Siti Fauziyah, Maksum Radji, Retnosari Andrajati


 Aging and diseases associated with aging is a condition associated with old age. An important approach to maintaining health status and physical examination in geriatric patients is very important, including nutrition problems, sight, hearing, urine containment, balance and fall prevention, osteoporosis, and polypharmacy. The use of polypharmacy will give some impact on the elderly, including increasing the improper treatment, adverse drug reactions (ADRs), and some of the problems that affect the changing nature of the pharmacokinetics and pharmacodynamics of drugs. Aging in the elderly with some diseases, the possibility of getting more number of drugs consequently has the potential to improve prescribing patterns that are not appropriate and contribute to ADRs and hospitalizations. This review will describe the effect of polypharmacy in elderly patients.


Polypharmacy, Adverse drug reactions, Drug-drug interactions, Elderly, Inappropriate medication.

| PDF |


Minister of Health of the Republic of Indonesia. No. 79. On the Implementation in the Hospital Care of the Elderly; 2014. Available from: http://www.lshk.or.id/uu/PMK%20No.%2079%20ttg%20 Penyelenggaraan%20Pelayanan%20Geriatri%20di%20RS.pdf.

Indonesian Central Statistics Agency. Indonesia Population Projection; 2010-2035. Available from: http://www.bappenas.go.id/ files/5413/9148/4109/Proyeksi_Penduduk_Indonesia_2010-2035.pdf.

Mamun K, Lien CT, Goh-Tan CY, Ang WS. Polypharmacy and inappropriate medication use in Singapore nursing homes. Ann Acad Med Singapore 2004;33(1):49-52.

Koh Y, Kutty FB, Li SC. Drug-related problems in hospitalized patients on polypharmacy: The influence of age and gender. Ther Clin Risk Manag 2005;1(1):39-48.

Elliott RA, Booth JC. Problems with medicine use in older Australians : A review of recent literature. J Pharm Pract Res 2014;44:258-71.

Jetha S. Polypharmacy, the elderly, and deprescribing. Consult Pharm 2015;30(9):527-32.

Department of Health and Human Services USA. A Profile of Older Americans; 2015. Available from: https://www.aoa.acl.gov/aging_ statistics/profile/2015/docs/2015-profile.pdf.

Thürmann PA. Ageing of the Population, Polypharmacy, Potentially Inappropriate Prescribing and Quality Indicators. In European Perspective in Rational and Individualized Drug Therapy in Older Patients and Ageism - Priorities for Next Decades. Press Company Prager-LD, Praha; 2016. p. 8-10. Available from: http://www. notoageism.com/wp-content/uploads/2015/05/e_Abstract-Book_ Prague-EU-COST-Action-Training-School.pdf.

United Nations. World Population Ageing; 2015. United Nations, New York; 2015. Available from: http://www.un.org/en/development/desa/ population/publications/pdf/ageing/WPA2015_Report.pdf.

Nobili A, Garattini S, Mannucci PM. Multiple diseases and polypharmacy in the elderly: Challenges for the internist of the third millennium. J Comorbidity 2011;1:28-44.

Lavan AH, Gallagher PF, O’Mahony D. Methods to reduce prescribing errors in elderly patients with multimorbidity. Clin Interv Aging 2016;11:857-66.

Morley JE. Hormones and the aging process. J Am Geriatr Soc 2003;51 7 Suppl: S333-7.

Walston J, Hadley EC, Ferrucci L, Guralnik JM, Newman AB, Studenski SA, et al. Research agenda for frailty in older adults: Toward a better understanding of physiology and etiology: Summary from the American geriatrics society/national institute on aging research conference on frailty in older adults. J Am Geriatr Soc 2006;54(6):991-1001.

Sinclair AJ, Morley JE, Vellas B. Pathy’s Principles and Practice of Geriatric Medicine. 5th ed. Chichester: A John Wiley & Sons, Ltd.; 2012.

McLean AJ, Le Couteur DG. Aging biology and geriatric clinical pharmacology. Pharmacol Rev 2004;56(2):163-84.

