week 3

Methods

A literature search was conducted to identify current research related to medication reconciliation and reducing polypharmacy in older adults. The main concepts used for the search were medication reconciliation, medication review, polypharmacy, potentially inappropriate medications, older adults, and deprescribing. Search terms included “medication reconciliation” OR “comprehensive medication review” OR “medication review,” AND “polypharmacy” OR “potentially inappropriate medications,” AND “older adults” OR “elderly” OR “geriatric.” The term “deprescribing” was also used to help identify studies evaluating interventions to reduce unnecessary medication use in older adults. These terms were based on the concepts identified in the PICOT question.

The literature search was conducted using PubMed and four databases available through EBSCOhost: CINAHL Complete, MEDLINE with Full Text, Health Source: Nursing/Academic Edition, and Alt HealthWatch. The search focused on research published within the past five years. In EBSCOhost, the search was limited to peer-reviewed articles published from August 25, 2021, through August 25, 2026, and secondary sources were excluded. After applying the search terms and filters, 98 articles remained. In PubMed, the search was limited to the past five years and filtered to include clinical trials, controlled clinical trials, pragmatic clinical trials, and randomized controlled trials. After applying these filters, 50 articles remained.

Articles were initially reviewed by title and abstract for relevance to the PICOT question. Studies were considered for inclusion if they focused on older adults with polypharmacy or potentially inappropriate medication use and evaluated an intervention involving medication reconciliation, medication review, medication optimization, or deprescribing. Studies were further reviewed for interventions and outcomes related to medication burden, potentially inappropriate medications, medication safety, or implementation of medication review. Articles that did not address the population, intervention, or outcomes related to the clinical question were excluded. After screening and reviewing the full-text articles, 13 studies from PubMed and 2 unique studies from the EBSCOhost databases were selected, resulting in a total of 15 studies included in the literature review.

Identification of studies via databases and registers

Duplicate records removed (n = 0) Records marked as ineligible by automation tools (n = 0) Records removed for other reasons (n = 0)

Records identified through database searching EBSCOhost (n = 98) PubMed (n = 50) Total (n = 148)

Identification

Records screened

(n = 148)

Records excluded**

(n =128)

Reports sought for retrieval

(n = 20)

Reports not retrieved

(n = 0)

Screening

Reports assessed for eligibility

(n = 20)

Reports excluded (n = 5): Duplicate reports (n = 2) Study protocol/no outcomes (n = 1) Scoping review/secondary source (n = 1) Did not evaluate an intervention of interest (n = 1)

Studies included in review

(n = 15)

Reports of included studies

(n = 15)

Included

PICOT	Your Project	Keywords/Search Terms
P – Population	Older adults with polypharmacy	older adults OR elderly OR geriatric
I – Intervention	Structured medication reconciliation or medication review	“medication reconciliation” OR “comprehensive medication review” OR “medication review”
C – Comparison	Usual care or no structured medication review	“usual care” OR “standard care”
O – Outcome	Reduction in polypharmacy and potentially inappropriate medications	polypharmacy OR “potentially inappropriate medications” OR deprescribing
T – Time	During the intervention and follow-up period	No specific search term

PICOT Question:

In older adults with polypharmacy, how does a structured medication reconciliation or medication review intervention, compared with usual care, affect polypharmacy and potentially inappropriate medication use?

Background and Significance

Polypharmacy is a common problem among older adults, especially those who have multiple chronic conditions and are followed by different healthcare providers. Somerville et al. (2026 defined polypharmacy as the use of five or more medications at the same time. The authors noted that polypharmacy can increase the risk of potentially inappropriate medications, duplicate medications, drug interactions, medication errors, falls, cognitive and functional decline, and difficulty managing medications correctly. These concerns make medication safety especially important for older adults.

Primary care has an important role in identifying and managing polypharmacy because the primary care provider often sees the overall picture of the patient's health and medication regimen. However, older adults may receive medications from several specialists, and the medication list in the electronic health record may not always represent exactly what the patient is taking at home. Martinez et al. (2022) studied 44,570 adults aged 65 and older in primary care and found that patients were taking an average of 6.8 medications. The study also found variation in prescribing between physicians. Physicians with lower prescribing rates performed better on medication reconciliation and prescribed fewer potentially inappropriate medications. The authors suggested that improving medication reconciliation may help reduce polypharmacy.

