Polypharmacy in Older Patients
Henry J. Woodford
Abstract
Polypharmacy is common among older people and is associated with multiple adverse outcomes. Assessing whether it is appropriate or inappropriate for an individual is more informative than relying on a simple pill count. Modern medicine is based on single disease guidelines that promote prescribing but tend not to have deprescribing criteria. Barriers to deprescribing promote the accumulation of medicines over time. Clinical trial data have limitations due to the selected populations recruited. Some evidence suggests older people with multi-morbidity may benefit less and people with frailty are at increased risk of harm. Prescribing can be inappropriate if it is not evidence-based, harm is likely to exceed the benefit, includes hazardous medications or combinations of medicines, the patient experiences therapeutic burden, there is reduced adherence or prescribing cascades. Medicines optimisation aims to improve prescribing quality for an individual patient and may include deprescribing. It is a complex process that includes shared decision-making, careful follow-up, and communication of any resulting prescription changes.