Author(s): Mia Robb Stahler, DO, Casey Salandra, DO, Niran Vijayaraghavan, MD, Victoria Noel, MD, Ankit Patel, MD
Originally published: December 28, 2012 Last updated: March 20, 2025
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Disease/Disorder

Definition

Polypharmacy is most commonly defined as the concurrent use of 5 or more medications. Recent literature suggests distinguishing between ‘appropriate polypharmacy’, where multiple medications are clinically justified, and ‘inappropriate polypharmacy’, where medication use may be unnecessary or harmful.1,2,3 Excessive polypharmacy, defined as taking 10 or more medications, continues to be a concern, especially in older populations Polypharmacy can also be defined as the use of potentially inappropriate medications, which increases the risk for adverse drug events (ADEs), the underuse of medications contrary to instructions, and medication duplication, rather than looking at the number of medications prescribed. Polypharmacy is most commonly seen in patients with multiple comorbidities, especially in patients with heart failure or cancer.

Etiology

Polypharmacy is most common in older adults with multiple chronic conditions, especially those not well-represented in clinical trials. Recent studies emphasize the importance of deprescribing as a strategy to mitigate inappropriate polypharmacy, particularly in managing drug-drug interactions and reducing adverse events.4,5,6 Management of multiple chronic conditions, each driven by disease specific treatment guidelines, is a major contributor to polypharmacy, which may put them at risk for ADEs. Polypharmacy may occur secondary to one or more of the following etiologies.

  • Drug-drug interactions, where the administration of 2 or more medications precipitates the adverse event.5
  • Drug-disease state interactions, where the medication adversely impacts a patient’s disease (conversely, where the drug’s metabolism is negatively affected by the patient’s disease state).
  • Prescription of potentially inappropriate medications (PIMs) and or inappropriate dosage, especially in older populations.
  • Failure of deprescribing PIMs and preventative medications with no benefits, given patient’s remaining lifespan or unacceptable treatment burden.
  • Prescribing cascades (prescribing a medication to manage a side effect of another medication).6
  • Unrecognized/undisclosed over the counter (OTC) and dietary supplements which are significant cause of polypharmacy in patients of all age groups.7

Epidemiology

The prevalence of polypharmacy varies greatly, reported between 10%and 90% across different patient populations.8 Global data indicates a continuing rise in polypharmacy, particularly among aging populations. In the U.S., the prevalence of polypharmacy rose to 16.3% in 2017-2018.6 The determinants of polypharmacy include sociodemographic parameters (age, sex, income, and place of residence, ethnicity, behavior), chronic conditions (cardiovascular, metabolic disease, multiple comorbidity status), and the healthcare system being studied.9 Age, chronic conditions, demographics, socioeconomics and self-assessed health factors were independent predictors of polypharmacy.8 A recent data from European nations also show high rates, with nearly 30% of adults over 65 regularly taking five or more medications.8,11 One study in Europe reported the overall prevalence for each age group as 25.3% for those aged 65-74, 36.4% for aged 75-84 and 46.5% for those aged 85 or older.10 The overall prevalence rates of polypharmacy in women and men were almost identical.10

A large prospective, longitudinal, register-based cohort study involving 1,742,336 individuals aged ≥65 years between 2010 and 2013 in Sweden revealed 44% of the population studied met the definition of polypharmacy (≥ 5 drugs) and 11.7% of excessive polypharmacy (≥ 10 drugs).12 A cross-sectional study in China involving 258 individuals revealed the prevalence of excessive polypharmacy (≥ 11 medications) was 96.5% in older hospitalized patients aged ≥80 years.13 A study in Korea including 319,185 participants aged ≥65 years revealed 86.4% taking ≥ 6 medications, 44.9% taking ≥ 11 medications and 3% taking ≥ 21 medications.14 A similar study in Taiwan reported 83.5% of elderly participants were found to have polypharmacy defined as taking ≥ 6 drugs.15

