Knowing When to Stop: Navigating Polypharmacy Training in Geriatric Psychiatry

Area of Science:

• Geriatric Psychiatry
• Medical Education
• Pharmacology

Background:

• Polypharmacy is a significant concern in older adults, increasing risks of adverse drug events and neuropsychiatric symptoms.
• Psychiatry residents are increasingly involved in the care of older adults but may lack specialized training in managing complex medication regimens.

Purpose of the Study:

• To explore psychiatry residents' experiences, challenges, and perceived educational gaps in managing polypharmacy among older adults.
• To identify system-level issues and educational deficits impacting resident training in geriatric pharmacotherapy.

Main Methods:

• Qualitative descriptive approach using longitudinal clinical reflections, supervision discussions, and interdisciplinary forums over 12 months.
• Inclusion of perspectives from grand rounds and a focused literature review on geriatric psychiatry training.

Main Results:

• Residents frequently observed neuropsychiatric symptoms linked to polypharmacy and encountered issues with high-risk medications during care transitions.
• Systemic problems included non-specific EHR alerts, limited pharmacist involvement, and inconsistent handoff protocols.
• Significant educational gaps were identified in deprescribing tools, regulatory knowledge, communication strategies, and access to geriatric psychiatry mentorship.

Conclusions:

• Psychiatry residents require enhanced training in polypharmacy management for older adults.
• Structured curricula focusing on deprescribing, regulatory aspects, and interdisciplinary collaboration are essential.
• Addressing these educational deficits is crucial for improving medication safety and geriatric care.