Deprescribing before Dependency: Optimizing Medications in a Middle-aged Patient

In the evolution of medicine, which has significantly increased life expectancy, the global population over 60 years is projected to double to 2.1 billion by 2050. However, ageing is often accompanied by multimorbidity and polypharmacy, which increase the risk of adverse drug events (ADEs), drug interactions, and reduced quality of life. In India, the prevalence of multimorbidity among adults is approximately 28.3%. This is a case of a 57-year-old female with long-standing rheumatoid arthritis, type 2 diabetes mellitus, osteoarthritis, hypertension, and newly diagnosed osteoporosis and iron deficiency anemia. At presentation, she was on 13 medications, reflecting a significant polypharmacy burden. A medication appropriateness index (MAI) assessment was conducted, yielding a score of 12, indicating a mild-to-moderate risk of polypharmacy. Following MAI-guided review and clinical judgment, potentially inappropriate medications were discontinued. This case illustrates the value of the MAI in optimizing pharmacotherapy for patients under 65 years with multimorbidity, for whom standard tools like STOPP/START, Beers Criteria, and fit for the aged are not formally validated. Personalized deprescribing interventions reduced the medication burden and potential for adverse outcomes. In addition, as reported in various studies, gaps in inter-professional communication and limited patient guidance highlight the need for better educational and monitoring strategies to manage polypharmacy effectively. Structured individualized approaches like the MAI can enhance the quality of care in younger geriatric patients with complex medical needs. Interdisciplinary coordination and targeted education for healthcare providers and patients are essential to ensure safe, effective, and patient-centered pharmacotherapy.