Consequences of polypharmacy

Polypharmacy has been linked to a broad range of negative consequences for patients and health care system as summarized in Table 1. Polypharmacy increases risk of adverse drug events (ADEs), as well as serious drug-drug and drug-disease interactions. One example of an ADEs include fracture from increased falls due to medications. Polypharmacy increases risk of falls by 1.5-2 times.20 There may be reduced medication adherence by patients with significant amounts of medications, increased hospitalizations with longer length of stay, functional declines, impaired ability to perform independent activities of daily living, and increased risk of geriatric syndromes. All of these complications lead to increased health care costs across the system.2,16-19 Additionally, polypharmacy may cause increased mortality.17A recent study reported polypharmacy decreased overall survival in acute myeloid leukemia (AML) particularly among patients aged <60 years old.18

Table 1. Negative Consequences of Polypharmacy 2,7,18,50-54

Polypharmacy – Table 1

Risk factors for polypharmacy

The single most important predictor for inappropriate prescribing and risk of ADEs in older patients is the number of prescribed drugs.21 Recent evidence shows a strong association between polypharmacy and multiple chronic conditions, including cardiovascular disease, diabetes, and cancer12 Prevalence of polypharmacy in cancer population increased from 13% in patients taking 2 medications to 82% in those taking ≥ 7 medications.22 Of all the chronic conditions, COPD was most strongly associated with both polypharmacy (≥6 medications) and excessive polypharmacy (≥ 11 medications).23 Age is also an independent risk factor for polypharmacy.14 Females aged over 85 years with moderate self-reported health were associated with excessive polypharmacy.24 A new area of focus is the role of mental health conditions, where polypharmacy often involves psychotropic medications, increasing the risk of adverse drug events.16 In young adults, medications for developmental disabilities, chronic pain, mental health, diabetes, heart disease and neurological conditions including stroke usually contribute to polypharmacy.2,26 Residence at long term care facilities and malnutrition were also associated with polypharmacy in older adults.27,28 Over the counter medications (OTCs) and herbal supplements are often unrecognized but significant cause of polypharmacy in patients of all age groups.7 Lack of connection to a primary care physician is also associated with polypharmacy. When multiple subspecialists prescribe for the same patient, potential interactions may be left undetected. Once a patient starts a medication, it may never be discontinued because of so-called therapeutic inertia, where patients accumulate multiple drugs and incomplete information from the prescriber, resulting in continued consumption of the agent(s). Risk factors for polypharmacy at the patient and the health system levels are summarized in Table 2.

Table 2. Risk Factors for Polypharmacy 2,55-57

Polypharmacy – Table 2

Patho-anatomy/physiology of polypharmacy

Aging and associated comorbidities makes the elderly prone to polypharmacy secondary to significant changes in drug pharmacokinetics and pharmacodynamics as a result of age-related physiological changes, susceptibility and vulnerability to drug adverse effects.29,30 The bioavailability of a drug, absorption, distribution, metabolism and excretion of pharmacokinetics can also be modified with aging.31 Age-related pharmacodynamic changes are associated with the number, activity and expression of receptors, and the ability to signal transduction and changes in homeostatic mechanisms.32

Essentials of Assessment

History

Assessment of polypharmacy and appropriate prescribing should begin with a comprehensive review of past medical history, especially chronic conditions, including COPD, diabetes mellitus, hypertension, depression, heart disease, chronic pain, cancer and heart failure that are associated with increased risk for polypharmacy in older adults.23,24,25 In young adults, the focus may be more on respiratory, neurologic, or metabolic life limiting conditions (conditions for which there is no reasonable hope of cure), especially if more than one life limiting condition is present.26Other considerations include developmental disabilities, chronic pain, and mental health disorders, as medications commonly prescribed for these disease states have been shown to contribute to polypharmacy.2 Past surgical history including prior fracture repairs, hip/knee arthroplasty, and back surgery should be reviewed. History taking should include assessment of potential medication side effects such as lightheadedness, dizziness, syncope, fatigue or poor appetite. Numerous studies have also shown an association between falls and polypharmacy, up to 50% increased risk of falls when taking ten or more drugs, illustrating the importance of obtaining a thorough fall history.45 Asking about recent hospitalizations is important as well, given the positive association between polypharmacy and hospital admissions and emergency department visits/revisits

