---
title: Geriatric Polypharmacy Review
description: A clinical reference on the assessment and management of polypharmacy in older adult patients.
keywords: [polypharmacy, geriatrics, medication review, deprescribing, adverse drug events]
category: clinical
---

## Introduction to Geriatric Polypharmacy

Polypharmacy, defined as the concurrent use of 5 or more medications, is a common and significant issue in the geriatric population. Older adults are particularly vulnerable to the risks of polypharmacy, including adverse drug events, drug-drug interactions, medication non-adherence, and functional decline. A comprehensive medication review is essential to identify and address polypharmacy in this patient population.

## Assessing Polypharmacy Risk

The first step in managing polypharmacy is to conduct a thorough medication review. This should include a complete list of all prescription medications, over-the-counter drugs, supplements, and herbal products the patient is taking. Key considerations in the polypharmacy assessment include:

- Medication appropriateness: Evaluate each medication for its indication, efficacy, safety, and alignment with the patient's goals of care.
- Medication interactions: Screen for potential drug-drug, drug-disease, and drug-nutrient interactions.
- Medication adherence: Assess the patient's ability to properly take all prescribed medications.
- Adverse drug events: Evaluate the patient's risk of falls, cognitive impairment, gastrointestinal bleeding, and other adverse effects.

Tools such as the Beers Criteria and STOPP/START criteria can be used to identify potentially inappropriate medications in older adults. Additionally, the Medication Appropriateness Index and the Medication Regimen Complexity Index can provide a more comprehensive assessment of polypharmacy risk.

## Deprescribing Approach

Once polypharmacy has been identified, the next step is to develop a deprescribing plan. Deprescribing is the process of tapering, stopping, or switching medications to reduce polypharmacy and minimize the risk of adverse drug events. The following steps outline a structured approach to deprescribing:

1. Prioritize medications: Identify which medications are the highest priority for discontinuation or dose reduction based on the patient's clinical status, medication appropriateness, and potential for harm.
2. Taper medications: For some medications, such as benzodiazepines or corticosteroids, a gradual tapering schedule is necessary to avoid withdrawal symptoms or rebound effects.
3. Monitor and follow up: Closely monitor the patient for any changes in symptoms or clinical status following medication changes. Adjust the deprescribing plan as needed based on the patient's response.
4. Involve the patient: Engage the patient and their caregivers in the deprescribing process, discussing the risks and benefits of each medication change.

Specific deprescribing guidelines, such as those developed by the Deprescribing Network, can provide additional guidance on appropriate medication tapering and discontinuation.

## Medication Management Strategies

In addition to deprescribing, other medication management strategies can help address polypharmacy in older adults:

1. Medication reconciliation: Ensure that the patient's medication list is accurate and up-to-date, and that all providers have access to this information.
2. Medication simplification: Consolidate medications with similar therapeutic effects, adjust dosing schedules to minimize the number of doses per day, and use extended-release formulations when appropriate.
3. Medication adherence support: Implement strategies to improve medication adherence, such as using pill organizers, simplifying medication regimens, and providing patient education.
4. Medication monitoring: Regularly monitor the patient's clinical status, laboratory values, and medication-related adverse events to identify and address any issues.

## Preventing Future Polypharmacy

To prevent the development of polypharmacy, it is important to implement strategies that promote appropriate medication prescribing and management. These strategies include:

1. Comprehensive geriatric assessment: Perform a thorough evaluation of the patient's medical, functional, cognitive, and social status to guide medication management.
2. Shared decision-making: Involve the patient and their caregivers in the decision-making process for medication initiation, continuation, and discontinuation.
3. Interprofessional collaboration: Foster collaboration between physicians, pharmacists, nurses, and other healthcare providers to optimize medication management.
4. Medication therapy management: Regularly review the patient's medication regimen and provide education and support to promote safe and effective medication use.

By implementing these strategies, healthcare providers can help prevent the development of polypharmacy and minimize the risks associated with the use of multiple medications in older adults.

## Conclusion

Geriatric polypharmacy is a significant and complex issue that requires a comprehensive approach to assessment and management. Healthcare providers must be vigilant in identifying polypharmacy, conducting thorough medication reviews, and implementing evidence-based strategies to optimize medication use and improve patient outcomes. By addressing polypharmacy, we can enhance the quality of life and safety of older adult patients.