Polypharmacy Issues in Older Patients Concerning but Improving
Geriatric medicine hinges on eight guiding principles, Freba Farhat, MD, said at the ElderDerm 2025 Conference in Washington, DC: life expectancy, multimorbidity, functional status, cognition, mobility, social support, patient preference, and polypharmacy. The last of those factors can sometimes be the most challenging for clinicians.
Dr. Farhat, an assistant professor in the Department of Dermatology at Georgetown University School of Medicine, noted the rarity of any geriatric patient being on fewer than five medications, which is the threshold for polypharmacy.
“One has to keep in mind that this may not be the only condition that a patient has,” Dr. Farhat said.
Guiding principles to consider regarding polypharmacy, she said, should include cognition, functional mobility, social support, medication interactions, and feasibility of systemic and/or topical regimen recommendations.
Dr. Farhat cited an Annales de Dermatologie et de Venereologie letter to the editor singling out anti-microbials as by far the most high-risk drug culprit in patients who were concomitantly on vitamin K antagonist drugs, leading to various hemorrhagic events and elevated international normalized ratio (INR).1 Drug culprits, she noted, included amoxicillin, clavulanic acid with amoxicillin, clarithromycin, fluorquinolones, and fluconazole.
Fortunately, Dr. Farhat said, dermatologist claims for potentially inappropriate medications for older patients decreased by an annual mean rate of 9.5% between 2013 and 2018.2 Those medications, identified via the Beers Criteria for Potentially Inappropriate Use in Older Adults, comprised anthicholinergic agents, central nervous system agents, proton-pump inhibitors, and nonselective NSAIDs.2
- Bouteiller J, Carvalho P, Commin MH, Massy N, Tetart F, Joly P. Severe drug-drug interactions in elderly patients on medications frequently used in dermatology. Ann Dermatol Venereol. 2021 Sep;148(3):183-184. doi: 10.1016/j.annder.2020.11.007. Epub 2021 Jul 15.
- Drozdowski R, Gronbeck C, Feng H. Declining utilization of potentially inappropriate medications in older adults by dermatologists: A cross-sectional Medicare analysis. J Am Acad Dermatol. 2022 Jun;86(6):1422-1425. doi: 10.1016/j.jaad.2021.06.839. Epub 2021 Jun 16.