Table 1 Drivers of Polypharmacy and Various Associated Negative Consequences

i. Indiscriminate use of clinical practice guidelines (CPGs) designed for the management of single diseases in elderly, multimorbid patients [17, 18].

i. Adverse drug events (ADEs)

ii. Adverse drug reactions (ADRs)

iii. Drug-drug interactions

iv. Drug-disease interactions

v. Medications non-adherence

vi. Medication errors

vii. Use of potentially inappropriate medications (PIMs)

viii. Renal failure

ix. Urinary incontinence

x. Falls and fractures

xi. Functional decline, disability and frailty

xii. Cognitive impairment and delirium

xiii. Malnutrition

xiv. Decreased quality of life

xv. Nursing home/long-term care placement

xvi. Hospitalizations

xvii. Mortality

ii. Protocol-driven medicine that recommends prescribing medications as the first line of treatment and “stepping up” drug regimens with higher doses and/or additional drugs if targets are not reached [17, 19, 20].

iii. Performance standards and incentives that coerce clinicians to follow guidelines focused on starting medications [18, 19].

iv. Research gaps that leaves many aspects of polypharmacy poorly understood [18, 19].

v. Inadequate clinician training on the management of polypharmacy (including monitoring, detecting, preventing, and evaluating adverse outcomes associated with polypharmacy) [18, 19].

vi. Fragmented healthcare systems that results in uncoordinated treatment by multiple prescribers [9, 19, 21].

vii. Growth of the pharmaceutical industry leading to an ever-increasing availability of medications for a growing number of medical conditions [19].

viii. Influence of the pharmaceutical industry on clinicians [19] and funding of clinical drug trials [22] and professional societies that publish CPGs [23].