Polypharmacy / Deprescribing
Polypharmacy and the Emerging Science of Deprescribing in Older Adults
Polypharmacy, commonly defined as the concurrent use of five or more medications, is highly prevalent among older adults due to the coexistence of multiple chronic diseases. While medications are essential for disease management, excessive and prolonged use increases the risk of adverse drug events (ADEs), hospitalizations, and mortality. Despite its impact on public health, polypharmacy remains understudied in geriatrics, especially regarding evidence-based strategies for deprescribing.
Prevalence of Polypharmacy
According to the Centers for Disease Control and Prevention (CDC), nearly 40% of adults aged 65 and older take five or more prescription medications daily (CDC, 2023).
The National Health and Nutrition Examination Survey (NHANES) reports that polypharmacy has nearly doubled in prevalence in the United States over the past 20 years, with the sharpest increase among those over age 65 (Qato et al., JAMA, 2016).
In nursing home settings, studies estimate that up to 91% of residents are prescribed at least one potentially inappropriate medication (O’Mahony et al., Age and Ageing, 2015).
Clinical Consequences of Polypharmacy
Polypharmacy is associated with a threefold increase in the risk of adverse drug reactions (Maher et al., Expert Opin Drug Saf, 2014).
Older adults experiencing polypharmacy are at a 1.5–2 times greater risk of falls compared to those taking fewer medications (Zia et al., J Gerontol A Biol Sci Med Sci, 2017).
Hospital data show that adverse drug events account for approximately 10% of emergency hospital admissions among older adults, with polypharmacy being the strongest predictor (Budnitz et al., NEJM, 2011).
Cognitive impairment and delirium are frequently linked to high medication burden, particularly with sedatives, anticholinergics, and opioid use (Campbell et al., J Am Geriatr Soc, 2016).
Deprescribing: An Emerging Approach
Deprescribing is defined as the planned and supervised process of reducing or stopping medications that may no longer be beneficial or may be causing harm. Unlike medication adherence strategies, deprescribing emphasizes appropriateness rather than quantity.
A systematic review (Page et al., JAMA Intern Med, 2016) found that deprescribing interventions reduced inappropriate medications by up to 25–40% without significant harm.
The OPTIMIZE trial (Shepherd et al., BMJ, 2020) demonstrated that structured deprescribing in older adults resulted in fewer falls and improved quality of life, with no increase in hospitalizations.
Despite these findings, there are no universally accepted clinical guidelines for deprescribing, and practices vary widely by region and physician training (Scott et al., Lancet Healthy Longev, 2022).
Research Gaps
Lack of Standardization: Most deprescribing efforts are based on tools such as the Beers Criteria or STOPP/START, which identify inappropriate medications but do not provide detailed tapering protocols.
Limited Inclusion in Trials: Older adults with multimorbidity are often excluded from clinical drug trials, leaving a gap in safety and efficacy data for deprescribing.
Long-Term Outcomes: Few studies measure the long-term impact of deprescribing on survival, cognitive function, or healthcare costs.
Polypharmacy in older adults is a major and growing public health challenge, strongly associated with falls, hospitalizations, cognitive decline, and mortality. Deprescribing has emerged as a promising strategy to mitigate these risks, yet remains an underdeveloped science due to limited research, lack of standardized protocols, and inadequate inclusion of older adults in clinical studies. Future research should prioritize large-scale randomized controlled trials, guideline development, and integration of deprescribing into routine geriatric care.