Understanding Polypharmacy

Polypharmacy, often defined as the use of five or more medications, is a growing health concern in Australia’s ageing population. While some degree of polypharmacy is clinically appropriate, it is also associated with increased risk of:

• Adverse drug reactions
• Drug–drug and drug–disease interactions
• Falls and functional decline
• Cognitive impairment
• Hospitalisation

However, not all polypharmacy is harmful. Many older adults benefit from multiple medications when prescribed carefully and reviewed regularly.

Appropriate vs Inappropriate Polypharmacy

Appropriate polypharmacy occurs when medications are:

• Prescribed based on the best available clinical evidence
• Aligned with a person’s comorbidities, goals of care, and life stage
• Actively monitored for interactions and cumulative burden

Inappropriate polypharmacy, by contrast, may involve:

• Medications that are no longer clinically necessary
• Duplicate or interacting therapies
• Prescribing cascades e.g. one medicine started to treat the side effects of another
• Medicines that don’t align with the patient’s current health status or care goals

Identifying these issues requires time, expertise, and collaboration, which is where Home Medicines Reviews (HMRs) and RMMRs provide value.

What is Deprescribing?

Deprescribing is the planned and supervised process of discontinuing or reducing medicines that may no longer be beneficial or may be causing harm. It is:

• A shared decision-making process between the pharmacist, GP, patient, and care team
• Guided by clinical evidence, patient goals, and current health status
• Often gradual, especially for medicines with withdrawal or rebound effects
• Designed to reduce harm while maintaining therapeutic benefit

Deprescribing is not about stopping all medicines. It’s about ensuring that every medication has a valid indication, is well tolerated, and contributes meaningfully to the patient’s well-being.

How Kate Supports Deprescribing

As a consultant pharmacist with experience in aged care and deprescribing research, Kate supports deprescribing through:

• HMRs and RMMRs for residents at risk of medication-related harm
• Collaboration with GPs and facility staff to explore deprescribing options
• Education and communication with patients and families to support informed decision-making
• Guidance on tapering plans for medicines with discontinuation risks (e.g. benzodiazepines, antidepressants, PPIs)

Her reports include evidence-based recommendations supported by clinical guidelines and deprescribing protocols.

Common Deprescribing Triggers

Deprescribing may be appropriate when:

• A medicine no longer aligns with the person’s goals or stage of life
• The original indication has resolved or changed
• The risks now outweigh the potential benefits
• The person is experiencing side effects or signs of medicine-related harm
• There is evidence of a prescribing cascade
• The patient is taking five or more regular medicines (polypharmacy)

Why Deprescribing Matters

Deprescribing may help reduce:

• Risk of falls
• Confusion and sedation
• Dizziness or low blood pressure
• Hospitalisations linked to adverse drug events
• Medication administration burden for care staff and families

It can also support quality of life, comfort, and autonomy, particularly for people with frailty, dementia, or receiving palliative care.

Referrals & Collaborative Practice

Kate accepts referrals for deprescribing support through:

• Home Medicines Reviews (HMRs)
• Residential Medication Management Reviews (RMMRs)
• Case conferencing or follow-up requests