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Invited Commentary
Less Is More
April 2016

Polypharmacy—Time to Get Beyond Numbers

Author Affiliations
  • 1Division of Geriatrics, Department of Medicine, University of California, San Francisco
  • 2San Francisco Veterans Affairs Health Care System, San Francisco, California
JAMA Intern Med. 2016;176(4):482-483. doi:10.1001/jamainternmed.2015.8597

When I tell someone that I am a geriatrician, I often get the same response. I am told half-jokingly that the person needs my services. Then, I am regaled with a story of how the person’s older parent, grandparent, or spouse is prescribed an enormous number of medications, thinks they might be causing problems, and does not know what to do about it.

It is this view of polypharmacy that often dominates patients’, and increasingly clinicians’, experience of medication use. This skeptical perspective is largely justified. The number of medications a person uses is by far the strongest risk factor for medication-related problems. As the number of medications rises, adverse drug reactions become more common. Adherence worsens. Out-of-pocket costs rise. Drug-drug interactions increase. The use of potentially inappropriate and unnecessary medications escalates.

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