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AJN  February 2020  Vol. 120, No. 2
ajnonline.com
Continuing Education
CE

1.5 HOURS
Mitigating the Dangers
of Polypharmacy in
Community-Dwelling
Older Adults
Tools to help promote safe and appropriate medication prescribing
and use.
ABSTRACT: Polypharmacy, the use by a patient of multiple medications, contributes to adverse drug
events, hospitalizations, geriatric syndromes, and increased health care costs. In the United States, poly
pharmacy is increasingly widespread, particularly among community-dwelling adults over age 62. In
2005-2006, 31% of such adults used five or more prescription drugs and 8.4% used medication combina
tions associated with potential interactions. By 2010-2011, 36% used five or more prescription drugs and
15% used potentially problematic drug combinations. Reducing the dangers of polypharmacy, however,
requires clinicians to broaden their focus, considering not only the number of drugs a patient takes, but
also the prescription of potentially inappropriate medications and potential prescribing omissions. This
article explores the factors that contribute to polypharmacy and discusses its negative physiological, psy
chological, and economic effects. It also describes strategies for reducing polypharmacy, including both
"explicit" approaches, which are grounded in the findings of literature reviews and expert opinion, and
"implicit" approaches, which are based on the provider's interpretation of clinical data and the patient's
medication regimen.
Keywords: adverse drug events, community-dwelling adults, deprescribing, older adults, polypharmacy,
potentially inappropriate medication, potentially inappropriate prescribing
T
D is an 86-year-old woman with a his
tory of chronic obstructive pulmonary dis
ease (COPD), hypertension, hyperlipidemia,
hypothyroidism, osteoarthritis, and angina. (This
case is a composite based on my experience.) TD
had a complicated left knee replacement nine years
ago. Her mobility is still impaired, and she's had
frequent falls. Over the past few months, she has
experienced headaches and vision problems. Based
on magnetic resonance imaging, these two symp
toms were attributed to a slow-growing pituitary
macroadenoma that is not currently amenable to
surgical or medical intervention. In recent weeks,
she has demonstrated both noticeable cognitive
decline and reduced functional ability.
TD's care is managed by her primary care physi
cian, cardiologist, pulmonologist, orthopedist,
endocrinologist, and neurologist. Her medical

Page 2
By Jaclyn Gabauer, MSN, RN, APN, AGCNS-BC, PCCN
record indicates that she is currently
taking the following prescription
drugs and over-the-counter (OTC)
supplements:
-   atenolol (Tenormin) 25 mg by
mouth daily for hypertension
-   ranolazine (Ranexa) 500 mg by
mouth twice daily for angina
-   gabapentin (Neurontin) 600 mg
by mouth three times daily,
though she couldn't recall why it
had been prescribed or by whom
-   hydrochlorothiazide (Microzide)
12.5 mg by mouth daily for
hypertension
-   levothyroxine (Synthroid) 25
mcg by mouth daily for hypo
thyroidism
-   omeprazole (Prilosec) 40 mg by
mouth daily for gastroesopha
geal reflux disease (GERD), pre
scribed by a gastroenterologist
10 years ago and subsequently
renewed by her primary care physician
-   low-dose (81-mg) aspirin once daily to prevent
cardiovascular events
-   fluticasone 250 mcg-salmeterol 50 mcg (Advair
Diskus), one inhalation twice daily for COPD
-   albuterol (Ventolin HFA) two puffs every six
hours as needed for shortness of breath
-   a self-prescribed daily multivitamin
-   self-prescribed vitamin D3 50 mcg daily
TD has been reminded that it's important to take
her prescribed medications as instructed and is
aware that her mother had a massive fatal heart
attack after she stopped taking her blood pressure
medications. Nevertheless, TD frequently remarks
that she's taking too many medications-that the
costs are too high, the adverse effects too great, and
that it's difficult to remember what medication to
take and when. In fact, over the past year, she
abruptly stopped using her fluticasone-salmeterol
inhaler because of its high cost. She also stopped
taking ranolazine and gabapentin owing to related
dizziness and fatigue, respectively. Following these
discontinuations, she continued to have significant
dyspnea, angina, and generalized pain, all of which
limited her activities of daily living.
Unfortunately, all of TD's providers remain
focused on their specialty, with none attending to
coordination of care or optimization of drug therapy.
