CE: Mitigating the Dangers of Polypharmacy in Community-Dwelling Older Adults

Polypharmacy, the use by a patient of multiple medications, contributes to adverse drug events, hospitalizations, geriatric syndromes, and increased health care costs. In the United States, polypharmacy is increasingly widespread, particularly among community-dwelling adults over age 62. In 2005-2006, 31% of such adults used five or more prescription drugs and 8.4% used medication combinations associated with potential interactions. By 2010-2011, 36% used five or more prescription drugs and 15% used potentially problematic drug combinations. Reducing the dangers of polypharmacy, however, requires clinicians to broaden their focus, considering not only the number of drugs a patient takes, but also the prescription of potentially inappropriate medications and potential prescribing omissions. This article explores the factors that contribute to polypharmacy and discusses its negative physiological, psychological, and economic effects. It also describes strategies for reducing polypharmacy, including both "explicit" approaches, which are grounded in the findings of literature reviews and expert opinion, and "implicit" approaches, which are based on the provider's interpretation of clinical data and the patient's medication regimen.