How should I approach the management of polypharmacy in elderly patients to minimize adverse drug reactions?

To manage polypharmacy in elderly patients effectively and minimize adverse drug reactions (ADRs), a comprehensive, patient-centred approach is essential. This involves regular, systematic medication reviews focusing on the necessity, effectiveness, and safety of each drug, particularly in those prescribed 10 or more regular medicines or at high risk of ADRs ⁴.

Key steps include:

• Engage a pharmacist with relevant clinical expertise to support medicines optimisation and strategic decision-making about medicines use ³.
• Assess the patient's frailty and multimorbidity status, as these increase susceptibility to ADRs due to altered pharmacokinetics and pharmacodynamics in older adults ¹,⁴.
• Review all medications, including prescription, over-the-counter, and herbal remedies, to identify potential drug–drug interactions and inappropriate prescribing, which are common contributors to ADRs in the elderly ¹,²,⁷.
• Consider deprescribing where appropriate, especially psychotropic drugs and those with anticholinergic effects, to reduce cognitive impairment, falls risk, and other ADRs ⁵,⁶.
• Involve the patient in shared decision-making, taking into account their preferences, treatment goals, and quality of life to balance benefits and risks of polypharmacy ³,⁴.
• Monitor closely for ADRs, including rare or delayed effects, and adjust treatment accordingly ¹,².
• Implement multifactorial interventions, including medication review as part of falls risk assessment and management, to reduce adverse outcomes ⁶.

This approach aligns with the concept of polypharmacy stewardship, which emphasises coordinated, multidisciplinary efforts to optimise medication regimens and reduce harm in older adults (Daunt et al., 2023). Medication-related problems in older people often arise from complex regimens and physiological changes with age, necessitating tailored management strategies (Wong, 2020). Pharmacotherapy in elderly patients, such as those with heart failure, requires vigilance for adverse events and dose adjustments (Rich, 2012).

In summary, minimizing ADRs in elderly patients with polypharmacy requires regular, multidisciplinary medication reviews, frailty and multimorbidity assessment, deprescribing when appropriate, patient-centred care, and vigilant monitoring for interactions and side effects ¹,³,⁴,⁷ (Daunt et al., 2023; Wong, 2020; Rich, 2012).