Wooten JM. Pharmacotherapy considerations in elderly adults. South Med J 2012;105(8):437-45.

Elsawy B, Higgins KE. The geriatric assessment. Am Fam Physician 2011;83(1):48-56.

Cassel CK, Leipzig R, Cohen, HJ, Larson EB, Meier DE, editors. Geriatric Medicine: An Evidence-Based Approach. 4th ed. USA: Springer; 2003.

British Geriatrics Society. Comprehensive Geriatric Assessment; 2014. Available from: http://www.bgs.org.uk/cga-managing/resources/ campaigns/fit-for-frailty/frailty-cga.

Gupta M, Agarwal M. Understanding medication errors in the elderly. N Z Med J 2013;126(1385):62-70.

O’Connor MN, Gallagher P, O’Mahony D. Inappropriate prescribing: Criteria, detection and prevention. Drugs Aging 2012;29(6):437-52.

Davies EA, O’Mahony MS. Adverse drug reactions in special populations - The elderly. Br J Clin Pharmacol 2015;80(4):796-807.

Sato I, Akazawa M. Polypharmacy and adverse drug reactions in

Japanese elderly taking antihypertensives: A retrospective database study. Drug Healthc Patient Saf 2013;5:143-50.

Schuler J, Dückelmann C, Beindl W, Prinz E, Michalski T, Pichler M. Polypharmacy and inappropriate prescribing in elderly internal-medicine patients in Austria. Wien Klin Wochenschr 2008;120(23-24):733-41.

Hanlon JT, Artz MB, Pieper CF, Lindblad CI, Sloane RJ, Ruby CM, et al. Inappropriate medication use among frail elderly inpatients. Ann Pharmacother 2004;38(1):9-14.

Milton JC, Hill-Smith I, Jackson SH. Prescribing for older people. BMJ 2008;336(7644):606-9.

Jayarama N, Sleeba SK, Prabhakar K. Adverse drug reactions in adults leading to emergency department visits. Int J Pharm Pharm Sci 2012;4 Suppl 4:642-6.

Teka F, Teklay G, Ayalew E, Teshome T. Potential drug - Drug interactions among elderly patients admitted to medical ward of Ayder Referral Hospital, Northern Ethiopia: A cross sectional study. BMC Res Notes 2016;9(1):431.

Obreli Neto PR, Nobili A, de Lyra DP Jr, Pilger D, Guidoni CM, de Oliveira Baldoni A, et al. Incidence and predictors of adverse drug reactions caused by drug-drug interactions in elderly outpatients: A prospective cohort study. J Pharm Pharm Sci 2012;15(2):332-43.

Calderón-Larrañaga A, Poblador-Plou B, González-Rubio F, Gimeno-Feliu LA, Abad-Díez JM, Prados-Torres A. Multimorbidity, polypharmacy, referrals, and adverse drug events: Are we doing things well? Br J Gen Pract 2012;62(605):e821-6.

de Lyra DP, Kheir N, Abriata JP, da Rocha CE, Dos Santos CB, Pelá IR. Impact of pharmaceutical care interventions in the identification and resolution of drug-related problems and on quality of life in a group of elderly outpatients in Ribeirão Preto (SP), Brazil. Ther Clin Risk Manag 2007;3(6):989-98.

Al-Hamid A, Ghaleb M, Aljadhey H, A slanpour Z. A systematic review of hospitalization resulting from medicine-related problems in adult patients. Br J Clin Pharmacol 2014;78(2):202-17.

Nivya K, Sri Sai Kiran V, Ragoo N, Jayaprakash B, Sonal Sekhar M. Systemic review on drug related hospital admissions - A PubMed based search. Saudi Pharm J 2015;23(1):1-8.

Shah BM, Hajjar ER. Polypharmacy, adverse drug reactions, and geriatric syndromes. Clin Geriatr Med 2012;28(2):173-86.

Mangoni AA, Jackson SH. Age-related changes in pharmacokinetics and pharmacodynamics: Basic principles and practical applications. Br J Clin Pharmacol 2004;57(1):6-14.

Hobson M. Medications in older patients. West J Med 1992;157(5):539-43.

