DOI: 10.26650/istanbuljpharm.2026.1796212 ISSN: 2587-2087

Reducing Drug-Related Problems and Optimising Therapy in Older Adults with Polypharmacy: A Systematic Review of Community Pharmacy-Based Medication Reviews

Favian Rafif Firdaus, Alsita Salsabila Yulnanda, Hananditia Rachma Pramestutie
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Background and Aims: Polypharmacy is increasingly common among older adults, particularly those living with multiple chronic conditions, and is associated with a greater risk of drug-related problems (DRPs), inappropriate prescribing, and poor treatment adherence. This systematic review synthesised evidence on the effects of pharmacist-led medication review (MR) interventions on DRPs, medication adherence, deprescribing, and selected clinical outcomes among older adults with polypharmacy.Methods: The review was conducted in accordance with Cochrane guidance and PRISMA recommendations. Scopus, MEDLINE (EBSCO), and ScienceDirect were searched for interventional studies published between 2020 and 2025. Eligible studies included adults with polypharmacy (commonly defined as the use of five or more medications) who received pharmacist-led structured MR in community pharmacy or related primary care settings and reported quantitative outcomes. Study selection, data extraction, and methodological appraisal using Joanna Briggs Institute tools were independently undertaken by two reviewers.Results: Twenty-three studies were included, most of which were randomised or controlled interventional studies. Across the included studies, pharmacist-led MR interventions were generally associated with reductions in DRPs, improvements in medication adherence, and greater prescribing optimisation, including deprescribing of potentially inappropriate or high-risk medicines. Some studies also reported improvements in selected clinical indicators and potential economic benefits. However, the evidence was heterogeneous regarding study design, intervention components, outcome measures, and methodological quality.Conclusion: Overall, pharmacist-led medication review appears to be a promising strategy to support safer and more appropriate medication use among older adults with polypharmacy, although further well-designed studies are needed to clarify long-term clinical, humanistic, and economic outcomes.

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