Polifarmacia y multimorbilidad: rediseño de la medicina interna para la población envejeciente

The increasing coexistence of multiple chronic conditions in aging populations has intensified the global challenge of polypharmacy, demanding a redefinition of internal medicine toward more integrated, patient-centered care. This multinational cross-sectional study examined the relationship between multimorbidity and polypharmacy among 1,260 adults aged ≥60 years in Mexico, Colombia, and Ecuador. Data were collected through standardized interviews and analyzed using descriptive and multivariate methods. Results revealed that 62.3% of participants had three or more chronic conditions and 65% met the criteria for polypharmacy (≥5 medications daily). The prevalence of adverse drug events (ADEs) increased proportionally with the number of medications, reaching 55% among participants taking nine or more drugs. Multivariate analysis identified ≥3 chronic diseases (aOR = 3.2), age ≥75 years (aOR = 1.9), low education (aOR = 1.7), and female sex (aOR = 1.4) as significant predictors of polypharmacy. Cross-country comparison showed higher institutional readiness in Mexico and Colombia, particularly in pharmacovigilance programs and clinical pharmacy access, though deprescribing practices and public awareness remained limited. Findings highlight the need for regional strategies to strengthen medication safety, promote deprescribing, and integrate pharmacists into multidisciplinary teams. Aligning with the United Nations Sustainable Development Goal 3, this study calls for the redesign of internal medicine to prioritize rational pharmacotherapy, equity, and patient well-being in the context of population aging.