Medication review reduces prescribing problems amid rising polypharmacy

Clinical takeaway: Review the full medication list, including over-the-counter products and supplements, when caring for older adults. Check for interactions, drugs that may no longer be appropriate, and treatments that may be missing. A pharmacist-led review can help turn those findings into prescribing changes.

Taking more medications does not necessarily mean receiving better treatment. Two new studies show the scale of medication problems among older adults and test a way to address them in patients with cancer.

In a nationally representative US survey, regular use of five or more prescription drugs rose from 31.0% of community-dwelling older adults in 2015–2016 to 35.7% in 2021–2023. The proportion taking a combination with a potentially major drug interaction fell from 25.7% to 22.3%, but still exceeded one in five. Antidepressants were the drug class most often involved in flagged combinations in the later survey.

The second study, a randomized trial in ten German cancer rehabilitation clinics, explored what a structured medication review could change. Among 443 patients aged 65 or older taking at least five drugs, a pharmacist assessed medications and sent recommendations to the treating physician. At discharge, 29.9% of patients assigned to pharmacist-led medication review had at least one potentially inappropriate medication, compared with 70.8% receiving usual care. Those assigned to the review were also less likely to have unnecessary medications or missing indicated treatments.

Together, the studies make a case for reviewing more than the number of medications an older patient takes. A complete review should check for potentially serious interactions, drugs without a clear indication, and treatments that may be missing. The German trial shows that pharmacist recommendations can improve prescribing by discharge, although their effect on patient outcomes remains to be seen.

The pharmacist-led comprehensive medication review "substantially improved the medication quality of older cancer patients with polypharmacy," said trial coauthor Ben Schöttker, PhD.

Sources: Qato DM, et al. (2026 Sep 24) JAMA. Polypharmacy and drug-drug interactions among older adults; Degen M, et al. (2026 Sep 23) J Intern Med. Cancer co-medication quality in older patients with polypharmacy: A large randomized trial testing a medication review versus usual care