Obtaining an accurate medication list and reconciliation of prescription medications, OTC medications, and herbal supplements is essential for assessment of polypharmacy. Drug allergies, drug reactions and side effects of prior medications should also be obtained. With multiple subspecialists being a risk factor for polypharmacy, it is recommended to find out the number of prescribers in addition to the number of medications. For those patients with cognitive impairment, it is recommended to assess safety and accuracy of medication management by investigating who manages the patient’s medications. Consequences of polypharmacy may also be reflected by patient’s functional status including evaluation of their ability to perform activities of daily living, transfers, ambulation, living situation, use of durable medical equipment, and caregiver assistance43,45

Physical examination

The elements included in a physical examination are generally guided by history. For example, specific screens for common geriatric syndromes, such as falls, delirium, and incontinence, can be incorporated into the physical examination. For assessment and management of polypharmacy, physical examination should focus on identification and diagnosis of conditions that may increase risk for polypharmacy or be consequences of polypharmacy as discussed below.

  • Vital signs: blood pressure to assess for hypotension or orthostatic hypotension; heart rate to assess for any abnormal rate and rhythm; temperature to assess for fever oxygen saturation to assess for hypoxia
  • General appearance: frailty, BMI, cachexia
  • Visual acuity assessment, use of corrective lens and last vision evaluation
  • Hearing assessment, use of hearing aids and last hearing evaluation
  • Cognition (e.g., dementia, cognitive impairment, delirium)
  • Cardiovascular (e.g., orthostasis, lower extremity edema)
  • Respiratory (e.g., wheezing from COPD)
  • Hematologic (e.g., epistaxis)
  • Integumentary (e.g., bruises, rashes)
  • Liver disease (e.g., hepatomegaly)
  • Renal failure (e.g., decreased urine output)
  • Musculoskeletal exam, gait analysis and balance
  • Neurological: strength, sensation to light touch, pinprick, vibration and proprioception and deep tendon reflexes to assess for neuropathy, evaluation for tremor, spasticity, rigidity

Laboratory studies

Laboratory studies are guided by the history obtained and the findings on physical examination. As part of the assessment of risk for adverse effects of polypharmacy in older adults CBC with differential, CMP, magnesium level, phosphorus level, thyroid stimulating hormone, free T3 and T4, and/or urine analysis could be ordered depending upon the clinical circumstances33 It is prudent to add prealbumin level in addition to albumin level included in CMP in order to assess recent oral intake and nutritional status33 Due to drug-nutrient interactions and drug-induced vitamin B12 deficiency, B12 level should be measured.34 For patients on warfarin, it is warranted to monitor PT/INR more frequently than usual to appropriately lower its dosage when the patient is concomitantly taking other medications such as antibiotics, antifungal, antiepileptics, and duloxetine, that can interfere with hepatic metabolism37 Close monitoring of plasma trough level of vancomycin, digoxin, tacrolimus, cyclosporin, or phenytoin is essential in appropriate patients. It should be noted that serum creatinine alone is not an adequate measure of renal function. Older adults with decreased muscle mass may have serum creatinine levels within normal range, but in fact may have significantly compromised renal function as reflected by reduced creatinine clearance index (CrCI), which is calculated using the Cockroft-Gault formula.

Social role and social support system

As discussed above, polypharmacy can occur at the patient level and at the health care system level.2 Awareness and knowledge of polypharmacy among health care providers and the general population is key to addressing polypharmacy. Judicious prescribing with cognizance of the role of other prescribing providers and appropriate deprescribing relies on the partnership between patients, families, caregivers and health care providers.2,35 Deprescribing often elicits fear from patients and their caregivers as they are often worried about missing future benefits from prescribed medications as well as possible negative consequences from stopping the medications. Ultimately, team-based care with patient and caregiver support, improved communication, and utilization of practical tools and resources are paramount in effective deprescribing.35  