When, for unknown reasons, TD's systolic blood
pressure reached 180 mmHg, her primary care phy
sician recommended that she take an additional half
of her daily 25-mg atenolol tablet. A week later,
Photo (c) Shutterstock / Africa Studio.
without communicating with TD's primary care phy
sician, TD's cardiologist told her to double her daily
25-mg atenolol dose, exacerbating TD's concerns
about the number of medications she's taking and
the difficulty she's having in managing the regimen.
In fact, TD's concerns are not without founda
tion. Some of the medications she's taking may not
be medically appropriate at this time.
This article takes a critical look at how we
understand polypharmacy, its prevalence, conse
quences, and contributing factors, with a focus on
ways to reduce the prescription and use of poten
tially inappropriate medications among community-
dwelling older adults.
POLYPHARMACY: PREVALENCE AMONG OLDER ADULTS
The term polypharmacy describes the use by a
patient of multiple medications, with some
researchers having designated a threshold number
of five or more. A 2016 analysis of longitudinal
data from a nationally representative sample of
community-dwelling U.S. adults, ages 62 to 85,
found that the use of five or more prescription
drugs in this group grew from 31% in 2005-2006
to 36% in 2010-2011.1 When OTC medications
and dietary supplements were included in the analy
sis, the percentages rose from 53% to 67% within
this five-year period. The analysis further noted that
in 2010-2011, more than 15% of these older adults
were using medication combinations associated
with potential drug-drug interactions, up from
8.4% in 2005-2006.1
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WHY POLYPHARMACY AMONG OLDER ADULTS IS A PROBLEM
"Numbers are not the enemy," observed Steinman
in a 2016 commentary published in JAMA Internal
Medicine.2 Five or more medications may be medi
cally necessary to treat patients with multiple
comorbidities. In 2012, 60% of U.S. adults ages 65
and older managed two or more chronic diseases.3
But polypharmacy is not without risks, especially
among older patients. Drug interactions are a fre
quent cause of preventable adverse drug events
(ADEs), and the single greatest ADE risk factor is
the number of medications a patient takes.2
Age-related physiological changes can increase the
risk of ADEs, which account for up to 10% of hospital
admissions among older adults and are often prevent
able.4 Such changes include the following5:
-   decreased gastric acidity
-   increased body fat
-   decreased total body water
-   reduced blood flow to the liver and kidneys
-   altered drug receptor sensitivity
These changes may significantly alter both phar
macokinetics (the effects of the body on a drug's
absorption, bioavailability, distribution, metabolism,
and excretion) and pharmacodynamics (the bio
chemical, physiological, and molecular effects of a
drug on the body). For example, age-related physio
logical changes may necessitate dosage adjustments
of certain drugs to prevent either an exaggerated or
a reduced drug-receptor response (see Table 15).
Besides ADEs, polypharmacy poses other risks
for older patients, including the following6, 7:
-   nonadherence to medication regimens
-   diminished ability to perform activities of daily
living
-   functional decline
-   falls
-   cognitive impairment
-   urinary incontinence
-   malnutrition
-   higher costs for both patients and health care
systems
FACTORS CONTRIBUTING TO POLYPHARMACY
The prevalence of polypharmacy among older
adults in the United States can be attributed to
numerous factors.
Demographics. The U.S. older adult population
is increasing, and older adults are at greater risk for
chronic disease. According to the Office of Disease
Prevention and Health Promotion, U.S. residents
ages 65 and older numbered 46.3 million in 2014,
representing 14.5% of the U.S. population, and by
the year 2060 that number is projected to reach 98
million, or 23.5% of the population.3
Comorbidities. The chronic diseases common in
older adults, which include heart disease, cancer,
COPD, stroke, diabetes, and Alzheimer's disease,3 often
coexist. Managing these comorbidities has inevitably
increased prescription drug use in this population.
