Older adults face unique risks from polypharmacy because age-related changes in absorption, distribution, metabolism, and excretion increase susceptibility to adverse drug effects. Common causes include multiple chronic conditions, fragmented care across specialists, and prescribing cascades where new drugs treat side effects of others. Consequences range from falls and delirium to hospital admission and loss of independence, making risk-reduction strategies central to preserving quality of life.
Medication review and deprescribing
A cornerstone strategy is regular comprehensive medication review and deprescribing led by clinicians and pharmacists. Michael A. Steinman, University of California, San Francisco, has described structured deprescribing approaches that prioritize stopping or tapering drugs with limited benefit or high risk in older adults. Tools such as the American Geriatrics Society Beers Criteria developed by an expert panel at the American Geriatrics Society and the STOPP/START criteria help identify potentially inappropriate medications. Effective deprescribing is patient-tailored and gradual, reducing withdrawal risk and allowing clinical reassessment.
Communication, monitoring, and dosing
Shared decision-making and clear communication reduce harms by aligning treatment with patient goals. Shelly L. Gray, University of Washington, emphasizes pharmacist-clinician collaboration and medication reconciliation at care transitions to prevent errors. Dose adjustments based on renal and hepatic function, avoidance of high-risk drug combinations, and simplification of regimens to once-daily dosing or combination products lower the chance of missed doses and interactions. Ongoing monitoring for adverse effects, with prompt follow-up after any medication change, is essential to catch problems early.
System and cultural considerations
Systems-level interventions such as electronic decision support embedded in electronic health records, pharmacist-led clinics, and transitional-care programs reduce prescribing errors and readmissions. Cultural and territorial nuances matter: patient beliefs about medications, trust in clinicians, and access to pharmacy services in rural or underserved areas influence uptake of deprescribing. Nonpharmacologic alternatives for pain, insomnia, or behavioral symptoms—physical therapy, cognitive-behavioral therapy, and social support—can address underlying needs while lowering medication burden. Implementing these strategies requires clinician training, time for shared decision-making, and policies that support medication reviews as a routine part of care. When combined, these approaches reduce adverse events, improve function, and respect older adults’ priorities.