Johnell K, Fastbom J. Multi-dose drug dispensing and inappropriate drug use: A nationwide register-based study of over 700,000 elderly. Scand J Prim Health Care 2008;26(2):86-91.

Di Giorgio C, Provenzani A, Polidori P. Potentially inappropriate drug prescribing in elderly hospitalized patients: An analysis and comparison of explicit criteria. Int J Clin Pharm 2016;38(2):462-8.

Hamano J, Tokuda Y. Inappropriate prescribing among elderly home care patients in Japan: Prevalence and risk factors. J Prim Care Community Health 2014;5(2):90-6.

Mansur N, Weiss A, Beloosesky Y. Is there an association between inappropriate prescription drug use and adherence in discharged elderly patients? Ann Pharmacother 2009;43:177-84.

Cahir C, Fahey T, Teeling M, Teljeur C, Feely J, Bennett K. Potentially inappropriate prescribing and cost outcomes for older people: A national population study. Br J Clin Pharmacol 2010;69(5):543-52.

Onda M, Imai H, Takada Y, Fujii S, Shono T, Nanaumi Y. Identification and prevalence of adverse drug events caused by potentially inappropriate medication in homebound elderly patients: A retrospective study using a nationwide survey in Japan. BMJ Open 2015;5(8):e007581.

Wickop B, Härterich S, Sommer C, Daubmann A, Baehr M, Langebrake C, et al. Potentially inappropriate medication use in multimorbid elderly inpatients: Differences between the FORTA, PRISCUS and STOPP Ratings. Drugs Real World Outcomes 2016;3(3):317-25.

Amann U, Schmedt N, Garbe E. Ärztliche verordnungen von potenziell inadäquater medikation bei älteren: Eine analyse basierend auf der PRISCUS-liste. Dtsch Arztebl Int 2012;109(5):69-75.

Henschel F, Redaelli M, Siegel M, Stock S. Correlation of incident potentially inappropriate medication prescriptions and hospitalization: An analysis based on the PRISCUS list. Drugs Real World Outcomes 2015;2(3):249-59.

Endres HG, Kaufmann-Kolle P, Steeb V, Bauer E, Böttner C, Thürmann P. Association between Potentially Inappropriate Medication (PIM) use and risk of hospitalization in Older adults: An observational study based on routine data comparing PIM use with use of PIM alternatives. PLoS One 2016;11(2):e0146811.

Yang PJ, Lee YT, Tzeng SL, Lee HC, Tsai CF, Chen CC, et al. Potentially inappropriate prescribing in disabled older patients with chronic diseases: A screening tool of older persons’ potentially inappropriate prescriptions versus beers 2012 criteria. Med Princ Pract 2015;24(6):565-70.

Chowta MN, Adhikari PM, Raj S, Laxman M, Kariappa A, George J, et al. Evaluation of appropriateness of prescription and polypharmacy in the geriatric population: A cross sectional study at a comprehensive geriatric clinic in a tertiary care hospital. Int J Pharm Pharm Sci 2016;8(3):119-23.

Mekonnen AB, Bhagavathula AS. Inappropriate medication use in the elderly population attending Gondar University hospital: A preliminary assessment. Int J Pharm Pharm Sci 2014;6(10):540-3.

About this article




Polypharmacy, Adverse drug reactions, Drug-drug interactions, Elderly, Inappropriate medication.





Additional Links

Manuscript Submission


Asian Journal of Pharmaceutical and Clinical Research
Vol 10 Issue 7 July 2017 Page: 44-49

Print ISSN


Online ISSN


Authors & Affiliations

Siti Fauziyah
Department of Pharmacy, Faculty of Pharmacy, University of Indonesia, Depok, 16424, Indonesia

Maksum Radji
Department of Pharmacy, Faculty of Pharmacy, University of Indonesia, Depok, 16424, Indonesia

Retnosari Andrajati
Department of Pharmacy, Faculty of Pharmacy, University of Indonesia, Depok, 16424, Indonesia

Article Tools

Email this article (Login required)
Email the author (Login required)


  • There are currently no refbacks.