Polypharmacy is a major health issue for older adults. Entangled with several geriatric syndromes, including frailty, falls and cognitive decline, research focused on polypharmacy has been challenged by heterogeneity in its definition, confounding by comorbidities and limited prospective data. In this Review, we discuss varying definitions for polypharmacy and highlight the need for a uniform definition for future studies. We critically appraise strategies for reducing medication prescriptions and implementing deprescribing as a mechanism to reduce the potential harmful effects of polypharmacy. As we look to the future, we assess the role of novel analytics and high-throughput technology, including multiomics profiling, to advance research in polypharmacy and the development of new strategies for risk stratification in the age of precision medicine.
Subscribe to Journal
Get full journal access for 1 year
only $9.92 per issue
All prices are NET prices.
VAT will be added later in the checkout.
Tax calculation will be finalised during checkout.
Rent or Buy article
Get time limited or full article access on ReadCube.
All prices are NET prices.
Ogden, D. Magic, Witchcraft, and Ghosts in the Greek and Roman Worlds: A Sourcebook (Oxford Univ. Press, 2002).
Rollason, V. & Vogt, N. Reduction of polypharmacy in the elderly: a systematic review of the role of the pharmacist. Drugs Aging 20, 817–832 (2003).
Medication Safety in Polypharmacy: Technical Report (World Health Organization, 2019); https://apps.who.int/iris/rest/bitstreams/1235792/retrieve
Jokanovic, N., Tan, E. C. K., Dooley, M. J., Kirkpatrick, C. M. & Bell, J. S. Prevalence and factors associated with polypharmacy in long-term care facilities: a systematic review. J. Am. Med. Dir. Assoc. 16, 535.e1–535.e12 (2015).
Kantor, E. D., Rehm, C. D., Haas, J. S., Chan, A. T. & Giovannucci, E. L. Trends in prescription drug use among adults in the United States from 1999–2012. J. Am. Med. Assoc. 314, 1818–1831 (2015).
Qato, D. M., Wilder, J., Schumm, L. P., Gillet, V. & Alexander, G. C. Changes in prescription and over-the-counter medication and dietary supplement use among older adults in the United States, 2005 vs 2011. JAMA Intern. Med. 176, 473–482 (2016).
Maher, R. L., Hanlon, J. & Hajjar, E. R. Clinical consequences of polypharmacy in elderly. Expert Opin. Drug Saf. 13, 57–65 (2014).
Morin, L., Johnell, K., Laroche, M.-L., Fastbom, J. & Wastesson, J. W. The epidemiology of polypharmacy in older adults: register-based prospective cohort study. Clin. Epidemiol. 10, 289–298 (2018).
Kojima, T. et al. Association of polypharmacy with fall risk among geriatric outpatients. Geriatr. Gerontol. Int. 11, 438–444 (2011).
Arauna, D. et al. Polypharmacy is associated with frailty, nutritional risk and chronic disease in Chilean older adults: remarks from PIEI-ES study. Clin. Interv. Aging 15, 1013–1022 (2020).
Li, J.-W., Hsieh, H.-M., Weng, S.-F. & Lee, I.-C. Polypharmacy and utilization of health care services: a cohort study of people aged over 50 years in Taiwan. Asia-Pac. J. Public Health 31, 257–266 (2019).
Flaherty, J. H., Perry, H. M., Lynchard, G. S. & Morley, J. E. Polypharmacy and hospitalization among older home care patients. J. Gerontol. A Biol. Sci. Med. Sci. 55, M554–M559 (2000).
Brockhattingen, K. K., Anru, P. L., Masud, T., Petrovic, M. & Ryg, J. Association between number of medications and mortality in geriatric inpatients: a Danish nationwide register-based cohort study. Eur. Geriatr. Med. 11, 1063–1071 (2020).
Veehof, L., Stewart, R., Haaijer-Ruskamp, F. & Jong, B. M. The development of polypharmacy. A longitudinal study. Fam. Pract. 17, 261–267 (2000).
Viktil, K. K., Blix, H. S., Moger, T. A. & Reikvam, A. Polypharmacy as commonly defined is an indicator of limited value in the assessment of drug-related problems. Br. J. Clin. Pharm. 63, 187–195 (2007).
Lai, S.-W. & Liao, K.-F.Optimal cutoff of polypharmacy and outcomes. J. Clin. Epidemiol. 66, 465–466 (2013).
Langeard, A. et al. Polypharmacy cut-off for gait and cognitive impairments. Front. Pharmacol. 7, 296 (2016).
