Collaborative Pharmacy Care Improves Polypharmacy in Older Adults

Community pharmacists across the US have demonstrated the unique ability to improve polypharmacy outcomes among older adults through a series of medication discontinuations, dosing adjustments, and adherence improvements, according to a study published in Farmacéuticos Comunitarios.¹

“I am convinced when a single drug is prescribed, the doctor probably knows what to anticipate,” Bernard Lown, MD, a world-renowned medical expert, said to the Lown Institute.² “When 2 drugs are prescribed, uncertainty prevails. When 3 drugs are prescribed, a doctor hasn’t the foggiest notion how a patient will react. When 4 drugs are prescribed, God doesn’t know what might ensue.”

The case study specifically followed an 82-year-old woman living alone who was managing 10 different active pharmaceutical ingredients. Despite her initial independence, she began experiencing persistent fatigue and significant electrolyte disturbances, leading her family to seek intervention at a community pharmacy to improve her medication adherence and safety.¹

Upon a comprehensive review, the pharmacist identified several drug-related problems, including the dangerous combination of 2 potassium-depleting diuretics (torasemide and hydrochlorothiazide), which had directly contributed to her confirmed hypokalemia.

READ MORE: One in 6 Deprescribed Medications Are Restarted Within 90 Days

The situation, however, reflects a broader medication overload epidemic where more than 40% of older adults take 5 or more prescriptions daily, often resulting in millions of preventable adverse drug events and hospital admissions.²

By coordinating closely with the patient’s family and primary care team, the pharmacist adjusted her hypertension dosage, discontinued unnecessary medications like torasemide and paracetamol, and initiated appropriate treatment for newly detected cognitive impairment.¹

This collaborative approach not only normalized her potassium levels and blood pressure but also significantly improved her sleep quality and functional autonomy. Such interventions position pharmacists as deprescribing heroes who possess the specialized knowledge required to identify and taper medications that have become unnecessary or harmful.^1-3

However, scaling these successes requires addressing deep-seated systemic barriers identified in recent systematic reviews. These obstacles are often categorized into 4 types: those centered on the pharmacy profession, the patients, the physical layout of the pharmacy, and society.⁴

Time constraints and heavy workloads are cited as the most prevalent barriers, frequently compounded by the lack of financial incentives in current reimbursement models that typically reward the quantity of drugs dispensed rather than the quality of clinical services, such as deprescribing. Furthermore, many pharmacists hesitate to intervene due to a lack of role clarity or a fear of interference within the medical hierarchy, particularly when a patient’s clinical condition appears superficially stable.^2-5

To mitigate these challenges, the WHO Global Network for Age-friendly Cities and Communities encourages pharmacies to adopt 15 specific commitments across areas like pharmacy layout and communication. Age-friendly practices include providing ramps and handrails, using clear signage, and ensuring low noise levels to assist those with sensory impairments.^4,6

Pharmacists can also employ specific communication techniques, such as the teach-back method, to verify that patients truly understand their medication instructions, which is vital for those with hearing or cognitive difficulties. The use of multicompartment compliance aids further serves as a lifeline for patients struggling with complex regimens or declining dexterity.^1,4,6

Despite the clear benefits, pharmacists often report a lack of standardized deprescribing algorithms and fragmented access to patient records as major hurdles to consistent care.^3,5

Research into the role of US pharmacists emphasizes that despite being uniquely positioned to provide an expert perspective on a patient’s medication history, the lack of universal electronic health records often leaves them with an incomplete clinical picture. Bridging these gaps through integrated care models and shared digital platforms is essential for the future of geriatric pharmacotherapy.

The long-term success of collaborative care, however, depends on evolving professional education. Currently, many student pharmacists report limited exposure to deprescribing concepts in their didactic curriculum and express discomfort when initiating conversations about discontinuing chronic medications.⁵

Experts recommend integrating practical simulations and clinical rotations focused on medication review early in pharmacy training to build competence and confidence. By fostering a health care culture where deprescribing is viewed as just as valuable as prescribing, pharmacists can play a pivotal role in ensuring sustainability and the well-being of the aging population.^1,5

“The coordinated intervention contributed to improved clinical control, reduced exposure to unnecessary medications, and positively impacted the patient’s overall well-being and quality of life,” concluded the authors of the current study.¹ “This intervention model may be applicable to other older patients with polypharmacy and a high risk of clinical deterioration, particularly when concerns regarding adherence exist or when functional or cognitive decline is detected. Its implementation requires a collaborative framework between primary care and community pharmacy to facilitate the identification and prioritization of suitable candidates.”

READ MORE: Effective Medication Alert Systems Require Optimization for Improvement

REFERENCES

1. Vera Peña A, Dévora Gutiérrez S, Morales Marrero C, et al. Pharmacotherapeutic optimization in a polymedicated patient through coordinated pharmaceutical intervention: a community pharmacy case report. Farm Comunitarios. 2026 Jun 17;18(3):e253. doi: 10.33620/FC.2173-9218.2026.24

2. Garber J. How pharmacists can be deprescribing heroes. Lown Institute. March 2, 2021. Accessed August 4, 2026. https://lowninstitute.org/how-pharmacists-can-be-deprescribing-heroes/

3. Bolt J, Khattra P, Chiu D, et al. Pharmacists’ barriers and enablers to deprescribing: a systematic review and meta-synthesis. Res Social Adm Pharm. 2026;22(4):561-573. doi:10.1016/j.sapharm.2026.01.006

4. Pedro R, Mateos-Campos R, Cruz A. Identification of barriers that can influence older adults in community pharmacies: a systematic review. Healthcare (Basel). 2025 Apr 24;13(9):981. doi: 10.3390/healthcare13090981

5. Cernasev A, Scott D, Eckert B, et al. The role of U.S. pharmacists in deprescribing: recommendations based on a systematic literature review of qualitative studies. Explor Res Clin Soc Pharm. 2025 Jun 24;19:100625. doi: 10.1016/j.rcsop.2025.100625

6. How pharmacies are helping to create age-friendly communities. International Pharmaceutical Federation. May 14, 2019. Accessed August 4, 2026. https://www.fip.org/how-pharmacies-are-helping-to-create-age-friendly-communities