Polypharmacy
Formal Definition
The concurrent use of multiple medications, typically defined as ≥5 or ≥10 drugs, common in elderly patients with multiple chronic conditions; associated with increased risk of adverse drug reactions, drug-drug interactions, falls, cognitive impairment, and non-adherence; addressed through medication reconciliation and deprescribing.
How It's Used on the Ward
"They are on a lot of meds" or "polypharmacy is a problem" — the medication burden in older patients that often causes more harm than the conditions being treated.
Example
""82-year-old admitted for a fall: medication review shows she is on 14 medications including 3 anticholinergics, a benzodiazepine, and two nephrotoxic agents. The Beers Criteria flags 6 of her medications as potentially inappropriate in the elderly. Starting a systematic deprescribing conversation.""
Clinical Context
AGS Beers Criteria: evidence-based list of medications potentially inappropriate in adults ≥65 years. High-risk categories in elderly: anticholinergics (cognitive impairment, urinary retention, constipation), benzodiazepines (falls, sedation), sedative-hypnotics, antipsychotics, NSAIDs, sulfonylureas (prolonged hypoglycemia). STOPP/START criteria: another validated tool for inappropriate prescribing and omissions. Deprescribing principles: review indication, assess benefit/harm ratio in current context, taper rather than abrupt stop (avoid withdrawal). Drug-drug interactions: anticoagulant interactions (warfarin + antibiotics/antifungals), QT prolongation drug combinations. Medication reconciliation at every care transition reduces adverse events.
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