Rehabilitation Management and Treatments 

Available or current treatment guidelines

Recent guidelines emphasize the need for routine medication reviews to support deprescribing practices. The 2023 update to the Beers Criteria and the STOPP/START version 3 criteria offer clear guidelines for discontinuing potentially inappropriate medications.5,37,38 A medication reconciliation should take place prior to prescribing any new medication to identify PIMs and polypharmacy35 Halli-Tierney et al proposed the following questions for judicious prescribing2

  • Is there an underlying cause for the issues/symptoms that should be addressed first?
  • Is the new medication necessary?
  • Any nonpharmacological therapies available?
  • Benefits and risks of new medication? Do the benefits outweigh the risks?
  • What are the patient’s and caregiver’s goals with treatment?
  • Prescriber’s goal with treatment?
  • Patient’s estimated life expectancy when considering age and comorbidities?
  • Is the patient agreeable to the medication through shared decision making?
  • Patient’s adherence to medications?
  • Patient’s affordability to the new medication?
  • Deprescribing is defined as the systematic process of identifying and discontinuing drugs in instances in which existing or potential harms outweigh existing or potential benefits within the context of an individual patient’s care goals, current level of functioning, values, and preferences.21 Deprescribing should be considered when there is a concern for ADE, failure to control disease/symptom, resolution of disease/symptom, lack of a valid indication, result of the prescribing cascade (a medication prescribed to treat an adverse effect of another medication), or lack of benefits of preventative medications based upon patient’s remaining lifespan.21,35

Several tools, including implicit, explicit, or mixed approaches, have been described to educate and guide clinicians in efforts to reduce polypharmacy.37 The Medication Appropriateness Index (MAI) remains a valuable implicit tool for clinicians, assessing factors such as medication need, therapy optimization, and appropriateness of dosage and formulation. However, recent developments emphasize explicit tools, such as the 2023 American Geriatrics Society (AGS) Beers Criteria® and STOPP/START version 3, which offer updated and clearer guidelines on potentially inappropriate medications (PIMs) and optimal treatment for older adults.5,38 These tools are easier to implement in clinical settings and help streamline the decision-making process for deprescribing, although they may not fully consider patient complexity.2,5,38

Table 3 Common High-risk Potentially Clinically Important Drug-Drug Interactions in Older Adults37

Polypharmacy – Table 3

Table 4 Common High-risk Medications That Should Be Avoided or Have Their Dosage Reduced based on CrCI in Older Adults37

Polypharmacy – Table 4

The STOPP/START criteria version 3 (2023) continues to serve as essential tools for identifying potentially inappropriate medications (STOPP) and suggesting safer alternative treatments (START) for older adults.38 Recent updates emphasize more detailed criteria for drug-drug and drug-disease interactions, which further support deprescribing efforts. The application of these criteria has been shown to improve clinical outcomes, particularly in multi-morbid older adults. However, despite advancements in software-based applications, effective implementation still requires face-to-face consultations between clinicians and trained personnel (e.g., pharmacists) to interpret and tailor recommendations to individual patient needs.38

The benefits and efficacy of deprescribing are well-documented across patient, clinician, and system levels, including reductions in adverse drug events and healthcare costs.2,5,21,35 Despite these benefits, barriers to deprescribing persist at both patient and provider levels. 35, 41,42 Patient-related challenges include fear of adverse drug withdrawal, resistance to changing established medication routines, and external pressures from caregivers or family members.35,42 Provider-related barriers include concerns over potential withdrawal effects, adherence to rigid clinical guidelines, difficulties in medication reconciliation, and a lack of time, skills, or confidence in deprescribing.35,41,43

Patient & family education

Deprescribing presents an opportunity to raise awareness of different options and engage in discussions with patients and caregivers about whether to continue, reduce, or discontinue a medication.39 Prescribers should weigh benefits/risks and patient goals and preferences. In an inpatient rehabilitation setting, it is important to engage with your internist/hospitalist for appropriate deprescribing and educating resident physicians and advanced practice practitioners on polypharmacy. Physician’s partnering with pharmacists, nurses and allied health professionals is essential to this effort.

