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This physician forum is the second part of a 2-part feature on health care for transgender and gender-divergent youth in the United States. The first part outlines the current legislative climate surrounding pediatric gender-affirming care and the health consequences of anti-trans laws.
The following transcription of our physician forum has been edited for clarity and length.
Matthew Eck: Welcome to today's virtual forum in which we will be discussing gender-affirming hormone therapy for transgender and gender-diverse children. My name is Matthew and I will be your moderator today. Before we dive into our questions, I would like to go around and invite each of our brilliant guests to introduce themselves and share a brief description of their current appointments. Let's start with you, Dr Forcier.
Michelle Forcier, MD, MPH: My name is Michelle Forcier. I use “she” and “they” pronouns. I am a pediatrician, but I've been providing gender, sex, and reproductive health care for over 25 years. I am located on the East Coast, and I am a clinician for Folx Health, and I consult across a lot of different agencies.
ME: Thank you, Dr Forcier. How about you, Dr Bethin?
Kathleen Bethin, MD, PhD: Hi, I am Kathy Bethin. I am a pediatric endocrinologist at University of Buffalo, and I've been a pediatric endocrinologist for, like, 25 years. I do all of endocrine, but I'm the lead for our gender health clinic.
ME: Amazing. Thank you, Dr Bethin. And finally, Dr Shumer.
Daniel Shumer, MD: Hi, I am Dan Shumer, I use “he/him” pronouns. I'm also a pediatric endocrinologist and I work at the University of Michigan as the Clinical Director for the Child and Adolescent Gender Clinic. And I've been involved in gender care since the beginning of my career.
ME: All right, thank you, Dr Shumer. I'm going to go ahead and jump into our first question.
What factors do you consider when initiating a pediatric patient on hormone therapy? Do any patient-specific factors influence your opinion on the risk-benefit ratio of hormone therapy?
MF: I think the way I look at gender care and initiating hormone therapy is [that] gender care is a part of human development, it's a part of primary care. It really is a part of understanding how people grow…their hormones, pre-puberty and puberty, adulthood, into their elder years. It's also a way of understanding where people are in terms of their social, emotional, and cognitive development.
Starting people on gender hormones or gender care is really a matter of where they are in the process of knowing who they are, what their gender identity is, and where they are in their gender identity development. And then [determining] if they require anything that is medical, or if they just require more conversation, support, and resources.
So the sort of primary care approach is, first of all, just finding out who the patient is, listening to their gender narrative, and looking at their support and family and resources. And from there coming up with a strategic plan that is developmentally appropriate.
ME: Thank you for sharing, Dr Forcier. Dr Bethin, would you like to add anything to that?
KB: Yeah, I like to get their story of when this began and try to see where they are and have a discussion. I encourage people to refer even the young kids, just so we can talk and let them know what to expect in the future. And then I ask them to come back once a year, just so we can touch base and see if they're still thinking that way.
And most of the time people come to me and they want hormone therapy, but there are even teenagers that are like, “I'm still thinking about this.” And so we just have a conversation and decide when they're ready.
ME: Thank you, Dr Bethin. How about you, Dr Shumer? Would you like to add anything to that?
DS: Sure. I think the first thing I wanted to say is that having a difference in gender identity, itself, is not a medical problem. It's not a mental health problem. But if someone has a difference in their gender identity, and that difference is causing them distress in their life or impairment in certain social or school activities, making it harder for them to function, contributing to poor mental health — there’s a term for that, and it's called gender dysphoria.
When I'm thinking of gender dysphoria as a medical problem, I'm thinking to myself, that's not too dissimilar to other medical problems, like anxiety, for example. If someone has anxiety, you might say, “Well, what's the goal of treatment?” The goal of treatment would be to reduce the anxiety. “What are the treatment options?” There [are] a lot of non-medical treatment options, like seeing a therapist, or avoiding things that make you anxious, or going for a run. And if those things are helpful, and the anxiety is reduced, then that's terrific. But in the case that it's not, you might also consider a medical intervention, like an anti-anxiety medicine, with the goal of reducing the anxiety and improving well-being. And if you decided to use a medical intervention, then you would re-evaluate that as you used it and re-evaluate that every time you saw the patient for anxiety.
