Vol. 2, Issue 1, Part A (2025)

Background: Polypharmacy among elderly inpatients is a growing clinical concern, often leading to adverse drug events (ADEs), potentially inappropriate medications (PIMs), and increased healthcare utilization. Clinical pharmacist-led interventions have been proposed as a strategy to optimize prescribing and enhance medication safety, yet limited data exist on their impact within inpatient settings.
Objective: This study aimed to evaluate the effect of clinical pharmacist interventions on the management of polypharmacy among elderly inpatients, focusing on reducing medication count, PIMs, drug-drug interactions (DDIs), and ADEs, and improving overall clinical outcomes.
Methods: A prospective comparative study was conducted in a tertiary care teaching hospital over six months, involving 140 elderly patients (≥60 years) with polypharmacy (≥5 medications). Participants were randomized into two groups: the control group received standard care, while the intervention group received pharmacist-led medication review, reconciliation, and counselling in addition to routine care. Data were analyzed using SPSS v26.0, applying Student’s t-test for continuous variables and Chi-square test for categorical data, with p<0.05 considered statistically significant.
Results: The intervention group demonstrated a significant reduction in the mean number of medications at discharge (9.6 → 7.8; p<0.001), PIM prevalence (47.1% → 20.0%; p=0.01), and DDIs (42.9% → 21.4%; p=0.02), as well as a marked decrease in ADEs (15.7% → 5.7%; p=0.04). The average length of hospital stay was reduced by nearly one day (6.5±2.4 vs. 7.4±2.8; p=0.03). Physician acceptance of pharmacist recommendations was high (85.2%), indicating strong interdisciplinary collaboration.
Conclusion: The integration of clinical pharmacists into inpatient geriatric care significantly improves medication appropriateness and patient safety by reducing PIMs, DDIs, and ADEs. These findings advocate for the institutionalization of clinical pharmacy services as a core component of hospital-based geriatric care to ensure rational drug use and optimized clinical outcomes in elderly patients with polypharmacy.