Polypharmacy Reduction in Older Adults in Canada

Polypharmacy, usually defined as the daily use of five or more medications, is common among older Canadians and is linked to adverse drug events, falls, cognitive decline, frailty, and loss of independence. This narrative review examines the Canadian evidence on reducing polypharmacy in older adults, with attention to primary care and long-term care. National data show that roughly one in five Canadians aged 65 to 85 lives with both multimorbidity and polypharmacy, that about two thirds of seniors on public drug programs use five or more drug classes, and that long-term care residents are prescribed antipsychotics at about eight times the community rate. Observational studies tie anticholinergic and sedative exposure and psychotropic use to falls, dementia, and poorer physical performance, and polypharmacy itself to frailty. Deprescribing interventions reduce potentially inappropriate medications: in Canadian trials, 27 to 43 percent of participants in intervention arms stopped a targeted drug, compared with 5 to 13 percent receiving usual care. Evidence that this translates into fewer hospital admissions, better mobility, or higher quality of life is weaker and often inconclusive, and team-based primary care has not improved prescribing on its own. The review concludes with recommendations for Canadian physicians, including routine structured medication review, a defined role for the pharmacist, use of national deprescribing guidelines, and attention to patient priorities, together with research priorities that measure function rather than medication counts alone.