Untangling the risk of polypharmacy as a contributor to geriatric falls: A narrative review

Abstract: Polypharmacy, which is usually described as taking five or more drugs at the same time, is an increasingly challenging issue in geriatric care. Although polypharmacy is common in the treatment of various chronic illnesses, it leads to the escalation of risks of drug–drug interactions, adverse drug events, and deterioration of physiological reserve, which are major contributors to falls, a major cause of injury and disability, as well as death among the aged. The search in this narrative review was carried out using PubMed, Scopus, Web of Science, Google Scholar, and Cochrane Library databases. The search targeted peer-reviewed articles covering topic areas of polypharmacy, geriatric falls, and medication safety in persons aged 65 years and above. Results indicate that psychotropic, sedative-hypnotic, and antihypertensive medications are some of the highly risk categories of drugs most closely linked with falls. This narrative review provides an overview of the epidemiology and pathophysiology of polypharmacy-induced falls, outlines high-risk drug classes, including psychotropic, sedative-hypnotic, and antihypertensive drugs, and discusses evidence-based tools to identify patients at risk. Future considerations suggest that further research is necessary to uncover causal mechanisms, as well as the development of specific polypharmacy risk prediction models and the application of artificial intelligence to medication management systems. The challenge of polypharmacy presented by falls should be treated with a patient-centered approach based on weighing the therapeutic advantage against the harm, to provide safe and efficient care to the aging population.