Polypharmacy in the older patient

The progressive ageing of the population is associated with a higher prevalence of chronic diseases, many of which occur simultaneously. Comorbidity causes the prescription of a high number of medications, which leads to a higher frequency of adverse effects, interactions, hospital admissions, poorer quality of life and lack of therapeutic compliance. Qualitatively, polypharmacy is understood as the fact of taking more medications than clinically appropriate, and there may be inadequate polypharmacy and adequate polypharmacy. Quantitatively, the most widespread criterion is to place a level of polypharmacy from 5 or more drugs and extreme polypharmacy or hyperpolypharmacy to the use of 10 or more. But more than quantity, quality matters, with the term appropriate polypharmacy becoming relevant. This term recognizes that patients can benefit from multiple medications if the prescription is based on the best possible evidence, reflects the patients’ clinical conditions, and considers potential interactions. It is necessary to actively monitor prescriptions in polymedicated elderly patients to establish the benefit-risk ratio of each indication. The systematic review of medication has been associated with improved adherence and the indication of drugs appropriate to the clinical situation and greater efficiency. Deprescribing consists of reviewing and evaluating the patient’s therapeutic plan with the aim of withdrawing, substituting or reducing the dose of unnecessary drugs or with an unfavorable benefit-risk ratio. Inpatient deprescribing interventions are very likely to reduce the risk of readmission in the short term, although their effect on mortality is uncertain.