Association of Polypharmacy with Medication Transport Behaviors and Therapeutic Indication Awareness Among Older Outpatients: A Cross- Sectional Study

Abstract Background: Polypharmacy is a major geriatric syndrome that compromises treatment adherence and increases adverse drug events. In ambulatory geriatric care, encouraging patients to bring their physical medications (the "bag-of-medications" approach) plays a key role in medication reconciliation. However, data on how medication-carrying behavior relates to therapeutic indication awareness among older adults attending geriatric outpatient clinics remain limited. This study aimed to determine the prevalence of polypharmacy in an outpatient geriatric population, evaluate patients' medication-carrying habits and indication awareness during routine clinic visits, and assess their clinical correlates. Methods This cross-sectional study included 152 geriatric outpatients (aged ≥ 65 years) who presented to a hospital geriatric outpatient clinic in Türkiye between July 28 and August 8, 2025. Data on sociodemographics, Katz ADL, Lawton-Brody IADL, and Clinical Frailty Scale (CFS) were collected. Active regimens were verified via electronic health records and the national e-Nabız digital repository. Polypharmacy was defined as ≥ 5 concurrent medications, hyperpolypharmacy as ≥ 10. Potentially inappropriate medications (PIMs) were identified using STOPP/START criteria (version 3). Group differences were evaluated using Chi-square, Fisher's exact, or Mann–Whitney U tests. Results Among 152 outpatients (75.0% female, median age 74 years), polypharmacy was present in 55.3% (n = 84) and hyperpolypharmacy in 9.9% (n = 15). Male patients had a significantly higher rate of hyperpolypharmacy than females (21.1% vs. 6.1%, p = 0.008). Polypharmacy was significantly associated with living with a spouse (p = 0.002), being a caregiver (30.95% vs. 17.65%, p = 0.044), lower ADL scores (median 5.0 vs. 6.0, p = 0.039), higher CFS frailty (p = 0.009), higher burden of cardiovascular and metabolic comorbidities, and dramatically elevated PIM use (33.33% vs. 4.41%, p < 0.001). Overall, 50.0% (n = 76) brought their physical medications to their clinic appointment. Patients who brought their medications demonstrated significantly higher indication awareness compared to those who did not (77.6% vs. 32.9%, p < 0.001). Patients unaware of their indications trended toward higher polypharmacy rates (63.8% vs. 48.8%, p = 0.075). Conclusions Polypharmacy and PIM use are highly prevalent among geriatric outpatients and strongly linked to frailty and functional decline. Physical medication transport behavior serves as a robust clinical proxy for therapeutic indication awareness during outpatient clinic visits. Routine geriatric outpatient appointments should integrate systematic medication reconciliation and "brown-bag" review strategies to enhance medication literacy and rational prescribing.