Table 1. Physiological Age-Related Changes and Effects on Drug Therapy5
Physiological Changes
Effects on Drug Therapy
Changes related to pharmacokinetics
Absorption: decreased gastrointestinal motility;
Delayed or decreased absorption of acidic drugs
decreased gastric pH
Distribution: increased percentage of body fat with
-  Water-soluble drugs can reach toxic concentrations,
concomitant decrease in muscle mass and total
and fat-soluble drugs may have prolonged effects
body water; decreased serum albumin levels
-  Increase in the free or unbound portion of protein-
bound drugs
Metabolism: decrease in hepatic blood flow;
Standard doses of drugs with a high first-pass effect
decreased liver mass; decreased enzymatic activity
can reach toxic levels (because less of the drug is
of the cytochrome P-450 isoenzyme system
subject to immediate metabolism)
Excretion: decreased renal mass, renal blood flow,
Increased concentration of renally excreted drugs
and glomerular filtration rate
Changes related to pharmacodynamics
Altered sensitivity of drug receptors, possibly due to a
-  Increased effects of anticholinergics, barbiturates,
reduced number of drug receptors, reduced receptor
benzodiazepines, warfarin, and opioids
binding, or altered sensitivity of receptors with either
-  Decreased response to adrenergic agonists and
enhanced or diminished cellular response
some adrenergic antagonists (-blockers, for
example)
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Potentially inappropriate prescribing is a major
contributor to polypharmacy among older adults.
Potentially inappropriate prescribing is a term that
includes both of the following8:
-   prescription of potentially inappropriate medi
cations-that is, those that confer potential
harms that are as great or greater than any
potential therapeutic benefits
-   potential prescribing omissions, in which medi
cations that may significantly improve clinical
status are not prescribed
A fragmented health care system perpetuates
polypharmacy by providing insufficient monitoring.
Ineffective coordination among health care special
ists can result in therapeutic duplication and harmful
drug interactions. Although pharmacists can iden
tify problematic interactions during the dispensing
phase, patients often use more than one pharmacy. A
cross-sectional study of 59 adults ages 65 and older
who were enrolled in an Ohio senior program found
that 21 (35.6%) used five or more prescription drugs
and 24 (40.6%) used multiple pharmacies.9 The use
of mail-order pharmacies has also become increas
ingly common, particularly among older adults with
Medicare Part D coverage, which promotes their ser
vices. While mail-order pharmacies are cost-effective
and convenient, the absence of face-to-face interac
tion with a pharmacist may increase the risk of inap
propriate prescribing.
Disease-specific guidelines are often based on
findings from randomized controlled trials that
exclude or underrepresent older adults with multi
ple comorbidities. And, as Wallis observes, such
guidelines tend to focus on the addition of drugs,
while providing little or no counseling on the time-
consuming, poorly incentivized process of critically
appraising complex medication regimens and safely
discontinuing inappropriate drugs.10
Patient and caregiver expectations. Patient satis
faction is often tied to the quantity of health care
services provided, including the number of treat
ments given and prescriptions written, though
greater use of such services is also associated with
higher mortality rates.11 Moreover, providers with
limited knowledge of age-related pharmacokinetic
and pharmacodynamic changes may be reluctant to
discontinue medications initiated by another pro
vider and may even incorrectly interpret an ADE as
a new diagnosis necessitating additional medication.
A survey of 160 Italian physicians that assessed their
feelings about deprescribing in older adults, found
that 72% reported feeling confident in their ability
to deprescribe, but only 53% said they were com
fortable discontinuing medications endorsed by
guidelines, 40% were reluctant to deprescribe medi
cations prescribed by another physician, and 45%
were hesitant to stop medications that either the
patient or caregiver considered necessary.12
DEPRESCRIBING: POLYPHARMACY REDUCTION STRATEGIES
Deprescribing is the planned process of safely
withdrawing potentially inappropriate medica
tions. This underutilized therapeutic option can
reduce ADEs, improve patient adherence, and
lower costs.
Several clinical tools are available to assist pro
viders with the identification of potentially inap
propriate medications (see Table 213-16). Levy cate
gorizes these tools as either "explicit" approaches,
such as the Beers Criteria13 and the STOPP/START
tools,14 which are grounded in the findings of
extensive literature reviews and expert opinion, or
"implicit" approaches, such as the ARMOR pro
tocol15 and the Tool for Identifying and Discontin
uing Potentially Inappropriate Drugs,16 which are
based on the provider's interpretation of clinical
data and the patient's medication regimen.17 These
criteria and tools can help providers identify drugs
known to cause harm in older patients. Although
none were developed explicitly for nurses, all can
be used by nurses working in conjunction with a
prescribing clinician.
Collaboration between the patient,
nurse, and prescribing clinician can
reduce medication-related harm.
