POLYPHARMACY IN THE GERIATRIC POPULATION: A COMPREHENSIVE SYSTEMATIC REVIEW OF EPIDEMIOLOGY, PATHOPHYSIOLOGY, CLINICAL CONSEQUENCES, AND PHARMACOTHERAPY OPTIMIZATION STRATEGIES

Justyna Słowik; Izabela Sieradzka; Katarzyna Wajda; Dorota Wikiera; Magdalena Pomykalska; Zuzanna Wnęk; Eryk  Trela

doi:10.31435/ijitss.3(51).2026.5936

Authors

Justyna Słowik Saint Queen Jadwiga Clinical Provincial Hospital in Rzeszów, Rzeszów, Poland https://orcid.org/0009-0006-9219-8377
Izabela Sieradzka Saint Queen Jadwiga Clinical Provincial Hospital in Rzeszów, Rzeszów, Poland https://orcid.org/0009-0004-3849-9844
Katarzyna Wajda Medical College of the University of Rzeszów, Rzeszów, Poland https://orcid.org/0009-0008-6631-8923
Dorota Wikiera Medical College of the University of Rzeszów, Rzeszów, Poland https://orcid.org/0009-0001-0371-0361
Magdalena Pomykalska Medical College of the University of Rzeszów, Rzeszów, Poland https://orcid.org/0009-0000-7104-0729
Zuzanna Wnęk Medical College of the University of Rzeszów, Rzeszów, Poland https://orcid.org/0009-0008-9479-5946
Eryk Trela Medical College of the University of Rzeszów, Rzeszów, Poland https://orcid.org/0009-0003-5799-6507

DOI:

https://doi.org/10.31435/ijitss.3(51).2026.5936

Keywords:

Geriatric Medicine, Geriatric Pharmacology, Geriatric Population, Polypharmacy

Abstract

Population aging has become a major demographic and public health challenge worldwide. Increased life expectancy and advances in healthcare have led to a growing number of older adults living with multiple chronic diseases. Consequently, multimorbidity and polypharmacy have become increasingly common in geriatric practice. Polypharmacy is commonly defined as the regular use of five or more medications, while excessive polypharmacy refers to the use of ten or more drugs. Modern geriatric medicine emphasizes that the appropriateness of treatment is more important than the number of medications alone. Therefore, a distinction should be made between appropriate and inappropriate polypharmacy.

Appropriate polypharmacy refers to evidence-based pharmacotherapy in which multiple medications are clinically justified and optimized to improve patient outcomes. Inappropriate polypharmacy occurs when medications without clear indications are prescribed, when therapeutic duplication exists, or when treatment risks outweigh benefits. Older adults are particularly vulnerable to adverse drug reactions because of age-related physiological changes, frailty, cognitive impairment, and multiple comorbidities.

An important mechanism contributing to inappropriate polypharmacy is the prescribing cascade, in which adverse drug reactions are misinterpreted as new medical conditions, leading to additional prescriptions. This process increases the risk of drug–drug interactions, hospitalization, functional decline, and reduced quality of life. Symptoms such as dizziness, fatigue, falls, constipation, or cognitive impairment may often result from medication-related toxicity rather than normal aging.

This systematic review summarizes the epidemiology, mechanisms, clinical consequences, and evidence-based strategies for optimizing pharmacotherapy in older adults, including medication review, deprescribing, interdisciplinary collaboration, and individualized patient-centered care.

References

Varghese, D., & Patel, P. (2026). Polypharmacy. In StatPearls. StatPearls Publishing. Retrieved April 17, 2026, from https://www.ncbi.nlm.nih.gov/books/NBK532953/

Sharma, R., Sharma, T., McCready-Branch, B., Chauhan, A., Carter, C., Park, S., et al. (2025). Medication use by older adults with frailty: A scoping review. Pharmacy, 13, Article 170. https://doi.org/10.3390/pharmacy13060170

Pazan, F., & Wehling, M. (2021). Polypharmacy in older adults: A narrative review of definitions, epidemiology and consequences. European Geriatric Medicine, 12, 443–452. https://doi.org/10.1007/s41999-021-00479-3

