Polypharmacy and older people

The use of polypharmacy (multiple medicines) is increasingly common in older people. There is no consensus on a clinical definition of polypharmacy and so it is often defined using a simple numerical threshold. However, current perspectives recommend that polypharmacy is classified as either ‘appropriate’ or ‘problematic’. Older people are especially vulnerable to the effects of polypharmacy because of altered physiology and the existence of comorbidities. The use of single evidence-based guidelines to manage comorbidities can cause problematic polypharmacy, and fears about polypharmacy can lead to under-prescribing. A range of interventions are available to improve the appropriate use of prescribing in older people. Considering the clinical context of polypharmacy alongside an awareness of its perils is important to ensure the benefits of using multiple medicines are balanced against the potential harms.