Gnjidic, D., Le Couteur, D. G., Kouladjian, L. & Hilmer, S. N. Deprescribing trials: methods to reduce polypharmacy and the impact on prescribing and clinical outcomes. Clin. Geriatr. Med. 28, 237–253 (2012).
Masnoon, N., Shakib, S., Kalisch-Ellett, L. & Caughey, G. E.What is polypharmacy? A systematic review of definitions. BMC Geriatr. 17, 230 (2017).
Kuijpers, M. A. J., van Marum, R. J., Egberts, A. C. G. & Jansen, P. A. F. Relationship between polypharmacy and underprescribing. Br. J. Clin. Pharm. 65, 130–133 (2008).
2019 American Geriatrics Society Beers Criteria Update Expert Panel. American Geriatrics Society 2019 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. J. Am. Geriatr. Soc. 67, 674–694 (2019).
O’Mahony, D. et al. STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Age Ageing 44, 213–218 (2015).
Hamilton, H., Gallagher, P., Ryan, C., Byrne, S. & O’Mahony, D. Potentially inappropriate medications defined by STOPP criteria and the risk of adverse drug events in older hospitalized patients. Arch. Intern. Med. 171, 1013–1019 (2011).
Osei, E. K., Berry-Cabán, C. S., Haley, C. L. & Rhodes-Pope, H.Prevalence of Beers criteria medications among elderly patients in a military hospital. Gerontol. Geriatr. Med. 2, 1–6 (2016).
Hill-Taylor, B. et al. Application of the STOPP/START criteria: a systematic review of the prevalence of potentially inappropriate prescribing in older adults, and evidence of clinical, humanistic and economic impact. J. Clin. Pharm. Ther. 38, 360–372 (2013).
Hanlon, J. T. et al. A method for assessing drug therapy appropriateness. J. Clin. Epidemiol. 45, 1045–1051 (1992).
Kuhn-Thiel, A. M., Weiß, C. & Wehling, M. & FORTA authors/expert panel members. Consensus validation of the FORTA (Fit fOR The Aged) List: a clinical tool for increasing the appropriateness of pharmacotherapy in the elderly. Drugs Aging 31, 131–140 (2014).
Pazan, F., Weiss, C. & Wehling, M. & FORTA. The EURO-FORTA (Fit fOR The Aged) List: international consensus validation of a clinical tool for improved drug treatment in older people. Drugs Aging 35, 61–71 (2018).
Rudolph, J. L.The Anticholinergic Risk Scale and anticholinergic adverse effects in older persons. Arch. Intern. Med. 168, 508–513 (2008).
Boustani, M., Campbell, N., Munger, S., Maidment, I. & Fox, C. Impact of anticholinergics on the aging brain: a review and practical application. Aging Health 4, 311–320 (2008).
Hilmer, S. N.A drug burden index to define the functional burden of medications in older people. Arch. Intern. Med. 167, 781–787 (2007).
Fox, C. et al. Effect of medications with anti-cholinergic properties on cognitive function, delirium, physical function and mortality: a systematic review. Age Ageing 43, 604–615 (2014).
Carnahan, R. M., Lund, B. C., Perry, P. J., Pollock, B. G. & Culp, K. R. The Anticholinergic Drug Scale as a measure of drug-related anticholinergic burden: associations with serum anticholinergic activity. J. Clin. Pharm. 46, 1481–1486 (2006).
Khera, A. V. et al. Genetic risk, adherence to a healthy lifestyle, and coronary disease. N. Engl. J. Med. 375, 2349–2358 (2016).
Michel, J.-P., Dreux, C. & Vacheron, A. Healthy ageing: evidence that improvement is possible at every age. Eur. Geriatr. Med. 7, 298–305 (2016).
Stone Neil, J. et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults. J. Am. Coll. Cardiol. 63, 2889–2934 (2014).
Doan, J., Zakrzewski-Jakubiak, H., Roy, J., Turgeon, J. & Tannenbaum, C. Prevalence and risk of potential cytochrome P450-mediated drug–drug interactions in older hospitalized patients with polypharmacy. Ann. Pharmacother. 47, 324–332 (2013).
Vik, S. A., Maxwell, C. J. & Hogan, D. B. Measurement, correlates, and health outcomes of medication adherence among seniors. Ann. Pharmacother. 38, 303–312 (2004).