Alhumaidi, R. M., Bamagous, G. A., Alsanosi, S. M., Alqashqari, H. S., Qadhi, R. S., Alhindi, Y. Z., et al. (2023). Risk of polypharmacy and its outcome in terms of drug interaction in an elderly population: A retrospective cross-sectional study. Journal of Clinical Medicine, 12, Article 3960. https://doi.org/10.3390/jcm12123960

Peterson, M. E., Stollings, J. L., & Ely, E. W. (2026). Identifying and resolving drug-related problems in geriatric patients. Hospital Pharmacy. Advance online publication. https://doi.org/10.1177/00185787251414339

Wang, Z., Liu, T., Su, Q., Luo, H., Lou, L., Zhao, L., et al. (2024). Prevalence of polypharmacy in elderly population worldwide: A systematic review and meta-analysis. Pharmacoepidemiology and Drug Safety, 33, Article e5880. https://doi.org/10.1002/pds.5880

Delara, M., Murray, L., Jafari, B., Bahji, A., Goodarzi, Z., Kirkham, J., et al. (2022). Prevalence and factors associated with polypharmacy: A systematic review and meta-analysis. BMC Geriatrics, 22, Article 601. https://doi.org/10.1186/s12877-022-03279-x

Wang, X., Liu, K., Shirai, K., Tang, C., Hu, Y., Wang, Y., et al. (2023). Prevalence and trends of polypharmacy in U.S. adults, 1999–2018. Global Health Research and Policy, 8, Article 25. https://doi.org/10.1186/s41256-023-00311-4

Kardas, P., Urbański, F., Lichwierowicz, A., Chudzyńska, E., Kardas, G., & Czech, M. (2021). Prevalence and age structure of polypharmacy in Poland: Results of the analysis of the national real-world database of 38 million citizens. Frontiers in Pharmacology, 12, Article 655364. https://doi.org/10.3389/fphar.2021.655364

Kardas, P., Lichwierowicz, A., Urbański, F., Chudzyńska, E., Czech, M., & Kardas, G. (2021). Prevalence of chronic polypharmacy in community-dwelling elderly people in Poland: Analysis of national real-world database helps to identify high-risk group. Frontiers in Pharmacology, 12, Article 739740. https://doi.org/10.3389/fphar.2021.739740

Błeszyńska Marunowska, E., Jagiełło, K., Grodzicki, T., Wierucki, Ł., Sznitowska, M., Kalarus, Z., et al. (2022). Polypharmacy among elderly patients in Poland: Prevalence, predisposing factors, and management strategies. Polish Archives of Internal Medicine, 132, Article 16347. https://doi.org/10.20452/pamw.16347

Neumann-Podczaska, A., Tobis, S., Antimisiaris, D., Mossakowska, M., Puzianowska-Kuznicka, M., Chudek, J., et al. (2022). Polypharmacy in Polish older adult population—A cross-sectional study: Results of the PolSenior project. International Journal of Environmental Research and Public Health, 19, Article 1030. https://doi.org/10.3390/ijerph19031030

Cadenas, R., Diez, M. J., Fernández, N., García, J. J., Sahagún, A. M., Sierra, M., et al. (2021). Prevalence and associated factors of polypharmacy in nursing home residents: A cross-sectional study. International Journal of Environmental Research and Public Health, 18, Article 2037. https://doi.org/10.3390/ijerph18042037

Burato, S., Leonardi, L., Antonazzo, I. C., Raschi, E., Ajolfi, C., Baraghini, M., et al. (2021). Comparing the prevalence of polypharmacy and potential drug–drug interactions in nursing homes and in the community-dwelling elderly of Emilia-Romagna region. Frontiers in Pharmacology, 11, Article 624888. https://doi.org/10.3389/fphar.2020.624888

Ngcobo, N. N. (2025). Influence of ageing on the pharmacodynamics and pharmacokinetics of chronically administered medicines in geriatric patients: A review. Clinical Pharmacokinetics, 64, 335–367. https://doi.org/10.1007/s40262-024-01466-0

Mangoni, A. A., Woodman, R. J., & Jarmuzewska, E. A. (2025). Pharmacokinetic and pharmacodynamic alterations in older people: What we know so far. Expert Opinion on Drug Metabolism & Toxicology, 21, 811–829. https://doi.org/10.1080/17425255.2025.2503848

Cope, D. G. (2013). Polypharmacy in older adults: The role of the advanced practitioner in oncology. Journal of the Advanced Practitioner in Oncology, 4, 107–112. https://doi.org/10.6004/jadpro.2013.4.2.5

