Global burden of preventable medication-related harm in health care: a systematic review. Geneva: World Health Organization; 2023. Licence: CC BY-NC-SA 3.0 IGO. Available from https://iris.who.int/bitstream/handle/10665/376203/9789240088887-eng.pdf?sequence=1. Accessed 14 Oct 2024.

Hodkinson A, Tyler N, Ashcroft DM, et al. Preventable medication harm across health care settings: a systematic review and meta-analysis. BMC Med. 2020;18(1):313. https://doi.org/10.1186/s12916-020-01774-9.

Article  PubMed  PubMed Central  Google Scholar 

Global Health and Aging. Geneva: World Health Organization & US National Institute of Aging. 2016. Available from https://www.nia.nih.gov/sites/default/files/2017-06/global_health_aging.pdf. Accessed 14 Oct 2024.

Fortin M, Bravo G, Hudon C, et al. Prevalence of multimorbidity among adults seen in family practice. Ann Fam Med. 2005;3(3):223–8. https://doi.org/10.1370/afm.272.

Article  PubMed  PubMed Central  Google Scholar 

Mohideen FS, Rajkumar Honest PC, Syed MA, et al. Prevalence of multimorbidity among adults attending primary health care centres in Qatar: a retrospective cross-sectional study. J Family Med Prim Care. 2021;10(5):1823–8. https://doi.org/10.4103/jfmpc.jfmpc_2446_20.

Article  PubMed  PubMed Central  Google Scholar 

United Nations, Department of Economic and Social Affairs, Population Division (2020). World Population Ageing 2019 (ST/ESA/SER.A/444). Available from https://www.un.org/en/development/desa/population/publications/pdf/ageing/WorldPopulationAgeing2019-Report.pdf. Accessed 14 Oct 2024.

Fortin M, Haggerty J, Almirall J, et al. Lifestyle factors and multimorbidity: a cross sectional study. BMC Public Health. 2014;14:686. https://doi.org/10.1186/1471-2458-14-686.

Article  PubMed  PubMed Central  Google Scholar 

Aggarwal P, Woolford SJ, Patel HP. Multi-morbidity and polypharmacy in older people: challenges and opportunities for clinical practice. Geriatrics. 2020;5(4):85. https://doi.org/10.3390/geriatrics5040085.

Article  PubMed  PubMed Central  Google Scholar 

Dovjak P. Polypharmacy in elderly people. Wien Med Wochenschr. 2022;172(5–6):109–13. https://doi.org/10.1007/s10354-021-00903-0.

Article  PubMed  Google Scholar 

Medication Safety in Polypharmacy. Geneva: World Health Organization; 2019 (WHO/UHC/SDS/2019.11). Licence: CC BY-NC-SA 3.0 IGO. Available from https://iris.who.int/bitstream/handle/10665/325454/WHO-UHC-SDS-2019.11-eng.pdf?sequence=1. Accessed 14 Oct 2024.

Cadogan CA, Ryan C, Francis JJ, et al. Development of an intervention to improve appropriate polypharmacy in older people in primary care using a theory-based method. BMC Health Serv Res. 2016;16(1):661. https://doi.org/10.1186/s12913-016-1907-3.

Article  PubMed  PubMed Central  Google Scholar 

Mair A, Wilson M, Dreischulte T. Addressing the challenge of polypharmacy. Annu Rev Pharmacol Toxicol. 2020;60:661–81. https://doi.org/10.1146/annurev-pharmtox-010919-023508.

Article  CAS  PubMed  Google Scholar 

Onder G, Liperoti R, Fialova D, et al. SHELTER Project Polypharmacy in nursing home in Europe: results from the SHELTER study. J Gerontol A Biol Sci Med Sci. 2012;67(6):698–704. https://doi.org/10.1093/gerona/glr233.

Article  PubMed  Google Scholar 

Dwyer LL, Han B, Woodwell DA, et al. Polypharmacy in nursing home residents in the United States: results of the 2004 National Nursing Home Survey. Am J Geriatr Pharmacother. 2010;8(1):63–72. https://doi.org/10.1016/j.amjopharm.2010.01.001.

Article  PubMed  Google Scholar 

Alsuwaidan A, Almedlej N, Alsabti S, et al. A comprehensive overview of polypharmacy in elderly patients in Saudi Arabia. Geriatrics. 2019;4(2):36. https://doi.org/10.3390/geriatrics4020036.

Article  PubMed  PubMed Central  Google Scholar 

Al-Dahshan A, Al-Kubiasi N, Al-Zaidan M, et al. Prevalence of polypharmacy and the association with non-communicable diseases in Qatari elderly patients attending primary healthcare centers: a cross-sectional study. PLoS ONE. 2020;15(6): e0234386. https://doi.org/10.1371/journal.pone.0234386.

Article  CAS  PubMed  PubMed Central  Google Scholar 

Al-Hashar A, Al Sinawi H, Al Mahrizi A, et al. Prevalence and covariates of polypharmacy in elderly patients on discharge from a tertiary care hospital in Oman. Oman Med J. 2016;31(6):421–5. https://doi.org/10.5001/omj.2016.85.

