Frailty, cognitive impairment, and polypharmacy in geriatric patients: an integrative literature review

Abstract

Introduction: Polypharmacy in older adults is a highly relevant clinical challenge, associated with an increased risk of drug–drug interactions, adverse drug reactions (ADRs), and functional decline. Frailty and cognitive impairment, conditions prevalent in this population, may be exacerbated by excessive or inappropriate drug use. Underreporting of ADRs limits the understanding of therapeutic safety and hinders the implementation of preventive strategies. Methods: A narrative review of the literature was conducted using national and international databases. Original research articles, systematic reviews, and clinical guidelines addressing polypharmacy, frailty, cognitive impairment, and pharmacovigilance were included. Recent publications in both English and Spanish were considered. Results: Evidence shows that the use of five medications is associated with a 50% probability of clinically relevant drug–drug interactions, a risk that rises to 100% when seven or more drugs are taken, with a 20% probability of severe adverse reactions. The coexistence of frailty and cognitive impairment increases vulnerability to adverse events, negatively impacting quality of life and survival. Underreporting of ADRs remains a significant limitation in assessing treatment safety in this age group. Discussion: Optimizing detection of inappropriate prescribing, promoting evidence-based deprescribing, and strengthening pharmacovigilance systems are essential. Implementing comprehensive geriatric assessment and predictive risk models could support individualized prescribing, reduce adverse event rates, and preserve functional independence.