Beers Criteria. Developed by the geriatrician
Mark Beers in 1991, the Beers criteria were adopted
by the American Geriatrics Society in 2011 and
subsequently updated in 2012, 2015, and 2019.
The Beers Criteria are applicable to all populations
ages 65 and older in all settings, excluding hospice
and palliative care. Their aim is to improve the care
of older adults by reducing the prescription of
potentially inappropriate medications. Consistent
with the previous 2015 update, the 2019 update
retains the following five types of criteria13:
-   potentially inappropriate medications to avoid
in most older adults (these include medications
with strong anticholinergic properties, benzodi
azepines, and 1-blockers)
-   medications to avoid in specific diseases and
syndromes
-   drugs to be used with caution
-   medications requiring dose adjustment with
renal dysfunction
-   common drug-drug interactions
Application of the 2019 Beers Criteria to TD's
case highlights two potentially inappropriate
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Table 2. Deprescribing Tools
Name of Tool
Description
Beers Criteria13
STOPP/START Tools14
ARMOR Protocol15
Tool for Identifying and
Discontinuing Potentially
Inappropriate Drugs16
Lists medications to be avoided or used cautiously in adults ages 65 and
older, drugs to avoid in older adults with certain conditions, medications
requiring dose adjustment in patients with renal dysfunction, and com
mon drug-drug interactions.
STOPP assists providers with the identification of potentially inap
propriate medications. START draws attention to potential prescrib
ing omissions. Version 2, the 2015 update, includes 80 STOPP and
34 START criteria.
Includes the following essential steps:
-  Assess all medications
-  Review for interactions and adverse effects
-  Minimize nonessential medications
-  Optimize the dose based on renal and hepatic clearance
-  Reassess clinical status
Consists of 10 steps:
1. Determine the patient's current drug use, including over-the-counter
medications and supplements.
2. Identify patients at risk for, or currently experiencing, an adverse
drug reaction.
3. Estimate life expectancy.
4. Define goals of care.
5. Match each medication with its associated indication.
6. Determine the need for preventive medications.
7. Weigh the risks and benefits of each drug.
8. Rank drugs from highest to lowest utility.
9. Identify drugs to be discontinued (with the patient's approval).
10. Devise and implement a safe drug discontinuation plan.
ARMOR = Assess, Review, Minimize, Optimize, Reassess; START = Screening Tool to Alert to Right Treatment; STOPP = Screening Tool of Older People's
Prescriptions.
medications. First, TD had been taking omepra
zole for 10 years to treat GERD, although the
Beers Criteria cautions against proton pump
inhibitor use for longer than eight weeks. More
over, she could not remember the last time she
had experienced any symptoms of GERD or had
been assessed by a gastroenterologist. With pro
longed use, proton pump inhibitors may put
patients at risk for Clostridium difficile (now
Clostridioides difficile) infection, bone mineral
density loss, and fractures.13 It is also known to
impede the absorption of levothyroxine, which
TD is taking for hypothyroidism. Second, there
is little evidence supporting the efficacy of daily
aspirin for the primary prevention of cardiovas
cular events in adults ages 70 and older.13
STOPP/START tools. The Screening Tool of
Older People's Prescriptions (STOPP) and the
Screening Tool to Alert to Right Treatment
(START)14 were first published in 2008 by Gal
lagher and colleagues from the Department of
Geriatric Medicine at Cork University Hospital in
Ireland. The authors of STOPP/START version
2, published in 2015, reviewed and reassessed the
2008 criteria and, with input from an expert
panel representing 13 European countries, added
new evidence-based criteria and removed criteria
that had since become obsolete. STOPP/START
version 2 contains a total of 114 criteria, repre
senting a 31% increase from the initial publication.
The 80 STOPP criteria aim to more accurately
identify current potentially inappropriate medi
cations, whereas the 34 START criteria draw
attention to potential prescribing omissions, both
of which can adversely affect older patients.14
ARMOR protocol. The Assess, Review, Minimize,
Optimize, Reassess (ARMOR) protocol was ini
tially used in a long-term care setting, though its use
is encouraged in the outpatient setting as well.15 The
primary goal of application is to preserve the
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patient's functional status and quality of life. The
essential components of the ARMOR protocol are
as follows15:
-   assess all medications
-   review for interactions and adverse effects
-   minimize nonessential medications
-   optimize dosages based on renal and hepatic
clearance
-   periodically reassess clinical status
The Tool for Identifying and Discontinuing
Potentially Inappropriate Drugs. Developed by
Scott and colleagues, this is an evidence-based dis
continuation guide that consists of the following
10 steps16:
-   Determine every drug the patient takes by asking
the patient to bring all medications into the
appointment for reconciliation. Emphasize the
importance of including all OTC medications and
supplements as well as prescribed medications.