Leelakanok, N., Holcombe, A. L., Lund, B. C., Gu, X. & Schweizer, M. L. Association between polypharmacy and death: a systematic review and meta-analysis. J. Am. Pharm. Assoc. 57, 729–738.e10 (2017).
Jyrkkä, J., Mursu, J., Enlund, H. & Lönnroos, E. Polypharmacy and nutritional status in elderly people. Curr. Opin. Clin. Nutr. Metab. Care 15, 1–6 (2012).
Kojima, T. et al. Association of polypharmacy with fall risk among geriatric outpatients. Geriatr. Gerontol. Int. 11, 438–444 (2011).
Crentsil, V., Ricks, M. O., Xue, Q.-L. & Fried, L. P. A pharmacoepidemiologic study of community-dwelling, disabled older women: factors associated with medication use. Am. J. Geriatr. Pharmacother. 8, 215–224 (2010).
Staller, K. et al. Menopausal hormone therapy is associated with increased risk of fecal incontinence in women after menopause. Gastroenterology 152, 1915–1921 (2017).
Nuotio, M., Jylhä, M., Luukkaala, T. & Tammela, T. L. J. Health problems associated with lower urinary tract symptoms in older women. A population-based survey. Scand. J. Prim. Health Care 23, 209–214 (2005).
Rochon, P. A. & Gurwitz, J. H. Optimising drug treatment for elderly people: the prescribing cascade. Br. Med. J. 315, 1096–1099 (1997).
Savage, R. D. et al. Evaluation of a common prescribing cascade of calcium channel blockers and diuretics in older adults with hypertension. JAMA Intern. Med. 180, 643–651 (2020).
Gutiérrez‐Valencia, M. et al. The relationship between frailty and polypharmacy in older people: a systematic review. Br. J. Clin. Pharmacol. 84, 1432–1444 (2018).
Green, J. L., Hawley, J. N. & Rask, K. J. Is the number of prescribing physicians an independent risk factor for adverse drug events in an elderly outpatient population? Am. J. Geriatr. Pharmacother. 5, 31–39 (2007).
Hutchinson, T. A., Flegel, K. M., Kramer, M. S., Leduc, D. G. & Kong, H. H. Frequency, severity and risk factors for adverse drug reactions in adult out-patients: a prospective study. J. Chronic Dis. 39, 533–542 (1986).
Gandhi, T. K. et al. Drug complications in outpatients. J. Gen. Intern. Med. 15, 149–154 (2000).
Shah, R. R. & Smith, R. L. Addressing phenoconversion: the Achilles’ heel of personalized medicine. Br. J. Clin. Pharm. 79, 222–240 (2015).
Agbabiaka, T. B., Spencer, N. H., Khanom, S. & Goodman, C. Prevalence of drug–herb and drug–supplement interactions in older adults: a cross-sectional survey. Br. J. Gen. Pract. 68, e711–e717 (2018).
Jou, J. & Johnson, P. J. Nondisclosure of complementary and alternative medicine use to primary care physicians: findings from the 2012 National Health Interview Survey. JAMA Intern. Med. 176, 545–546 (2016).
Tesfamariam, S. et al. Self-medication with over the counter drugs, prevalence of risky practice and its associated factors in pharmacy outlets of Asmara, Eritrea. BMC Public Health 19, 159 (2019).
Stone, J. A. et al. A preliminary examination of over-the-counter medication misuse rates in older adults. Res. Soc. Admin. Pharm. 13, 187–192 (2017).
Armanious, M. & Vender, R. A review of drug–drug interactions for biologic drugs used in the treatment of psoriasis. J. Cutan. Med. Surg. https://doi.org/10.1177/1203475420952423 (2020)
Earl, T. R., Katapodis, N. D., Schneiderman, S. R. & Shoemaker-Hunt, S. J. Using deprescribing practices and the screening tool of older persons’ potentially inappropriate prescriptions criteria to reduce harm and preventable adverse drug events in older adults. J. Patient Saf. 16, S23–S35 (2020).
May, F. W., Rowett, D. S., Gilbert, A. L., McNeece, J. I. & Hurley, E. Outcomes of an educational-outreach service for community medical practitioners: non-steroidal anti-inflammatory drugs. Med. J. Aust. 170, 471–474 (1999).
Woodward, M. C. Deprescribing: achieving better health outcomes for older people through reducing medications. J. Pharm. Pract. Res. 33, 323–328 (2003).