Medication reconciliation and medication review can provide an opportunity to identify medications that are duplicated, unnecessary, inappropriate, or no longer needed. Kornholt et al. (2022) conducted a randomized clinical trial in geriatric outpatients taking nine or more medications. The intervention included an additional consultation with a physician who reviewed the patient's medications, provided medication education, and improved communication with the patient's primary care provider. The intervention reduced the number of medications by 2.0 medications at four months and by 1.3 medications at 13 months. The authors concluded that additional attention to medication review and communication with patients and primary care providers can result in a continued reduction in medication use among older adults with polypharmacy.

Medication reconciliation can also help identify potentially inappropriate medications and medication-related problems before they cause harm. Lee et al. (2023) studied a comprehensive medication reconciliation intervention in patients age 65 and older who were taking at least five medications. The intervention focused on potentially inappropriate medications and medication regimen complexity. At the 30-day follow-up, no adverse drug events were reported in the intervention group compared with five events in the control group. These findings support the importance of reviewing medication regimens carefully and improving communication among healthcare providers when caring for older adults with polypharmacy.

Study Impetus

I became interested in this topic because I have been completing my clinical rotations at the same primary care office since my first clinical course, and approximately 90% of the patient population I see is geriatric. One issue that I frequently notice is that many of these patients are taking several medications, sometimes prescribed by different providers and specialists. During visits, it can be difficult to know if the medication list in the chart is completely accurate or if the patient is still taking every medication that is listed.

I have also noticed that some older patients do not fully understand what their medications are for, why they need to take them, or the importance of taking the correct dose and frequency. Some patients recognize their medications mainly by the color or appearance of the pill instead of the medication name. I have also seen patients take medications that were prescribed to a spouse or friend because they had a similar health problem. Other patients may start taking vitamins or supplements after seeing advertisements without first discussing them with their healthcare provider. These situations can create safety concerns because patients may take duplicate medications, continue medications that were supposed to be discontinued, take an incorrect dose, or combine medications and supplements that may interact with each other.

At my clinical site, I have seen how important patient education is when reviewing medications. The provider takes time to explain medications and supplements to patients and, when appropriate, discusses how certain vitamins and nutrients can also be obtained through dietary sources. He sometimes uses pictures to help patients better understand this information. Seeing this has helped me understand that medication reconciliation is not only about updating the medication list in the chart. It is also an opportunity to find out what the patient is actually taking at home and make sure the patient understands what they are taking and why.

These experiences are what made me interested in improving medication reconciliation in older adults. I believe a more structured medication reconciliation process in primary care can help identify duplicate or potentially inappropriate medications, improve the accuracy of the medication list, improve communication between providers, and give patients a better understanding of their medications. This topic is important to me because these are problems I see regularly in clinical practice, and improving this process may help make medication use safer and easier for older adults.

References

Kornholt, J., Feizi, S. T., Hansen, A. S., Laursen, J. T., Reuther, L. Ø., Petersen, T. S., Pressel, E., & Christensen, M. B. (2022). Effects of a comprehensive medication review intervention on health-related quality of life and other clinical outcomes in geriatric outpatients with polypharmacy: A pragmatic randomized clinical trial. British Journal of Clinical Pharmacology, 88(7), 3360–3369. https://doi.org/10.1111/bcp.15287

Lee, S., Yu, Y. M., Han, E., Park, M. S., Lee, J.-H., & Chang, M. J. (2023). Effect of pharmacist-led intervention in elderly patients through a comprehensive medication reconciliation: A randomized clinical trial. Yonsei Medical Journal, 64(5), 336–343. https://doi.org/10.3349/ymj.2022.0620

Martinez, K. A., Linfield, D. T., Gupta, N. M., Alapati, M. V., Moussa, D., Hu, B., Kim, L. D., Lam, S., Russo-Alvarez, G., & Rothberg, M. B. (2022). Patient and physician factors contributing to polypharmacy among older patients. Current Medical Research and Opinion, 38(1), 123–130. https://doi.org/10.1080/03007995.2021.1982683

Somerville, E., Bollinger, R. M., Haxton, M., Holden, B., Chen, S.-W., Keleman, A., Sarrami, B., Yan, Y., & Stark, S. (2026). Feasibility, acceptability, and preliminary efficacy of a medication intervention for older adults. OTJR: Occupational Therapy Journal of Research. https://doi.org/10.1177/15394492261442163