-   Identify patients at risk for or currently experi
encing ADEs. This requires careful assessment,
because subtle changes such as confusion and
lethargy may be the only signs of an ADE in an
older adult.
-   Estimate the patient's life expectancy using a
clinical prognostication tool or life span calcu
lator.
-   Discuss goals of care with the patient. For patients
with an estimated life expectancy of less than two
years, treatment should be conservative, minimiz
ing the burden of unnecessary or unhelpful pills in
order to preserve quality of life.
-   Match each medication with its associated medical
indication, discontinuing any therapeutic duplica
tions and drugs with no clear clinical indication.
-   Determine the need for preventive medications,
discontinuing any for which time until expected
treatment benefit exceeds estimated life expec
tancy. For example, patients whose life expec
tancy is less than one year would derive little
benefit from preventive cardiovascular therapy
with statins or bisphosphonate therapy to pre
vent osteoporosis and fractures.
-   Delineate risks and benefits of the remaining drugs,
ranking them from highest to lowest in utility.
-   Identify all drugs that could potentially be discon
tinued, taking into account patient preferences.
-   Discuss recommendations for any drug discon
tinuations with the patient and seek the patient's
informed consent.
-   Wean patients off discontinued drugs one at a
time, monitoring patients closely for signs and
symptoms of worsening disease or withdrawal
symptoms.
THE NURSE'S ROLE IN MEDICATION MANAGEMENT
Nurses play a pivotal role in identifying and discour
aging inappropriate prescribing. Interdisciplinary
collaboration between the patient, nurse, and pre
scribing clinician can promote patient safety and
reduce medication-related harm. Comprehensive
medication assessment and patient engagement are
two nursing interventions that are essential to reduc
ing polypharmacy. If patients or their families equate
recommended drug discontinuations with sub
standard care, nurses can explain that the goal in
appropriate deprescribing is to improve patients'
health and quality of life, with all recommenda
tions following a critical, conscientious appraisal
of the drugs' costs and benefits, and taking into
account patient concerns and preferences. Nurses
may also be able to reduce polypharmacy by
encouraging the adjunctive use of nonpharmaco
logical interventions, such as guided imagery for
pain and relaxation.
TD'S DEPRESCRIBING
When TD's family alerted her primary care phy
sician to the problems she was having managing
her medications, the physician initiated medica
tion reconciliation and discovered that TD
had previously stopped using the fluticasone-
salmeterol inhaler, gabapentin, and ranolazine.
Upon learning that the inhaler was a financial
burden for TD, the physician prescribed a
more cost-effective, generic version. When TD
described the dizziness and fatigue she had
experienced with ranolazine and gabapentin,
the physician referred her to her cardiologist for
further evaluation of her angina and, since she
couldn't remember why she was taking gaba
pentin, supported her decision not to resume
treatment with that drug. Because TD's blood
tests revealed no evidence of vitamin deficiencies
and TD frequently mentioned the burden of
taking so many pills, her primary care physician
further suggested she could eliminate supple
mental vitamins from her medication regimen,
provided she made a conscientious effort to
include in her diet nutrient-dense foods high in
vitamin D and calcium. TD thus stopped taking
her self-prescribed daily multivitamin and vita
min D supplement. Furthermore, since TD had
no symptoms of GERD and was unaware of
any other condition for which she may have
been prescribed a proton pump inhibitor a
decade earlier, the primary care physician was
able to oversee the safe discontinuation of TD's
omeprazole, which is known to impede the
absorption of levothyroxine, as well as her daily
aspirin, which has recently been found to have
little efficacy in the primary prevention of car
diovascular events in adults ages 70 and older.
This reduction in pill burden improved TD's
daily functioning and increased her adherence
to her revised drug regimen.
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With the reduced pill burden, TD found she
was better able to manage her new medication
regimen, taking all medications as prescribed. She
developed a growing sense of confidence in her
providers' ability to respond to her concerns and
is now more apt to discuss any medication prob
lems with her providers rather than discontinu
ing medications without consulting them. With
her dyspnea under control, she is also better able
to participate in activities of daily living and social
events.
