Examining polypharmacy risks and impact on clinical outcomes in older adults: insights from a cohort study

Polypharmacy represents a growing concern among older adults because of its adverse events (AEs), including prescribing cascades . Data from tertiary care facilities in Saudi Arabia remain limited; therefore, we aim to explore the prevalence, clinical characteristics, and outcomes of polypharmacy among older adults attending outpatient clinics at King Abdulaziz Medical City (KAMC) in Riyadh. We retrospectively reviewed the electronic health records of older adults (aged ≥ 60 years) who presented to the outpatient clinic between January 2021 and December 2022. We categorized patients into a polypharmacy group (taking five or more medications) and a no-polypharmacy group (fewer than five). Extracted demographic, clinical, and laboratory data were analyzed. Additionally, we assessed the associations between polypharmacy and patient outcomes, including one-year mortality, healthcare utilization, and prescribing cascades, using logistic and linear regression analyses. We included 250 patients with a mean age of 78.3 years, and females accounted for 54.8% of the cohort. Polypharmacy was prevalent in 82.8% of participants and was significantly associated with higher rates of diabetes mellitus (DM), hypertension (HTN), dyslipidemia, heart failure (HF), anemia, and benign prostatic hyperplasia (BPH) (p < 0.05). Laboratory analyses revealed higher HbA1c and serum creatinine levels among patients with polypharmacy. Regression analysis showed a significant association between polypharmacy and prescribing cascades (aOR = 7.52; 95% CI: 1.67–33.81; p = 0.009), but no significant associations with one-year mortality, ICU admission or healthcare utilization (p > 0.05). Polypharmacy is highly prevalent among older adults and strongly linked to prescribing cascades, reflecting potential medication safety concerns. Although no significant association was observed with one-year mortality or healthcare utilization, medication review strategies and deprescribing initiatives are needed to achieve optimal outcomes in this population. Not applicable.