Reducing polypharmacy in geriatric patients: A deprescribing audit

Introduction
Polypharmacy, defined as the use of five or more medications, is common in older adults due to multiple chronic conditions. While often necessary, it is associated with adverse drug reactions, prescribing errors, and preventable hospitalisations. Medication review at admission is essential, particularly in frail patients, to identify inappropriate prescriptions and opportunities for deprescribing.

Methods
A retrospective audit was conducted on 30 patients aged ≥65 years, admitted to a geriatrics ward for less than one month. Data were collected from electronic health and GP records, including demographics, clinical frailty score (CFS), pre-admission medication lists, and deprescribing changes during admission. Patients with a CFS ≥7 (severe frailty) were analysed to determine whether deprescribing was considered. The main outcome was whether deprescribing recommendations were implemented by a consultant or senior pharmacist.

Results
Of the 30 cases reviewed, 19 (63%) included a recommendation for medication changes, while 11 (37%) did not. Patients with severe frailty were prescribed 7–20 medications at admission, with one patient taking 20. Despite high levels of polypharmacy, deprescribing occurred in only a minority of cases, usually involving discontinuation of just 1–2 medications. This highlights a significant gap between identified opportunities and actual implementation of deprescribing.

Conclusion
Deprescribing in frail older adults carries important clinical, safety, and financial benefits but remains underutilised. A proactive, multidisciplinary approach is required to embed regular medication review and deprescribing into routine care, optimising therapy and minimising harm in this vulnerable population.