Managing Polypharmacy and Deprescribing in Elderly

*Çiğdem Apaydın Kaya*

## **Abstract**

The increase in the number of medications used may result many negative consequences for patients and health system. Elderly patients are more likely to encounter these health problems associated with polypharmacy. Deprescribing, the process of tapering, withdrawing, discontinuing, or stopping medications, is important in reducing polypharmacy, adverse drug effects, inappropriate or ineffective medication use, and costs. Deprescribing in elderly patients in accordance with the evidence based guidelines has many positive outcomes in older people such as decrease in the risk of falls, improvement in cognition, and improvement in patients' global health status. Therefore, each visit of an elderly patient should be considered as an opportunity to evaluate the unnecessary use or harms of the prescribed or nonprescribed medications. Clinicians should decide to deprescription process by individualized care goals in line with current guidelines. Beers Criteria, STOPP/START and The Medication Appropriateness Index-MAI can be used to assit clinicians to identify unnecessary or potentially inappropriate drugs and reduce the number of medications in older patients. But, a balance is required between over and under prescribing. In conclusion, prevention of polypharmacy and withdrawing unneccesary and inappropriate medications may be the best clinical decision for family physicians who follow the elderly in primary care.

**Keywords:** polypharmacy, deprescription, elderly, older adults, aging, drug use, advers drug events, primary care

#### **1. Introduction**

Although lacking a consensus definition, the concurrent use of two or more medications is described polypharmacy [1]. However, in many researches investigating the use of multiple medications and their effects, the concurrent use of 5 or more drugs is defined as "polypharmacy" [2–4]. The concurrent use of 2 or 3 medications does not cause a significant problem if they are chosen correctly, but the use of 4 or more medications carries a significant risk. Although polypharmacy is seen in all age groups, it is more common with increasing age. Nearly half of the older people use at least 1 drug even though it is not necessary [5, 6]. One of the most important causes for the increase in the number of medications used in the elderly is the coexistence of more than one chronic disease.