Boateng, I., Pascual, C. R., Grassby, P., Asghar, Z., & Ibrahim, K. (2025). The impact of polypharmacy on health outcomes in the aged: A retrospective cohort study. PLOS ONE, 20, Article e0317907. https://doi.org/10.1371/journal.pone.0317907

Yan, Z., Fan, K. Q., Yu, T., Su, N., Zou, Y., & Xia, L. (2025). Polypharmacy, drug–drug interactions and adverse drug reactions in older Chinese cancer patients: Evidence from CHARLS. Frontiers in Pharmacology, 16, Article 1579023. https://doi.org/10.3389/fphar.2025.1579023

Dhalwani, N. N., Fahami, R., Sathanapally, H., Seidu, S., Davies, M. J., & Khunti, K. (2017). Association between polypharmacy and falls in older adults: A longitudinal study from England. BMJ Open, 7, Article e016358. https://doi.org/10.1136/bmjopen-2017-016358

Kotsalou, E. (2021). Polypharmacy in elderly people: Epidemiology, consequences and prevention strategies. International Journal of Endocrinology, 17, 56–62. https://doi.org/10.22141/2224-0721.17.1.2021.226432

Ziere, G., Dieleman, J. P., Hofman, A., Pols, H. A. P., Van Der Cammen, T. J. M., & Stricker, B. H. C. (2006). Polypharmacy and falls in the middle age and elderly population. British Journal of Clinical Pharmacology, 61, 218–223. https://doi.org/10.1111/j.1365-2125.2005.02543.x

Çakmak, G., & Öztürk, Z. A. (2021). The relationship between polypharmacy and frailty in older adults: Which frailty assessment tool shows the relationship best? Progress in Nutrition, 23, Article e2021295. https://doi.org/10.23751/pn.v23i3.12036

Gemikonakli, G., Mach, J., & Hilmer, S. N. (2021). Interactions between the aging gut microbiome and common geriatric giants: Polypharmacy, frailty, and dementia. The Journals of Gerontology: Series A, 76, 1019–1028. https://doi.org/10.1093/gerona/glaa047

Mach, J., Gemikonakli, G., Logan, C., Vander Wyk, B., Allore, H., Ekambareshwar, S., et al. (2021). Chronic polypharmacy with increasing drug burden index exacerbates frailty and impairs physical function, with effects attenuated by deprescribing, in aged mice. The Journals of Gerontology: Series A, 76, 1010–1018. https://doi.org/10.1093/gerona/glaa060

Mach, J., Allore, H., Gnjidic, D., Gemikonakli, G., Kane, A. E., Howlett, S. E., et al. (2022). Preclinical frailty assessments: Phenotype and frailty index identify frailty in different mice and are variably affected by chronic medications. Experimental Gerontology, 161, Article 111700. https://doi.org/10.1016/j.exger.2022.111700

Wu, H., Mach, J., Gnjidic, D., Naganathan, V., Blyth, F. M., Waite, L. M., et al. (2022). Comparing effects of polypharmacy on inflammatory profiles in older adults and mice: Implications for translational aging research. The Journals of Gerontology: Series A, 77, 1295–1303. https://doi.org/10.1093/gerona/glac061

Chippa, V., & Roy, K. (2026). Geriatric cognitive decline and polypharmacy. In StatPearls. StatPearls Publishing. Retrieved April 18, 2026, from http://www.ncbi.nlm.nih.gov/pubmed/34599530

Park, H. Y., Park, J. W., Song, H. J., Sohn, H. S., & Kwon, J. W. (2017). The association between polypharmacy and dementia: A nested case-control study based on a 12-year longitudinal cohort database in South Korea. PLOS ONE, 12, Article e0169463. https://doi.org/10.1371/journal.pone.0169463

Esumi, S., Ushio, S., & Zamami, Y. (2022). Polypharmacy in older adults with Alzheimer’s disease. Medicina, 58, Article 1445. https://doi.org/10.3390/medicina58101445

Hsu, Y. H., Liang, C. K., Chou, M. Y., Shen, H. C., Wang, Y. C., Iwaki, H., et al. (2025). Polypharmacy and risk of dementia progression in older adults with mild cognitive impairment: A longitudinal cohort study. Alzheimer’s & Dementia: Translational Research & Clinical Interventions, 11, Article e70179. https://doi.org/10.1002/trc2.70179