Translation into practice: practice “pearls”/performance improvement in practice (PIPs)/changes in clinical practice behaviors and skills

 The following 5-step process is recommended for appropriate deprescribing21

  1. Reconcile all medications according to indication
  2. Assess the appropriateness of each medication considering the risks and benefits of use
  3. Assess each medication for eligibility to be discontinued
  4. Prioritize medications for discontinuation
  5. Implement and monitor medication discontinuation.

Cutting Edge/Emerging and Unique Concepts and Practice

N/A

Gaps in the Evidence-Based Knowledge

Gaps are still present in research on barriers to deprescribing which largely includes practice types, patient population factors, and health care facilitators. Suboptimal deprescribing environments, such as lack of clinician time, lack of adequate staffing, lack of financial support, and workspace limitations are broad barriers that are not easily researched.40 Implementation of deprescribing interventions has been limited in research studies due to prescribers choosing not to participate. There are negative perceptions concerning deprescribing that are held by patients and prescribers. Deprescribing can be viewed as abandonment of care, deviation from a standard prescribing protocol, and even a money-saving exercise.48 Providers may also fear alienating their patients.

Lastly, there are significant lapses in deprescribing pertaining to rehabilitation environments. Recently, a randomized control study in a rehabilitation hospital implemented deprescribing rounds on patients which resulted in a significant change in total daily dose from baseline upon discharge, however, there was no change in death rates or hospitalization.49 Another study in a rehabilitation hospital demonstrated that reducing polypharmacy upon admission was positively associated with better functional status at discharge and a higher likelihood of being discharged to home in older patients with sarcopenia following a stroke.50 Further research is needed to evaluate the potential positive or negative outcomes of deprescribing in rehabilitation settings.

