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Feature Article

Polypharmacy in older people: when should you deprescribe?

David G Le Couteur, Andrew J McLachlan, Sarah N Hilmer

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Abstract

Nearly two-thirds of people aged 75 years or over take five or more medicines. Polypharmacy is associated with adverse outcomes, including geriatric syndromes (e.g. falls and confusion), institutionalisation and mortality. An individualised patient-centred approach that takes into account multimorbidity can help prioritise medicines and identify when deprescribing is indicated.

Key Points

  • Polypharmacy and deprescribing are major challenges for clinicians caring for older people with multimorbidity.
  • It is important to recognise the limitations of the evidence base in these situations and the central role of patient-centred care when prioritising medicines.
  • Awareness of pharmacological principles and the concept of potentially inappropriate medicines can assist in identifying red flag medicines that should be avoided or deprescribed.
  • Careful clinical monitoring after medicines have been changed is key to ensuring that patients’ goals are being met and harms avoided.
  • Picture credit: © Yoav Levy/Phototake/Diomedia.com

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