Polypharmacy Stewardship in the Elderly - Part 1: Concepts, Prevalence, and Prescribing Principles

About

Polypharmacy, the concurrent use of multiple medications, has become a critical issue in geriatrics, especially with the growing population of older adults with several chronic illnesses. The phenomenon of polypharmacy in the elderly arises from the need to treat multiple conditions simultaneously, often leading to overlapping prescriptions, duplicate therapies, and complex medication regimens. As a result, promoting safe medication use and ensuring coordinated care among healthcare providers have become essential goals in clinical practice.

The increasing prevalence of polypharmacy reflects evolving treatment standards and patient expectations; however, it also exposes the physiological vulnerabilities of aging. Older adults experience changes in pharmacokinetics and pharmacodynamics that affect drug absorption, metabolism, and elimination, making them more susceptible to adverse reactions. When multiple drugs are prescribed, these alterations can lead to interactions that compromise medication safety and therapeutic effectiveness.

Polypharmacy poses significant risks, including adverse drug events, falls, delirium, and hospitalizations. Identifying high-risk patients and medications is crucial to maintaining safe medication use in older adults. Recognizing which medications carry a high potential for harm allows healthcare professionals to implement strategies that minimize toxicity, simplify regimens, and preserve function and quality of life.

This lecture will emphasize the principles of polypharmacy stewardship and good prescribing practice for physicians and pharmacists. It will focus on optimizing medication regimens and enhancing medication safety. Through interprofessional collaboration, participants will learn to make thoughtful prescribing decisions that promote effective, safe medication use and improve outcomes in older adults.