Polypharmacy in older adults: Knowing when to deprescribe

Many studies have shown the benefits of certain medications for improving long-term outcomes in patients with chronic conditions. However, even when evidence-based recommendations are closely followed, there is a potential for adverse consequences because of the concurrent use of multiple medications. Such consequences include the following (Maher et al., 2014):

• Increased likelihood of an adverse event due to a single drug
• Harmful interactions between drugs
• Increased healthcare costs
• Nonadherence to medication regimens
• Functional decline
• Cognitive impairment
• Falls
• Malnutrition
• Urinary incontinence

As the population has aged and mortality rates have declined, these adverse consequences are challenging to clinicians treating older adults in particular, because of the increased prevalence of multimorbidity (i.e., the coexistence of two or more chronic health conditions) (Salive, 2013). Older patients are also more vulnerable to the adverse effects of medications because of age-associated physiological changes, including decreased renal and hepatic function, decreased lean body mass and total body water content, and declining vision and hearing (Bushardt et al., 2008).

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