PURPOSE: To increase the awareness of prescribing pitfalls commonly facing primary care clinicians who provide care for older individuals. EPIDEMIOLOGY: Medicare beneficiaries (14% of the US population) constitute 43% of total drug expenditures. Forty percent take ≥5 prescription medications daily and those in long-term care facilities may take more than 9 or 10 per day. REVIEW SUMMARY: Geriatric polypharmacy-the use of excessive and frequently inappropriate medications-is of prime importance to physicians because the clinical consequences of polypharmacy are numerous and serious. This article reviews the problem and highlights the unique pharmacokinetic and pharmacodynamic effects seen in older patients. Etiologies and consequences of polypharmacy are explored along with currently available interventions and future recommendations to reduce this problem. TYPE OF AVAILABLE EVIDENCE: Systematic reviews/meta- analyses, randomized-controlled trials, cohort studies, unstructured reviews, textbooks. GRADE OF AVAILABLE EVIDENCE: Fair. Evidence is sufficient to determine effects on health outcomes, but the strength of the evidence is limited by the number, quality, or consistency of the individual studies; its generalizability to routine practice; or the indirect nature of the evidence on health outcomes. CONCLUSION: It is imperative for clinicians to determine what medications their older patients are taking and how, and to work with older patients, caregivers, and pharmacists to develop the optimal therapeutic regimen. Future goals should be directed at including a larger number of older adults in clinical trials, improved tracking of adverse events and redundant medications for each patient, and development of tools to improve patient compliance.
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