References

  1. Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. What is polypharmacy? A systematic review of definitions. BMC Geriatr 2017;17(1):230.
  2. Halli-Tierney AD, Scarbrough C, Carroll D. Polypharmacy: Evaluating Risks and Deprescribing. Am Fam Physician 2019;100(1):32-8.
  3. Gnjidic D, Hilmer SN. A narrative review on the conceptual and operational definitions of polypharmacy within the older adult population. J Gerontol Med Sci. 2022. Steinman MA, Hanlon JT. Managing medications in clinically complex elders: ‘There’s got to be a happy medium.’ JAMA. 2021;325(19):1972-1983.
  4. Steinman MA, Hanlon JT. Managing medications in clinically complex elders: ‘There’s got to be a happy medium.’ JAMA. 2021;325(19):1972-1983.
  5. Holmes HM, Todd A. Deprescribing: Optimizing medication use in older people. Br J Clin Pharmacol. 2021;87(4):1527-1538.
  6. Rochon PA, Gurwitz JH. The prescribing cascade revisited. Lancet 2017;389(10081):1778-80.
  7. Sokol KC, Knudsen JF, Li MM. Polypharmacy in older oncology patients and the need for an interdisciplinary approach to side-effect management. J Clin Pharm Ther 2007;32(2):169-75.
  8. Khezrian M, McNeil CJ, Murray AD, Myint PK. An overview of prevalence, determinants and health outcomes of polypharmacy. Ther Adv Drug Saf 2020;11:2042098620933741.
  9. Guillot J, Maumus-Robert S, Bezin J. Polypharmacy: A general review of definitions, descriptions and determinants. Therapie 2020;75(5):407-16.
  10. Midão L, Giardini A, Menditto E, Kardas P, Costa E. Polypharmacy prevalence among older adults based on the survey of health, ageing and retirement in Europe. Arch Gerontol Geriatr 2018;78:213-20.
  11. Kantor ED, Rehm CD, Haas JS, et al. Trends in prescription drug use among adults in the United States from 1999-2018. JAMA. 2021;326(4):329-342.
  12. Morin L, Johnell K, Laroche ML, Fastbom J, Wastesson JW. The epidemiology of polypharmacy in older adults: register-based prospective cohort study. Clin Epidemiol 2018;10:289-98.
  13. Lai X, Zhu H, Huo X, Li Z. Polypharmacy in the oldest old (≥80 years of age) patients in China: a cross-sectional study. BMC Geriatr 2018;18(1):64.
  14. Kim HA, Shin JY, Kim MH, Park BJ. Prevalence and predictors of polypharmacy among Korean elderly. PLoS One 2014;9(6):e98043.
  15. Chan DC, Hao YT, Wu SC. Characteristics of outpatient prescriptions for frail Taiwanese elders with long-term care needs. Pharmacoepidemiol Drug Saf 2009;18(4):327-34.
  16.  Banerjee S, Smith SC, Latoo J. Polypharmacy in mental health: Implications and management. Br J Psychiatry. 2022;220(2):93-99.
  17. Wastesson JW, Morin L, Tan ECK, Johnell K. An update on the clinical consequences of polypharmacy in older adults: a narrative review. Expert Opin Drug Saf 2018;17(12):1185-96.
  18. Dhakal P, Lyden E, Muir KE, Al-Kadhimi ZS, Koll T, Maness LJ et al. Prevalence and effects of polypharmacy on overall survival in acute myeloid leukemia. Leuk Lymphoma 2020;61(7):1702-8.
  19. Davies LE, Spiers G, Kingston A, Todd A, Adamson J, Hanratty B. Adverse Outcomes of Polypharmacy in Older People: Systematic Review of Reviews. J Am Med Dir Assoc 2020;21(2):181-7.
  20. Ming Y, Zecevic A. Medications & Polypharmacy Influence on Recurrent Fallers in Community: a Systematic Review. Can Geriatr J 2018;21(1):14-25.
  21. Scott IA, Hilmer SN, Reeve E, Potter K, Le Couteur D, Rigby D et al. Reducing inappropriate polypharmacy: the process of deprescribing. JAMA Intern Med 2015;175(5):827-34.
  22. Goldberg RM, Mabee J, Chan L, Wong S. Drug-drug and drug-disease interactions in the ED: analysis of a high-risk population. Am J Emerg Med 1996;14(5):447-50.
  23. Jyrkkä J, Enlund H, Korhonen MJ, Sulkava R, Hartikainen S. Patterns of drug use and factors associated with polypharmacy and excessive polypharmacy in elderly persons: results of the Kuopio 75+ study: a cross-sectional analysis. Drugs Aging 2009;26(6):493-503.
