Title : Managing polypharmacy in the elderly

Background: Polypharmacy—commonly defined as the concurrent use of five or more medications—is increasingly prevalent among the elderly due to multimorbidity and age-related physiological changes. It is associated with adverse drug events, falls, cognitive decline, poor adherence, and increased healthcare utilization

Objective: To synthesize recent evidence on the prevalence, risks, and clinical management strategies of polypharmacy in older adults, with an emphasis on deprescribing, interdisciplinary care, and the role of digital tools.

Methods: A comprehensive literature search was conducted using PubMed, Scopus, and Web of Science (2016–2026) with keywords including "polypharmacy," "elderly," "deprescribing," and "medication review." After removing duplicates and applying inclusion/exclusion criteria, 40 peer-reviewed original studies were selected. Studies focusing on geriatric populations and validated tools like STOPP/START criteria were prioritized; reviews and systematic studies were excluded.

Results: Polypharmacy is associated with a higher incidence of drug-drug interactions, hospitalizations, and functional decline. Deprescribing interventions, particularly those led by pharmacists or conducted within interdisciplinary teams—have demonstrated improved prescribing appropriateness and reduced adverse outcomes, However, barriers persist, including prescriber hesitancy, poor interprofessional communication, and patient resistance. Digital clinical decision support systems show promise in guiding medication reviews but face usability and integration challenges.

Conclusion: Managing polypharmacy in older adults requires a multifaceted approach, combining evidence-based deprescribing protocols, interdisciplinary collaboration, patient education, and supportive digital infrastructure. Future strategies must address system-level barriers, promote shared decision-making, and tailor interventions to individual patient needs to enhance therapeutic outcomes and safety in geriatric care.

Keywords: Polypharmacy, Elderly, Deprescribing, Adverse Drug Reactions, Interdisciplinary Care, Digital Health, Medication Management, STOPP/START Guidelines, Clinical Decision Support Systems.

To be updated shortly..