors for polypharmacy include having multiple medical conditions managed by multiple subspecialist physicians, having chronic mental health conditions, and residing in a long-term care facility, while systems-level factors include poorly updated medical records, automated refill services, and prescribing to meet disease-specific quality metrics. ^[4] Polypharmacy in advancing age frequently results in drug therapy problems related to interactions, drug toxicity, falls with injury, delirium, and nonadherence, and is associated with increased hospitalizations and higher costs of care. ^[1] Polypharmacy is associated with adverse drug events, cognitive and functional impairment, increased healthcare costs, and increased risk of frailty, falls, hospitalizations, and mortality. ^[5]

Following demographic change and the growing number of elderly patients, polypharmacy is of major concern due to its associated risks and even mortality, and this geriatric syndrome has become more common as multimorbidity rises due to the ageing population. ^[6] In a systematic review and meta-analysis, the pooled estimated prevalence of polypharmacy was 37%, and the review highlighted that polypharmacy is common particularly among older adults and those in inpatient settings. ^[7] In a systematic review of older adult samples, the prevalence of polypharmacy, commonly defined as five or more medications, ranged from 2·6% to 86·6%. ^[8] Older age, polypharmacy, malnutrition, and living alone were among the factors that increased the risk of falls in the aging population in a systematic review and meta-analysis. ^[9]