  24. Junius-Walker U, Theile G, Hummers-Pradier E. Prevalence and predictors of polypharmacy among older primary care patients in Germany. Fam Pract 2007;24(1):14-9.
  25. Beezer J, Al Hatrushi M, Husband A, Kurdi A, Forsyth P. Polypharmacy definition and prevalence in heart failure: a systematic review. Heart Fail Rev 2021.
  26. Fraser LK, Gibson-Smith D, Jarvis S, Papworth A, Neefjes V, Hills M, Doran T, Taylor J. Polypharmacy in Children and Young People With Life-limiting Conditions From 2000 to 2015: A Repeated Cross-sectional Study in England. J Pain Symptom Manage. 2022 Sep;64(3):213-221.e1. doi: 10.1016/j.jpainsymman.2022.05.020. Epub 2022 Jun 5. PMID: 35675847.
  27. Jokanovic N, Tan EC, Dooley MJ, Kirkpatrick CM, Bell JS. Prevalence and factors associated with polypharmacy in long-term care facilities: a systematic review. J Am Med Dir Assoc 2015;16(6):535.e1-12.
  28. Jyrkkä J, Enlund H, Lavikainen P, Sulkava R, Hartikainen S. Association of polypharmacy with nutritional status, functional ability and cognitive capacity over a three-year period in an elderly population. Pharmacoepidemiol Drug Saf 2011;20(5):514-22.
  29. Koren G, Nordon G, Radinsky K, Shalev V. Clinical pharmacology of old age. Expert Rev Clin Pharmacol 2019;12(8):749-55.
  30. Geller AI, Nopkhun W, Dows-Martinez MN, Strasser DC. Polypharmacy and the role of physical medicine and rehabilitation. PM R 2012;4(3):198-219.
  31. Corsonello A, Pedone C, Incalzi RA. Age-related pharmacokinetic and pharmacodynamic changes and related risk of adverse drug reactions. Curr Med Chem 2010;17(6):571-84.
  32. Turnheim K. When drug therapy gets old: pharmacokinetics and pharmacodynamics in the elderly. Exp Gerontol 2003;38(8):843-53.
  33. Tatum Iii PE, Talebreza S, Ross JS. Geriatric Assessment: An Office-Based Approach. Am Fam Physician. 2018;97(12):776-784.
  34. Little MO. Updates in nutrition and polypharmacy. Curr Opin Clin Nutr Metab Care 2018;21(1):4-9.
  35. Thompson W, McDonald EG. Polypharmacy and Deprescribing in Older Adults. Annu Rev Med. 2024;75:113-127. doi:10.1146/annurev-med-070822-101947
  36. Pesante-Pinto JL. Clinical Pharmacology and the Risks of Polypharmacy in the Geriatric Patient. Phys Med Rehabil Clin N Am 2017;28(4):739-46.
  37. American Geriatrics Society. 2023 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2023;71(5):1010-1025.
  38. O’Mahony D, O’Sullivan D. STOPP/START criteria version 3: Updated guidance for clinical practice. Age Ageing. 2023;52(1):1-8.
  39. Thompson W, Reeve E. 2022. Deprescribing: moving beyond barriers and facilitators. Res. Soc. Adm. Pharm. 18:32547–49
  40. Doherty AJ, Boland P, Reed J et al., Barriers and facilitators to deprescribing in primary care: a systematic review. BJGP Open 2020; 4: bjgpopen20X101096. https://doi.org/10.3399/ bjgpopen20x101096
  41. Paque K, Vander Stichele R, Elseviers M, Pardon K, Dilles T, Deliens L et al. Barriers and enablers to deprescribing in people with a life-limiting disease: A systematic review. Palliat Med 2019;33(1):37-48.
  42. Reeve E, Gnjidic D, Long J, Hilmer SN. A systematic review of barriers to and enablers of deprescribing in older adults. Age Ageing. 2022;51(1)
  43. Rawle MJ, Cooper R, Kuh D, Richards M. Associations Between Polypharmacy and Cognitive and Physical Capability: A British Birth Cohort Study. J Am Geriatr Soc. 2018 May;66(5):916-923. doi: 10.1111/jgs.15317. Epub 2018 Mar 24. PMID: 29574684; PMCID: PMC6001617.
  44. Kua CH, Yeo CYY, Tan PC, Char CWT, Tan CWY, Mak V et al. Association of Deprescribing With Reduction in Mortality and Hospitalization: A Pragmatic Stepped-Wedge Cluster-Randomized Controlled Trial. J Am Med Dir Assoc 2021;22(1):82-9.e3.
  45. Pazan F, Wehling M. Polypharmacy in older adults: a narrative review of definitions, epidemiology and consequences. Eur Geriatr Med 2021;12(3):443-52.
