Polypharmacy and frailty in the elderly in the hospital setting.
Keywords:
Polypharmacy, Frailty, Frail Elderly, Drug Interactions, Adverse Effects, Hospitalization.Abstract
Introduction: Polypharmacy and frailty are prevalent and highly interrelated conditions in hospitalized older adults. Their presence creates a highly vulnerable environment for drug interactions and adverse events, which compromises patient safety and treatment effectiveness.
Objective: To analyze the scientific evidence on the negative synergy between polypharmacy and frailty in the hospital setting, with emphasis on the pathophysiological mechanisms, the risk of interactions, and mitigation strategies.
Methods: A narrative review of the literature was conducted using databases such as PubMed/Medline, SciELO, and the Cochrane Library, using the MeSH terms "Polypharmacy," "Frailty," "Drug Interactions," "Adverse Drug Events," "Aged," and "Hospitalization." Articles in Spanish and English, preferably published within the last 5 years, were selected.Results: Frailty, characterized by a loss of physiological reserve, alters the pharmacokinetics and pharmacodynamics of medications. Polypharmacy (more than five drugs) is an independent risk factor for frailty and vice versa. This combination exponentially increases the risk of drug-drug and drug-disease interactions, a direct and preventable cause of falls, delirium, functional impairment, and prolonged hospitalizations. Inappropriate prescribing is a common finding in this group.Conclusions: The intersection of polypharmacy and frailty constitutes a high-risk "iatrogenic geriatric syndrome" in the hospital setting. It is imperative to implement proactive strategies such as systematic medication review, the application of criteria, and an interdisciplinary approach with clinical pharmacists and geriatric teams to optimize prescribing and improve outcomes in this vulnerable population.
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Copyright (c) 2025 Yuniel Abreu Hernández, Daimara Barrera León, Jorge Luis Lorente Montiel
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