Patients with many chronic diseases are prescribed by their personal physician and specialists a large number of pills to be swallowed daily. The phenomenon is called polypharmacy, which carries the potential for increased risk and severity of adverse reactions.
Deprescribing can reduce adverse events and even hospitalizations, although evidence on even more serious outcomes, including death, is mixed, according to research published in the latest issue of the Rambam Maimonides Medical Journal (RMMJ) published by the Rambam Health Care Campus in Haifa.
“Polypharmacy is a common condition that occurs when a person is prescribed multiple medications to treat different diseases or chronic symptoms,” they wrote. “This can lead to a number of problems, including errors in taking or storing medicines, inappropriate prescriptions, drug interactions, and unwanted side effects. To prevent these problems, it’s very important to keep an accurate list of all prescribed medicines, including over-the-counter medications and supplements, and to periodically review this list with a doctor or pharmacist.”
Sometimes doctors aren’t aware of what others have prescribed or have not reassessed the patient’s condition to determine if he or she still needs to take them.
“As the medication experts responsible for the close monitoring of their patient, doctors, nurses, and pharmacists play a crucial role in the process of medication deprescribing,” wrote Dr. Carla Matos and Cindy Pinheiro of the Faculty of Health Sciences at Fernando Pessoa University in Porto, Portugal.
“They are involved in the therapeutic process and contribute to the appropriate use of medications and the proper discontinuation of those that no longer benefit the patient or are harmful. This role is particularly important for vulnerable groups, such as older people, who often take chronic medication.”
Better quality of life, lower healthcare costs
Drug deprescribing involves reducing the number of prescribed drugs that are no longer needed or that may be causing harmful effects. Medical professionals with expertise in this field should periodically review medications and communicate with prescribers to adjust drug therapy. The aim is to optimize drug therapy and improve quality of life, they stressed.
Conducting a meta-analysis, the researchers reviewed the literature on polypharmacy and the importance of suspending unnecessary or harmful medications in older people. They surveyed articles from 2023 to 2025 that appeared in these journal databases: Science, PubMed, and Scopus.
Some 116 journal studies were identified for possible consideration. After applying the inclusion and exclusion criteria, 79 papers were selected. Key findings from the included studies were extracted and synthesized for this narrative review.
They said they concluded that a multidisciplinary team “should play a pivotal role in this process by reviewing patients’ therapeutic regimens, identifying inappropriate medications, and deprescribing to reduce harm and enhance care. Their intervention can support more appropriate medication use, may improve patients’ quality of life, and has the potential to reduce healthcare costs.”
The population of older adults has been increasing globally, and the population of octogenarians is expected to grow steadily. This is especially true in Israel, where life expectancy is among the highest in the world – with women living 85.5–85.7 years and men 81.0 to 81.7 years, ranking fourth in the OECD. This represents a significant recent increase to a total average of 83.8 years.
Taking five medications or more daily is common in Israel, with prevalence estimates ranging from 37% to 51% in some reports. It is considered highly prevalent, often ranking among the highest in European surveys, with increased risk seen in older women, those with several chronic conditions, and the frail population, according to the Survey of Health, Ageing, and Retirement in Europe (SHARE).
Aging involves a decline in the functional reserve of multiple organs and systems, resulting in different pharmacokinetics, which is the study of how the body interacts with a drug throughout its exposure, to determine drug concentration, optimize dosage, and minimize toxicity. Thus, older adults often have several chronic diseases at the same time and reduced drug tolerance, thereby increasing the prevalence and severity of adverse effects. In addition, their increased comorbidities place older adults at significant risk of potentially inappropriate drug prescribing.
Their study dealt specifically with the issue of polypharmacy in frail older adults, focusing particularly on certain drugs that are widely used by this age group. It also considers the role of healthcare professionals in identifying inappropriate medications and managing withdrawal.
The presence of two or more chronic health problems, known as multimorbidity, is quite common in older people and influences the therapeutic management carried out by both healthcare providers and patients. Because this is very common in older adults and more frequent among the poor, it has become a growing concern worldwide.
Polypharmacy can be influenced by several factors, including the patient, the disease, the prescription, as well as patient-related factors such as level of education, socioeconomic status, smoking, obesity, place of residence, and ethnicity.
In the 65 to 69 age group that the researchers studied, the prevalence of polypharmacy was 24% in the most deprived group, compared to just seven percent in the least deprived group. Although the use of multiple medicines increases with age, men and women have almost identical rates of polypharmacy. Thus, polypharmacy is a problem that affects individuals of all age groups, but is particularly prevalent in older adults.
Proton pump inhibitors and proton pump inhibitors are drugs widely used for gastrointestinal problems, but several adverse effects connected with their prolonged use have been described, including cardiovascular disease, the development of dementia, Clostridium difficile infection, hip fractures, and pneumonia, they noted.
“Prescribing of these drugs has increased significantly in recent years, especially in older adults; however, several observational studies suggest that around two-thirds of patients receive inappropriate prescriptions without a gastrointestinal diagnosis.”
They studied not only medications for physical illnesses, but also for psychiatric disorders. Mental illness affects one-third of the European Union’s population and represents a major burden on healthcare systems, according to the team.
“Older people are particularly vulnerable to the adverse effects of psychotropic medicines due to age-related changes in pharmacokinetics and pharmacodynamics, high sensitivity to the effects of medication, and multiple comorbidities. Psychiatric disorders are more common in institutionalized older adults, and potentially inappropriate medication is a serious problem among hospitalized older people.”
Thus, they insisted that it was vital to include deprescribing plans in routine care to mitigate these consequences, especially those associated with high-risk medications such as antipsychotics, antidepressants, benzodiazepines, and others frequently used in people with dementia. “Doctors require specific skills and knowledge in geriatric care, and geriatric assessment should include frequent review of prescribed and non-prescribed medications used by older adult patients,” they concluded.
