Polypharmacy and super‐polypharmacy in non‐geriatric, adult populations: a scoping review of characteristics, risks, and deprescribing frameworks

Abstract Background Polypharmacy, typically defined as the concurrent regular use of multiple medications, is a significant concern across various age groups. While much attention has been given to its impact on older adults, the effects on non‐geriatric adults with frailty remain relatively uncertain and understudied. Aim The purpose of this scoping review was to identify available evidence on the prevalence and assessment management of polypharmacy and super‐polypharmacy and guidelines for deprescribing in non‐geriatric adults up to 65 years of age. Design In February 2024, an initial limited search of PubMed using keywords ‘polypharmacy’, ‘super‐polypharmacy’ and ‘deprescribing’ was undertaken and used to develop a full search strategy, including all the relevant and identified keywords and index terms. The Preferred Reporting Items for Systematic reviews and Meta‐Analyses extension for Scoping Reviews (PRISMA‐ScR) guidelines were followed for this review. Databases included PubMed, EBSCO MEDLINE, EBSCO CINAHL, PsycInfo, and Embase and the searches were conducted in March 2024. Primary, peer reviewed, empirical research (including quantitative, qualitative and quality improvement) studies, that were published in English between January 2000–March 2024 were included. Results Seventeen articles met the inclusion criteria. Most studies defined polypharmacy as the concurrent use of five or more medications by a patient. Age and the presence of chronic conditions were consistently identified as common factors contributing to polypharmacy. Most studies identified the need for effective intervention via multidisciplinary teams to identify inappropriate medications. Although included articles did discuss barriers and enablers for deprescribing, no specific information was identified detailing validated deprescribing tools or frameworks for use in adults up to 65 years of age. Conclusion Addressing polypharmacy requires a multifaceted approach that includes deprescribing as a pivotal intervention. There is a critical need for further research to develop and validate evidence‐based guidelines that specifically identify and manage polypharmacy in non‐geriatric adults. These guidelines should be comprehensive, considering the diverse health profiles and treatment complexities of this age group, to optimise medication use and improve overall health outcomes.