Fiske, M., Moen, A., Mdala, I., & Straand, J. (2024). Malnutrition and polypharmacy in older adult patients receiving home care nursing services: A cross-sectional study. Journal of the American Medical Directors Association, 25, 526–531. https://doi.org/10.1016/j.jamda.2023.11.016

Rahi, B., Daou, T., Gereige, N., Issa, Y., Moawad, Y., & Zgheib, K. (2020). Effects of polypharmacy on appetite and malnutrition risk among institutionalized Lebanese older adults—Preliminary results. Current Developments in Nutrition, 4, Article 69. https://doi.org/10.1093/cdn/nzaa040_069

Kose, E., Wakabayashi, H., & Yasuno, N. (2021). Polypharmacy and malnutrition management of elderly perioperative patients with cancer: A systematic review. Nutrients, 13, Article 1961. https://doi.org/10.3390/nu13061961

Nakamura, T., Itoh, T., Yabe, A., Imai, S., Nakamura, Y., Mizokami, Y., et al. (2021). Polypharmacy is associated with malnutrition and activities of daily living disability among daycare facility users: A cross-sectional study. Medicine, 100, Article e27073. https://doi.org/10.1097/MD.0000000000027073

Pan, S., Li, S., Shi, Y., Kang, Q., Jiang, S., Liu, G. G., et al. (2025). Polypharmacy and healthcare expenditures among older adults in the United States: A propensity score-matched study. BMC Geriatrics, Article 76. https://doi.org/10.1186/s12877-025-06545-w

Kwak, M. J., Chang, M., Chiadika, S., Aguilar, D., Avritscher, E., Deshmukh, A., et al. (2022). Healthcare expenditure associated with polypharmacy in older adults with cardiovascular diseases. The American Journal of Cardiology, 169, 156–158. https://doi.org/10.1016/j.amjcard.2022.01.012

Almodóvar, A. S., & Nahata, M. C. (2019). Associations between chronic disease, polypharmacy, and medication-related problems among Medicare beneficiaries. Journal of Managed Care & Specialty Pharmacy, 25, 573–577. https://doi.org/10.18553/jmcp.2019.25.5.573

Zhu, S., Zheng, X., Fan, M., Jin, Y., Chen, C., & Cheng, M. (2025). Comparative effectiveness of the Beers Criteria (2023) versus the STOPP (v3) in detecting potentially inappropriate medications in older adults with heart failure: A retrospective cross-sectional study. International Journal of Clinical Pharmacy, 47, 1485–1492. https://doi.org/10.1007/s11096-025-01964-6

Jandu, J. S., Mohanaselvan, A., Dahal, R., & Bista, S. (2024). Strategies to reduce polypharmacy in older adults. In StatPearls. StatPearls Publishing.

Thomas, R. E., & Thomas, B. C. (2019). A systematic review of studies of the STOPP/START 2015 and American Geriatrics Society Beers 2015 criteria in patients ≥ 65 years. Current Aging Science, 12, 121–154. https://doi.org/10.2174/1874609812666190516093742

Ubeda, A., Ferrándiz, M. L., Maicas, N., Gomez, C., Bonet, M., & Peris, J. E. (2012). Potentially inappropriate prescribing in institutionalised older patients in Spain: The STOPP-START criteria compared with the Beers criteria. Pharmacy Practice, 10, 83–91. https://doi.org/10.4321/s1886-36552012000200004

Chang, C. T., Chan, H. K., Tan, A. Y., Kamis, S. F., Yeo, Y. L., Azman, M. A., et al. (2024). Comparing Beers, STOPP and MALPIP criteria in detecting potentially inappropriate medications, clinical outcomes, and cost impacts among older Malaysians: A cohort study. Journal of Pharmaceutical Policy and Practice, 17, Article 2436896. https://doi.org/10.1080/20523211.2024.2436896

M. R. S., Amarnath, R., Avanti, S., & Dhareshwar, B. (2026). Comparison of Beers Criteria and STOPP/START (Screening Tool of Older Persons’ Prescriptions/Screening Tool to Alert to Right Treatment) criteria for assessing inappropriate drug use among elderly patients. Cureus, Article e102621. https://doi.org/10.7759/cureus.102621

