Balancing medicine and priorities: a pharmacist’s view onpolypharmacy in geriatric care

Polypharmacy is the concurrent use of multiple medications by a patient, usually five or more medications. The prevalence of polypharmacy increases with age due to the growing burden of chronic diseases and other health conditions experienced by adults aged > 60 years. Older adults are particularly vulnerable to complications because age-related physiological changes can alter the way medicines are absorbed, distributed, metabolised and eliminated from the body. Older adults often receive care from multiple healthcare providers, including general practitioners and specialists, which can increase the likelihood of being prescribed several medications, and they may use additional over-the-counter medicines, herbal products, and dietary supplements. Although the use of multiple medications may be necessary to effectively manage complex medical conditions and improve quality of life, addressing polypharmacy is important. While multiple medications are often needed to manage several chronic conditions in older adults, taking many medicines at the same time can increase the risk of medication-related problems like drug-drug interactions. Another factor that contributes to polypharmacy is the prescribing cascade, which occurs when the side-effect of a medication is misinterpreted as a new medical condition and treated with an additional medicine. Strategies to reduce polypharmacy include deprescribing, medication reconciliation, and multidisciplinary care, where pharmacists can play a role with the implementation of pharmaceutical care, comprehensive medication reviews, and targeted educational interventions.