Background: Polypharmacy, defined as the concurrent use of five or more medications, is highly prevalent among older adults and is increasingly linked with adverse clinical outcomes such as frailty, cognitive decline, hospital readmission, and mortality (1,2). Despite growing awareness, few studies integrate real-world hospital data with advanced predictive tools to assess and manage these risks effectively (3,4).
Objective: To analyze the effects of polypharmacy in older adults, evaluating associated risks (including frailty and mortality), clinical outcomes, and current management approaches, with an added focus on decision-support tools and a small-scale survey of local prescriber patterns.
Methods: This mixed-method study combined a secondary analysis of hospital patient records (n=200, aged ≥65) from a local tertiary care center with a community-based clinician survey (n=50). Variables included medication count, Charlson Comorbidity Index (CCI), presence of potentially inappropriate medications (PIMs), and clinical outcomes. A literature-integrated framework, guided by systematic reviews and recent AI-enhanced prediction models, was used to triangulate findings (5–9). Descriptive statistics, logistic regression, and comparative risk ratios were employed to assess associations between polypharmacy and outcomes such as frailty and hospitalization.
Results Polypharmacy (≥5 medications) was observed in 76% of hospitalized patients. Moderate to severe frailty was significantly more prevalent among those on ≥8 drugs (OR 2.9, CI 1.8–4.7; p < 0.01). The presence of ≥1 PIM was associated with a 1.8-fold increased risk of readmission. Decision-support algorithm (LASSO regression model from Elhosseiny et al. (10)) showed promising alignment with observed risk clusters.
Conclusion Polypharmacy in older adults correlates with increased clinical risk and healthcare burden. Evidence supports multidisciplinary deprescribing, pharmacist-led reviews, and AI-augmented predictive models as effective strategies to improve outcomes. System-wide implementation of screening and support tools is warranted for frailty-prone geriatric populations..
Keywords: Polypharmacy; Older Adults; Frailty; Clinical Outcomes; Deprescribing;; Medication Management