Thompson, W., & McDonald, E. G. (2024). Polypharmacy and deprescribing in older adults. Annual Review of Medicine, 75, 113–127. https://doi.org/10.1146/annurev-med-070822-101947

Linsky, A. M., Motala, A., Lawson, E., & Shekelle, P. (2023). Deprescribing to reduce medication harms in older adults: Rapid response. In Making healthcare safer IV: A continuous updating of patient safety harms and practices. Agency for Healthcare Research and Quality. Retrieved April 18, 2026, from https://www.ncbi.nlm.nih.gov/books/NBK600387/

Zhou, D., Chen, Z., & Tian, F. (2023). Deprescribing interventions for older patients: A systematic review and meta-analysis. Journal of the American Medical Directors Association, 24, 1718–1725. https://doi.org/10.1016/j.jamda.2023.07.016

McGrory, F., & Elnaem, M. H. (2025). Pharmacist-led interventions for polypharmacy management in older adults: A systematic review of strategies and outcomes in the United Kingdom and the Republic of Ireland. Pharmacy, 13, Article 109. https://doi.org/10.3390/pharmacy13040109

Gonçalves, J. R., Magalhães, N., Machado, S., Ramalhinho, I., & Cavaco, A. M. (2025). Pharmacist-mediated deprescribing in long-term care facilities: A systematic review. Pharmacy, 13, Article 3. https://doi.org/10.3390/pharmacy13010003

Jończyk, J., Szadkowska, E., & Michalska-Falkowska, A. (2022). Wielolekowość seniorów w Polsce: Aspekty prawno-społeczne i medyczne.

Peat, G., Fylan, B., Marques, I., Raynor, D. K., Breen, L., Olaniyan, J., et al. (2022). Barriers and facilitators of successful deprescribing as described by older patients living with frailty, their informal carers and clinicians: A qualitative interview study. BMJ Open, 12, Article e054279. https://doi.org/10.1136/bmjopen-2021-054279

Crutzen, S., Baas, G., Abou, J., van den Born-Bondt, T., Hugtenburg, J. G., Bouvy, M. L., et al. (2020). Barriers and enablers of older patients to deprescribing of cardiometabolic medication: A focus group study. Frontiers in Pharmacology, 11, Article 1268. https://doi.org/10.3389/fphar.2020.01268

Kim, J. L., Lewallen, K. M., Hollingsworth, E. K., Shah, A. S., Simmons, S. F., & Vasilevskis, E. E. (2023). Patient-reported barriers and enablers to deprescribing recommendations during a clinical trial (Shed-MEDS). The Gerontologist, 63. https://doi.org/10.1093/geront/gnac100

Robinson, M., Mokrzecki, S., & Mallett, A. J. (2024). Attitudes and barriers towards deprescribing in older patients experiencing polypharmacy: A narrative review. npj Aging, 10, Article 6. https://doi.org/10.1038/s41514-023-00132-2

Goyal, P., Requijo, T., Siceloff, B., Shen, M. J., Masterson Creber, R., Hilmer, S. N., et al. (2020). Patient-reported barriers and facilitators to deprescribing cardiovascular medications. Drugs & Aging, 37, 125–135. https://doi.org/10.1007/s40266-019-00729-x

Doherty, A. J., Boland, P., Reed, J., Clegg, A. J., Stephani, A. M., Williams, N. H., et al. (2020). Barriers and facilitators to deprescribing in primary care: A systematic review. BJGP Open, 4, Article bjgpopen20X101096. https://doi.org/10.3399/bjgpopen20X101096

Pickering, A. N., Hamm, M. E., Dawdani, A., Hanlon, J. T., Thorpe, C. T., Gellad, W. F., et al. (2020). Older patient and caregiver perspectives on medication value and deprescribing: A qualitative study. Journal of the American Geriatrics Society, 68. https://doi.org/10.1111/jgs.16370

Ramsdale, E., Malhotra, A., Holmes, H. M., Zubkoff, L., Wang, J., Mohile, S., et al. (2023). Emotional barriers and facilitators of deprescribing for older adults with cancer and polypharmacy: A qualitative study. Supportive Care in Cancer, 31. https://doi.org/10.1007/s00520-023-08084-9