Reeve, E., Gnjidic, D., Long, J. & Hilmer, S. A systematic review of the emerging definition of ‘deprescribing’ with network analysis: implications for future research and clinical practice. Br. J. Clin. Pharm. 80, 1254–1268 (2015).
Scott, I. A. et al. Reducing inappropriate polypharmacy: the process of deprescribing. JAMA Intern. Med. 175, 827–834 (2015).
Kutner, J. S. et al. Safety and benefit of discontinuing statin therapy in the setting of advanced, life-limiting illness: a randomized clinical trial. JAMA Intern. Med. 175, 691–700 (2015).
Olry de Labry Lima, A. et al. Evidence for deprescription in primary care through an umbrella review. BMC Fam. Pract. 21, 100 (2020).
Page, A. T., Clifford, R. M., Potter, K., Schwartz, D. & Etherton-Beer, C. D. The feasibility and effect of deprescribing in older adults on mortality and health: a systematic review and meta-analysis. Br. J. Clin. Pharm. 82, 583–623 (2016).
Sheppard, J. P. et al. Effect of antihypertensive medication reduction vs usual care on short-term blood pressure control in patients with hypertension aged 80 years and older: the OPTIMISE randomized clinical trial. J. Am. Med. Assoc. 323, 2039–2051 (2020).
Salanitro, A. H. et al. Rationale and design of the multicenter medication reconciliation quality improvement study (MARQUIS). BMC Health Serv. Res. 13, 230 (2013).
Gleason, K. M. et al. Results of the Medications at Transitions and Clinical Handoffs (MATCH) study: an analysis of medication reconciliation errors and risk factors at hospital admission. J. Gen. Intern. Med. 25, 441–447 (2010).
Petrov, K., Varadarajan, R., Healy, M., Darvish, E. & Cowden, C. Improving medication history at admission utilizing pharmacy students and technicians: a pharmacy-driven improvement initiative. Pharmacy Ther. 43, 676–684 (2018).
Van der Cammen, T. J. M., Rajkumar, C., Onder, G., Sterke, C. S. & Petrovic, M. Drug cessation in complex older adults: time for action. Age Ageing 43, 20–25 (2014).
Declercq, T. et al. Withdrawal versus continuation of chronic antipsychotic drugs for behavioural and psychological symptoms in older people with dementia. Cochrane Database Syst. Rev. 28, CD007726 (2013).
Linsky, A. & Zimmerman, K. M. Provider and system-level barriers to deprescribing: interconnected problems and solutions. Public Policy Aging Rep. 28, 129–133 (2018).
Doherty, A. J. et al. Barriers and facilitators to deprescribing in primary care: a systematic review. BJGP Open https://doi.org/10.3399/bjgpopen20X101096 (2020).
Zechmann, S. et al. Barriers and enablers for deprescribing among older, multimorbid patients with polypharmacy: an explorative study from Switzerland. BMC Fam. Pract. 20, 64 (2019).
Wallis, K. A., Andrews, A. & Henderson, M.Swimming against the tide: primary care physicians’ views on deprescribing in everyday practice. Ann. Fam. Med. 15, 341–346 (2017).
Jubraj, B. et al. A pilot survey of junior doctors’ attitudes and awareness around medication review: time to change our educational approach? Eur. J. Hosp. Pharm. 22, 243–248 (2015).
Lee, J., Negm, A., Wong, E. & Holbrook, A. Does deprescribing fall-associated drugs reduce falls and its complications?: a systematic review. Innov. Aging 1, 268 (2017).
Thompson, W. & Farrell, B. Deprescribing: what is it and what does the evidence tell us? Can. J. Hosp. Pharm. 66, 201–202 (2013).
Farrell, B. et al. Deprescribing proton pump inhibitors: evidence-based clinical practice guideline. Can. Fam. Physician 63, 354–364 (2017).
Gazarin, M. et al. Evaluating an inpatient deprescribing initiative at a rural community hospital in Ontario. Can. Pharm. J. (Ott.) 153, 224–231 (2020).
Vasilevskis, E. E. et al. A patient-centered deprescribing intervention for hospitalized older patients with polypharmacy: rationale and design of the Shed-MEDS randomized controlled trial. BMC Health Serv. Res. 19, 165 (2019).
Fried, L. P. et al. Frailty in older adults: evidence for a phenotype. J. Gerontol. A Biol. Sci. Med. Sci. 56, M146–M156 (2001).
Gaziano, J. M. et al. Million Veteran Program: a mega-biobank to study genetic influences on health and disease. J. Clin. Epidemiol. 70, 214–223 (2016).