IMPROVING PRESCRIBING PRACTICES
Polypharmacy among community-dwelling older
adults is a serious issue that's receiving increas
ing attention. But it's not simply the number of
medications a patient takes that defines prob
lematic usage; inappropriate prescribing and
oversight can cause patients like TD to experi
ence ADEs, functional decline, and geriatric syn
dromes. A multidisciplinary, systematic approach
to identifying and safely discontinuing poten
tially inappropriate medications can improve
outcomes and enhance quality of life for older
adult patients. Institutional policies and finan
cial incentives need to align with the process of
appropriate deprescribing in order to improve
prescribing practices throughout the U.S. health
care system. 
For three additional continuing nursing education
activities on the topic of polypharmacy, go to
www.nursingcenter.com/ce.
Jaclyn Gabauer is a clinical nurse specialist in the Department
of Diabetes Education at Capital Health System, Pennington,
NJ. Contact author: jgabauer2@capitalhealth.org. The author
and planners have disclosed no potential conflicts of interest,
financial or otherwise. A podcast with the author is available at
www.ajnonline.com.
REFERENCES
1. Qato DM, et al. Changes in prescription and over-the-counter
medication and dietary supplement use among older adults in
the United States, 2005 vs 2011. JAMA Intern Med 2016;
176(4):473-82.
2. Steinman MA. Polypharmacy-time to get beyond numbers.
JAMA Intern Med 2016;176(4):482-3.
3. Office of Disease Prevention and Health Promotion. HealthyPeople.
gov. Topics and objectives: older adults. 2019. https://www.
healthypeople.gov/2020/topics-objectives/topic/older-adults.
4. Rochon PA. Drug prescribing for older adults. UpToDate 2019.
https://www.uptodate.com/contents/drug-prescribing-for-older
adults.
5. Tabloski PA. Gerontological nursing. 3rd ed. Boston: Pearson; 2014.
6. Maher RL, et al. Clinical consequences of polypharmacy in
elderly. Expert Opin Drug Saf 2014;13(1):57-65.
7. Nguyen M. How can you best address polypharmacy in the elderly?
New York, NY: NYU Langone Health; 2017 Dec 21. Clinical
Correlations; https://www.clinicalcorrelations.org/2017/12/21/
how-can-you-best-address-polypharmacy-in-the-elderly.
8. Hill-Taylor B, et al. Effectiveness of the STOPP/START (Screening
Tool of Older Persons' potentially inappropriate Prescriptions/
Screening Tool to Alert doctors to the Right Treatment) criteria:
systematic review and meta-analysis of randomized controlled
studies. J Clin Pharm Ther 2016;41(2):158-69.
9. Golchin N, et al. Polypharmacy in the elderly. J Res Pharm
Pract 2015;4(2):85-8.
10. Wallis KA. No medicine is sometimes the best medicine.
BMJ Case Rep 2015;2015.
11. Fenton JJ, et al. The cost of satisfaction: a national study of
patient satisfaction, health care utilization, expenditures, and
mortality. Arch Intern Med 2012;172(5):405-11.
12. Djatche L, et al. How confident are physicians in deprescrib
ing for the elderly and what barriers prevent deprescribing?
J Clin Pharm Ther 2018;43(4):550-5.
13. American Geriatrics Society Beers Criteria Update Expert
Panel. American Geriatrics Society 2019 updated AGS Beers
Criteria for potentially inappropriate medication use in older
adults. J Am Geriatr Soc 2019;67(4):674-94.
14. O'Mahony D, et al. STOPP/START criteria for potentially
inappropriate prescribing in older people: version 2. Age
Ageing 2015;44(2):213-8.
15. Haque R. ARMOR: a tool to evaluate polypharmacy in
elderly persons. Ann Longterm Care 2009;17(6):26-30.
16. Scott IA, et al. Deciding when to stop: towards evidence-
based deprescribing of drugs in older populations. Evid
Based Med 2013;18(4):121-4.
17. Levy HB. Polypharmacy reduction strategies: tips on incor
porating American Geriatrics Society Beers and Screening
Tool of Older People's Prescriptions Criteria. Clin Geriatr
Med 2017;33(2)177-87.
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