Article  PubMed  PubMed Central  Google Scholar 

Donaldson LJ, Kelley ET, Dhingra-Kumar N, et al. Medication without harm: WHO’s third global patient safety challenge. Lancet. 2017;389(10080):1680–1.

PubMed  Google Scholar 

Medication Safety in Polypharmacy. Geneva: World Health Organization; 2019 (WHO/UHC/SDS/2019.11). Licence: CC BY-NC-SA 3.0 IGO. Available from https://www.who.int/docs/default-source/patient-safety/who-uhc-sds-2019-11-eng.pdf. Accessed 14 Oct 2024.

Hughes LD, McMurdo ME, Guthrie B. Guidelines for people not for diseases: the challenges of applying UK clinical guidelines to people with multimorbidity. Age Ageing. 2013;42(1):62–9. https://doi.org/10.1093/ageing/afs100.

Article  PubMed  Google Scholar 

Scott S, Twigg MJ, Clark A, et al. Development of a hospital deprescribing implementation framework: a focus group study with geriatricians and pharmacists. Age Ageing. 2019;49(1):102–10. https://doi.org/10.1093/ageing/afz133.

Article  PubMed  PubMed Central  Google Scholar 

Robinson M, Mokrzecki S, Mallett AJ. Attitudes and barriers towards deprescribing in older patients experiencing polypharmacy: a narrative review. Npj Aging. 2024;10:6. https://doi.org/10.1038/s41514-023-00132-2.

Article  PubMed  PubMed Central  Google Scholar 

Peat G, Fylan B, Marques I, et al. Barriers and facilitators of successful deprescribing as described by older patients living with frailty, their informal carers and clinicians: a qualitative interview study. BMJ Open. 2022;12(3): e054279. https://doi.org/10.1136/bmjopen-2021-054279.

Article  PubMed  PubMed Central  Google Scholar 

Linsky AM, Zimmerman K. Provider and system-level barriers to deprescribing: interconnected problems and solutions. Public Policy Aging Rep. 2018;28:129–33.

Google Scholar 

Maher RL, Hanlon J, Hajjar ER. Clinical consequences of polypharmacy in elderly. Expert Opin Drug Saf. 2014;13(1):57–65. https://doi.org/10.1517/14740338.2013.827660.

Article  PubMed  Google Scholar 

Scottish Government Model of Care Polypharmacy Working. Polypharmacy guidance, 2nd edition. Edinburgh: Scottish Government; 2015. Available from https://www.publications.scot.nhs.uk/files/dc20150415polypharmacy.pdf. Accessed 14 Oct 2024.

Haefeli WE, Meid AD. Pill-count and the arithmetic of risk: evidence that polypharmacy is a health status marker rather than a predictive surrogate for the risk of adverse drug events. Int J Clin Pharmacol Ther. 2018;56(12):572–6. https://doi.org/10.5414/CP203372.

Article  CAS  PubMed  Google Scholar 

Dumbreck S, Flynn A, Nairn M, et al. Drug-disease and drug-drug interactions: systematic examination of recommendations in 12 UK national clinical guidelines. BMJ. 2015;350: h949. https://doi.org/10.1136/bmj.h949.

Article  PubMed  PubMed Central  Google Scholar 

Davies LE, Spiers G, Kingston A, et al. Adverse outcomes of polypharmacy in older people: systematic review of reviews. J Am Med Dir Assoc. 2020;21(2):181–7. https://doi.org/10.1016/j.jamda.2019.10.022.

Article  PubMed  Google Scholar 

Barnett K, Mercer SW, Norbury M, et al. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet. 2012;380(9836):37–43. https://doi.org/10.1016/S0140-6736(12)60240-2.

Article  PubMed  Google Scholar 

Masnoon N, Shakib S, Kalisch-Ellett L, et al. What is polypharmacy? A systematic review of definitions. BMC Geriatr. 2017;17:230. https://doi.org/10.1186/s12877-017-0621-2.

Article  PubMed  PubMed Central  Google Scholar 

Stewart D, Mair A, Wilson M, et al. Simpathy consortium. Guidance to manage inappropriate polypharmacy in older people: systematic review and future developments. Expert Opin Drug Saf. 2017;16(2):203–13. https://doi.org/10.1080/14740338.2017.1265503.

Article  PubMed  Google Scholar 

Rankin A, Cadogan CA, Patterson SM, et al. Interventions to improve the appropriate use of polypharmacy for older people. Cochrane Database Syst Rev. 2018;9(9):CD008165. https://doi.org/10.1002/14651858.CD008165.pub4.

Article  PubMed  Google Scholar 

Mair A, Wilson M, Dreischulte T. The polypharmacy programme in Scotland: realistic prescribing. Prescriber. 2019;30(8):10–6.

Google Scholar 

Bakker L, Kemper PF, Wagner C, et al. A baseline assessment by healthcare professionals of Dutch pharmacotherapeutic care for the elderly with polypharmacy. Eur J Public Health. 2017;27(4):679–86. https://doi.org/10.1093/eurpub/ckx076.