Psaty, B. M. et al. Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) Consortium: design of prospective meta-analyses of genome-wide association studies from five cohorts. Circ. Cardiovasc. Genet. 2, 73–80 (2009).
Ngiam, K. Y. & Khor, I. W. Big data and machine learning algorithms for health-care delivery. Lancet Oncol. 20, e262–e273 (2019).
Gulshan, V. et al. Development and validation of a deep learning algorithm for detection of diabetic retinopathy in retinal fundus photographs. J. Am. Med. Assoc. 316, 2402–2410 (2016).
Chan, M., Nicklason, F. & Vial, J. H. Adverse drug events as a cause of hospital admission in the elderly. Intern. Med. J. 31, 199–205 (2001).
Stevenson, J. M. et al. Predicting adverse drug reactions in older adults; a systematic review of the risk prediction models. Clin. Inter. Aging 9, 1581–1593 (2014).
Sharif-Askari, F. S., Syed Sulaiman, S. A., Saheb Sharif-Askari, N. & Al Sayed Hussain, A.Development of an adverse drug reaction risk assessment score among hospitalized patients with chronic kidney disease. PLoS ONE 9, e95991 (2014).
Rozenblum, R. et al. Using a machine learning system to identify and prevent medication prescribing errors: a clinical and cost analysis evaluation. Jt. Comm. J. Qual. Patient Saf. 46, 3–10 (2020).
Lin, H.-H., Zhang, L.-L., Yan, R., Lu, J.-J. & Hu, Y. Network analysis of drug–target interactions: a study on FDA-approved new molecular entities between 2000 to 2015. Sci. Rep. 7, 12230 (2017).
Burkhardt, H. A., Subramanian, D., Mower, J. & Cohen, T. Predicting adverse drug–drug interactions with neural embedding of semantic predications. AMIA Annu. Symp. Proc. 2019, 992–1001 (2020).
Fick, D. M. et al. Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. Arch. Intern. Med. 163, 2716–2724 (2003).
Bjerrum, L., Søgaard, J., Hallas, J. & Kragstrup, J. Polypharmacy: correlations with sex, age and drug regimen. A prescription database study. Eur. J. Clin. Pharmacol. 54, 197–202 (1998).
Kocbek, S. et al. Building interpretable models for polypharmacy prediction in older chronic patients based on drug prescription records. PeerJ 6, e5765 (2018).
Levy, A. E. et al. Applications of machine learning in decision analysis for dose management for dofetilide. PLoS ONE 14, e0227324 (2019).
Schwartz, J. B. et al. Pharmacotherapy in older adults with cardiovascular disease: report from an American College of Cardiology, American Geriatrics Society, and National Institute on Aging workshop. J. Am. Geriatr. Soc. 67, 371–380 (2019).
Claesson, M. J. et al. Gut microbiota composition correlates with diet and health in the elderly. Nature 488, 178–184 (2012).
Falony, G. et al. Population-level analysis of gut microbiome variation. Science 352, 560–564 (2016).
Maier, L. et al. Extensive impact of non-antibiotic drugs on human gut bacteria. Nature 555, 623–628 (2018).
Vich Vila, A. et al. Impact of commonly used drugs on the composition and metabolic function of the gut microbiota. Nat. Commun. 11, 362 (2020).
Zimmermann, M., Zimmermann-Kogadeeva, M., Wegmann, R. & Goodman, A. L. Mapping human microbiome drug metabolism by gut bacteria and their genes. Nature 570, 462–467 (2019).
Haiser, H. J. et al. Predicting and manipulating cardiac drug inactivation by the human gut bacterium Eggerthella lenta. Science 341, 295–298 (2013).
Haiser, H. J., Seim, K. L., Balskus, E. P. & Turnbaugh, P. J. Mechanistic insight into digoxin inactivation by Eggerthella lenta augments our understanding of its pharmacokinetics. Gut Microbes 5, 233–238 (2014).
Schwab, R. S., England, A. C., Poskanzer, D. C. & Young, R. R. Amantadine in the treatment of Parkinson’s disease. J. Am. Med. Assoc. 208, 1168–1170 (1969).
Ianiro, G. et al. Faecal microbiota transplantation for the treatment of diarrhoea induced by tyrosine-kinase inhibitors in patients with metastatic renal cell carcinoma. Nat. Commun. 11, 4333 (2020).
Zadak, Z., Hyspler, R., Ticha, A. & Vlcek, J. Polypharmacy and malnutrition. Curr. Opin. Clin. Nutr. Metab. Care 16, 50–55 (2013).
