Polypharmacy common in older adults and linked to prescribing cascades

Polypharmacy was common among older adults attending outpatient clinics at King Abdulaziz Medical City in Riyadh, Saudi Arabia, and was strongly associated with prescribing cascades in a retrospective cohort study. The researchers defined polypharmacy as taking five or more medications and found that 82.8% of the 250 participants met that threshold. The association with prescribing cascades remained significant after regression analysis, with an adjusted odds ratio of 7.52 (95% confidence interval 1.67–33.81; p = 0.009). The findings point to a potential medication-safety problem in this population, although the study did not show significant associations with one-year mortality, intensive-care admission or healthcare utilization.

The analysis used electronic health records for patients aged 60 years or older who presented to the outpatient clinic between January 2021 and December 2022. Participants were divided into a polypharmacy group, taking five or more medications, and a no-polypharmacy group, taking fewer than five. The cohort had a mean age of 78.3 years, and 54.8% of participants were female. The investigators extracted demographic, clinical and laboratory information and examined the prevalence of polypharmacy, the clinical characteristics associated with it, and outcomes including one-year mortality, healthcare utilization and prescribing cascades. Logistic and linear regression analyses were used to assess associations between medication use and these outcomes.

Patients in the polypharmacy group had significantly higher rates of several chronic conditions, including diabetes mellitus, hypertension, dyslipidemia, heart failure, anemia and benign prostatic hyperplasia. Laboratory testing also revealed higher glycated hemoglobin, or HbA1c, and serum creatinine levels among participants taking five or more medications. These differences describe the clinical profile of the cohort rather than proving that additional medications caused the illnesses or laboratory abnormalities. The study was observational and retrospective, so its design cannot establish causal relationships between polypharmacy and the measured outcomes.

Prescribing cascades were the clearest outcome associated with polypharmacy: the adjusted odds ratio of 7.52 indicates substantially higher odds of this pattern in the group taking five or more medications than in the comparison group. The wide confidence interval, spanning 1.67 to 33.81, also indicates substantial imprecision in the estimated association. By contrast, the analysis found no significant associations between polypharmacy and one-year mortality, ICU admission or healthcare utilization, with all reported p-values greater than 0.05. Thus, the results do not support the conclusion that polypharmacy was associated with increased mortality or greater use of healthcare services in this cohort, even though it was linked to a marker of medication-related risk. The findings were limited to 250 older outpatients at one tertiary-care facility in Riyadh over a two-year period, and the investigators stated that strategies such as medication review and deprescribing initiatives may be needed. Those proposed responses were not evaluated in the study, and the results should not be interpreted as evidence of clinical benefit.

Subject of Research: Associations between polypharmacy, clinical conditions and prescribing cascades in older adult outpatients

Article Title: Examining polypharmacy risks and impact on clinical outcomes in older adults: insights from a cohort study

Article References: Milyani, R., Balubaid, H., Elsobky, N., Albalawi, S., Aldawsari, F., Al Asiri, F. A., Korayem, G. B., Albekery, M. A., & Al Sulaiman, K. (2026). Examining polypharmacy risks and impact on clinical outcomes in older adults: insights from a cohort study. BMC Geriatrics. https://doi.org/10.1186/s12877-026-08531-2

Image Credits: AI Generated

DOI: 10.1186/s12877-026-08531-2

Keywords: polypharmacy, older adults, prescribing cascades, medication safety, Saudi Arabia, outpatient care, retrospective cohort, healthcare utilization, Examining, risks, impact, clinical