  46. Lunsky Y, Modi M. Predictors of Psychotropic Polypharmacy Among Outpatients With Psychiatric Disorders and Intellectual Disability. Psychiatr Serv 2018;69(2):242-6.
  47. Yazici E, S Cilli A, Yazici AB, Baysan H, Ince M, Bosgelmez S et al. Antipsychotic Use Pattern in Schizophrenia Outpatients: Correlates of Polypharmacy. Clin Pract Epidemiol Ment Health 2017;13:92-103.
  48. Okeowo DA, Zaidi STR, Fylan B, Alldred DP. Barriers and facilitators of implementing proactive deprescribing within primary care: a systematic review. Int J Pharm Pract. 2023 Apr 10;31(2):126-152. doi: 10.1093/ijpp/riad001. PMID: 36860190.
  49. Wong APY, Ting TW, Charissa EJM, Boon TW, Heng KY, Leng LL. Feasibility & Efficacy of Deprescribing rounds in a Singapore rehabilitative hospital- a randomised controlled trial. BMC Geriatr. 2021 Oct 21;21(1):584. doi: 10.1186/s12877-021-02507-0. PMID: 34674645; PMCID: PMC8529728.
  50. Kose E, Matsumoto A, Yoshimura Y. Association between deprescribing from polypharmacy and functional recovery and home discharge among older patients with sarcopenia after stroke. Nutrition. 2023 Jul;111:112040. doi: 10.1016/j.nut.2023.112040. Epub 2023 Mar 24. PMID: 37141661
  51. Xu Q, Ou X, Li J. The risk of falls among the aging population: A systematic review and meta-analysis. Front Public Health. 2022 Oct 17;10:902599. doi: 10.3389/fpubh.2022.902599. PMID: 36324472; PMCID: PMC9618649.
  52. Garfinkel D. Poly-de-Prescribing to Treat Polypharmacy: Efficacy and Safety. Ther. Adv. Drug Saf. 2018;9:25–43. doi: 10.1177/2042098617736192.
  53. Gagnon ME, Talbot D, Tremblay F, Desforges K, Sirois C. Polypharmacy and risk of fractures in older adults: A systematic review. J Evid Based Med. 2024 Mar;17(1):145-171. doi: 10.1111/jebm.12593. Epub 2024 Mar 22. PMID: 38517979.
  54. J, Algharably EAE, Budnick A, Wenzel A, Dräger D, Kreutz R. High Prevalence of Multimorbidity and Polypharmacy in Elderly Patients With Chronic Pain Receiving Home Care are Associated With Multiple Medication-Related Problems. Front Pharmacol. 2021 Jun 8;12:686990. doi: 10.3389/fphar.2021.686990. PMID: 34168565; PMCID: PMC8217758.
  55. Maher RL, Hanlon J, Hajjar ER. Clinical consequences of polypharmacy in elderly. Expert Opin Drug Saf. 2014 Jan;13(1):57-65. doi: 10.1517/14740338.2013.827660. Epub 2013 Sep 27. PMID: 24073682; PMCID: PMC3864987.
  56. Delara, M., Murray, L., Jafari, B. et al. Prevalence and factors associated with polypharmacy: a systematic review and meta-analysis. BMC Geriatr 22, 601 (2022)
  57. Ye L, Yang-Huang J, Franse CB, Rukavina T, Vasiljev V, Mattace-Raso F, Verma A, Borrás TA, Rentoumis T, Raat H. Factors associated with polypharmacy and the high risk of medication-related problems among older community-dwelling adults in European countries: a longitudinal study. BMC Geriatr. 2022 Nov 7;22(1):841. doi: 10.1186/s12877-022-03536-z. PMID: 36344918; PMCID: PMC9641844.
  58. Kornholt J, Feizi ST, Hansen AS, Laursen JT, Johansson KS, Reuther LØ, Petersen TS, Pressel E, Christensen MB. Medication changes implemented during medication reviews and factors related to deprescribing: Posthoc analyses of a randomized clinical trial in geriatric outpatients with polypharmacy. Br J Clin Pharmacol. 2023 Nov;89(11):3291-3301. doi: 10.1111/bcp.15805. Epub 2023 Jul 6. PMID: 37254818.

Original Version of the Topic

Andrew I. Geller, MD, Dale Strasser, MD. Polypharmacy. 12/28/2012

Previous Revision(s) of the Topic

Natasa Miljkovic, MD, PhD. Polypharmacy. 9/13/2016

Shangming Zhang, MD, Nicole Swallow, MD, William Pomilla, MD. Polypharmacy. 11/17/2021

Author Disclosure

Mia Robb Stahler, DO
Nothing to Disclose

Casey Salandra, DO
Nothing to Disclose

Niran Vijayaraghavan, MD
Nothing to Disclose

Victoria Noel, MD
Nothing to Disclose

Ankit Patel, MD
Nothing to Disclose