Chen, R. Y. et al. Duodenal microbiota in stunted undernourished children with enteropathy. N. Engl. J. Med. 383, 321–333 (2020).
Cavallari, L. H. et al. Multi-site investigation of outcomes with implementation of CYP2C19 genotype-guided antiplatelet therapy after percutaneous coronary intervention. JACC Cardiovasc. Interv. 11, 181–191 (2018).
Kim, D. et al. Targeted therapy guided by single-cell transcriptomic analysis in drug-induced hypersensitivity syndrome: a case report. Nat. Med. 26, 236–243 (2020).
Finkelstein, J., Friedman, C., Hripcsak, G. & Cabrera, M. Potential utility of precision medicine for older adults with polypharmacy: a case series study. Pharmgenomics Pers. Med. 9, 31–45 (2016).
Liu, J., Friedman, C. & Finkelstein, J. Pharmacogenomic approaches for automated medication risk assessment in people with polypharmacy. AMIA Jt Summits Transl. Sci. Proc. 2018, 142–151 (2018).
Jiang, Y. et al. Predicting putative adverse drug reaction related proteins based on network topological properties. Anal. Methods 6, 2692–2698 (2014).
Boland, M. R. et al. Systems biology approaches for identifying adverse drug reactions and elucidating their underlying biological mechanisms. Wiley Interdiscip. Rev. Syst. Biol. Med. 8, 104–122 (2016).
Levine, D. M., Lipsitz, S. R. & Linder, J. A. Trends in seniors’ use of digital health technology in the United States, 2011–2014. J. Am. Med. Assoc. 316, 538–540 (2016).
Cross, A. J., Elliott, R. A., Petrie, K., Kuruvilla, L. & George, J.Interventions for improving medication‐taking ability and adherence in older adults prescribed multiple medications. Cochrane Database Syst. Rev. 5, CD012419 (2020).
Patel, T. et al. A prospective study of usability and workload of electronic medication adherence products by older adults, caregivers, and health care providers. J. Med. Internet Res. 22, e18073 (2020).
Zárate-Bravo, E. et al. Supporting the medication adherence of older Mexican adults through external cues provided with ambient displays: feasibility randomized controlled trial. JMIR mHealth uHealth 8, e14680 (2020).
Huizer-Pajkos, A. et al. Adverse geriatric outcomes secondary to polypharmacy in a mouse model: the influence of aging. J. Gerontol. A Biol. Sci. Med. Sci. 71, 571–577 (2016).
Saka, B., Kaya, O., Ozturk, G. B., Erten, N. & Karan, M. A. Malnutrition in the elderly and its relationship with other geriatric syndromes. Clin. Nutr. 29, 745–748 (2010).
Lanhers, C. et al. Long-term cost reduction of routine medications following a residential programme combining physical activity and nutrition in the treatment of type 2 diabetes: a prospective cohort study. BMJ Open 7, e013763 (2017).
Kreuter, M. W., Scharff, D. P., Brennan, L. K. & Lukwago, S. N. Physician recommendations for diet and physical activity. Preventive Med. 26, 825–833 (1997).
Dietary Guidelines for Americans (USDA Food and Nutrition Service, 2021); https://www.fns.usda.gov/cnpp/dietary-guidelines-americans
Burton, D. G. A., Wilmot, C. & Griffiths, H. R. Personalising nutrition for older adults: the InCluSilver project. Nutr. Bull. 43, 442–455 (2018).
Gibson, A. et al. Effect of fruit and vegetable consumption on immune function in older people: a randomized controlled trial. Am. J. Clin. Nutr. 96, 1429–1436 (2012).
Ong, G.-J. et al. Clinician agreement and influence of medication-related characteristics on assessment of polypharmacy. Pharm. Res. Perspect. 5, e00321 (2017).
M.E.E. and A.T.C. received funding from the U.S. Department of Health & Human Services, National Institutes of Health (grant nos. RF1 AG067744 and U19 AG062682 to M.E.E., and nos. R35 CA253185, U19 AG062682 and RF1 AG067744 to A.T.C.).
The authors declare no competing interests.
Peer review information Nature Aging thanks Rohan Elliott and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Mehta, R.S., Kochar, B.D., Kennelty, K. et al. Emerging approaches to polypharmacy among older adults. Nat Aging 1, 347–356 (2021). https://doi.org/10.1038/s43587-021-00045-3