Polypharmacy, taking five or more prescription drugs, is common among older adults and leads to adverse events such as emergency department (ED) visits, hospitalizations, or even death. As more medications are added to a person’s regimen, this also can result in a prescribing cascade, in which new drugs are introduced to manage side effects and complications of existing medications. All this has contributed to a growing call for deprescribing, or medication optimization, in older adults. 

In one recent study, adverse outcomes such as hospitalizations, ED visits, and death were found more common in patients aged 65-84 experiencing polypharmacy. Among all participants using medications for more than 180 days, about 20% were hospitalized, 11% visited the emergency department, and 1% died. Those participants who experienced polypharmacy were 132% more likely to be hospitalized, 132% more likely to visit the emergency department and 163% more likely to die. For participants classified with excessive polypharmacy, those odds spiked to likelihoods of 185% for hospitalization, 192% for ED visits, and 257% for death.

More than 2 in 5 seniors experience polypharmacy. It is an issue in elder care, particularly for those with chronic or advanced disease. The medication burden increases as people near the end of life, with an average of more than 10 drugs per patient. Clinicians, patients, and caregivers are so focused on providing comfort and symptom relief they may not fully consider whether existing medications are causing the problems they are addressing through yet more medications.

Once the cascade begins, it can be challenging to stop, as the risk increases with each new prescription. Nearly half of older adults take five or more prescription medications; and those taking seven or more are more likely to experience an interaction or medication error. 

To address polypharmacy and prevent or reverse the prescribing cascade, it is critical to evaluate medication regimens, determining possible adverse events and identifying drugs that could be eliminated or changed. According to one study, patients who received a deprescribing intervention were 39% less likely to experience an adverse event compared with those who received “usual care.” Medication reviews by a pharmacist were the most commonly used method of deprescribing. 

In the long-term and senior care setting, however, consultant pharmacists can only recommend changes to medication regimens. Skilled nursing and assisted living providers can be key to facilitating deprescribing, by working with their prescribers to ensure response and/or action on these recommendations.