Best Practices for Managing Polypharmacy in Older Adults
1. Comprehensive Medication Review
- Regularly review all medications—including prescription drugs, over-the-counter products, and supplements—at least annually and after any hospitalization, fall, or significant health change[2][4][5].
- Use structured tools such as the Beers Criteria, STOPP/START, PRISCUS list, and medication review checklists to identify potentially inappropriate medications and drug-drug interactions[6][4][5][7].
- Involve pharmacists in medication reconciliation and review for additional expertise[1][3][8].
2. Individualized, Patient-Centered Care
- Assess each medication for current indication, benefit, and risk in the context of the patient’s goals, comorbidities, life expectancy, and functional status[1][5][9].
- Engage patients and caregivers in shared decision-making, discussing treatment objectives, preferences, and willingness to continue or discontinue medications[5][10][2].
3. Deprescribing When Appropriate
- Systematically identify and reduce or discontinue medications that are no longer necessary, have unclear benefit, or pose greater risk than reward—especially high-risk drugs such as benzodiazepines, anticholinergics, and certain antidepressants[1][6][11][9].
- Deprescribing should be gradual, with close monitoring for withdrawal effects or symptom recurrence, and should be coordinated between hospital and primary care providers for continuity[11][9].
4. Start Low, Go Slow
- Initiate new medications at the lowest effective dose and titrate slowly, considering age-related changes in drug metabolism and increased sensitivity to side effects[6][4][12].
- Prefer drugs with a lower risk of interactions, shorter half-lives, and simpler dosing regimens[6][12].
5. Monitor and Educate
- Routinely monitor for adverse drug reactions, drug efficacy, and signs of toxicity. Adjust regimens as needed based on ongoing assessment[1][4][2].
- Educate patients and caregivers about medication purposes, potential side effects, and the importance of adherence. Written instructions, pill organizers, and digital tools can support safe medication use[3].
6. Multidisciplinary Collaboration
- Foster communication and coordination among healthcare professionals—including physicians, pharmacists, nurses, and specialists—to optimize medication management and address polypharmacy-related challenges[1][3][8].
Tools and Resources
- Medication review tools (e.g., G-MEDSS, NO TEARS, Amsterdam tool) offer structured approaches for assessing medication appropriateness and patient goals[10][8][7].
- Patient-centered deprescribing interventions have been shown to safely reduce medication burden and improve outcomes in older adults[11].