If I'm extrapolating that to gender dysphoria as a medical problem, you say, “Well, there [are] lots of treatment options for gender dysphoria.” There's using a name or pronouns that feel most comfortable for you. There's picking clothes out in the morning that make you feel most confident going out to school. When you pick out your clothes in the morning, you might not be thinking, “I'm treating my gender dysphoria today.” But that's sort of how I think of it. You can talk to a therapist about how to cope with the feelings that you're having related to gender.
And I think it's just really important to say something that I think Dr Forcier touched on, which is that not everyone with a difference in gender identity needs or wants to see a doctor. But it's really when someone is having a difference in gender identity and having challenges with that — because their body is either changing in a way that is not in keeping with their gender identity and that's increasing their distress or making it harder for them to function like other children, or not developing the pubertal changes that other people with that gender are experiencing all around them — that [is when] a medical intervention could be considered.
And just like any other medical decision, just like deciding on an anti-anxiety pill, then you have a conversation with [the patient], including what are their personal factors, their other health concerns, their goals. Talk about the potential benefits of the intervention, talk about the potential risks of the intervention, and then make a decision with them and their family about whether starting that medical intervention could be the right next step for them or not.
ME: Thank you so much, Dr Shumer. That segues nicely into our next question when you brought up gender dysphoria and mental health struggles among transgender and gender-diverse youth.
How do you reconcile the potential clinical challenges of hormone therapy (such as loss of bone mineral density, infertility, and consent) while also considering how trans youth experience disproportionate rates of depression, anxiety, and suicidality?
KB: I talk to them about all of these items. I talk about how important it is for your bone health to get vitamin D and calcium and that any pausing of puberty is not healthy for [your] bones. And I remind them that we can't do this forever. Some patients are non-binary, or gender fluid, and that's great that I can block puberty for them, but at some point you have to allow either male or female hormones because it's not good for your bones.
And I talk about fertility, but that's one thing that is a little problematic because they're all too young to decide for sure that they don't want to have biological children. So, I bring it up every time. I'm like, “Okay, you're still good with adopting if you want children?” And I do talk about [the] research, that there might be new ways to have biological children in the future. But I think it's important to keep bringing it up so that they realize that as long as we continue on this path, there is the possibility that [they] won't have biological children.
ME: Thank you, Dr Bethin. Dr Shumer, do you have anything you would like to add to that?
DS: Yeah, I think there was a lot in your question. You talked about bone health. You talked about fertility… [You talked about] consent. I think that we could spend a whole session talking about all of those topics.
I think that, as Dr Bethin pointed out, you do gain bone density [through] exposure to sex hormones. And that's true, whether it's your endogenous hormones or hormones that are provided during gender transition. If you… measure a 12-year-old’s bone density and it's normal, [then] you take that person and put them on pubertal suppression and you re-measure their bone density at age 13, their [dual energy X-ray absorptiometry] score will be lower because you’re comparing them to other 13-year-olds who are now all going through puberty.
But that person will not be on pubertal suppression forever, and once they come off of their blockers or start hormones, there will be resumption of faster bone density accrual. I think that the takeaway, for me, is not to put someone on blockers for longer than they need to be [and] always thinking about the balance of risks and benefits and having open and candid conversations with them about these things, as Dr Bethin mentioned.
I think fertility is a different conversation, depending on the situation and the age. When you have older adolescents that are presenting to care, there [are] options of fertility preservation prior to starting hormones. When you're using pubertal suppression at the earliest stages of puberty, you're having a conversation about endogenous puberty — that your own puberty is required for fertility to occur, and that endogenous puberty has to happen at some point if you want to achieve fertility.
But these conversations have to be had at an age-appropriate level, and also with the parents. At the end of the day, in the room, the fertility conversation can be more or less meaningful to different patients and families. When we're thinking about what's the risk and what's the benefit, if someone feels that the risk of progressing through an unwanted puberty is, for them, so significant and the fertility question isn't of concern, then they may choose to start on pubertal suppression.
But as was mentioned, this is a conversation that doesn't end at the first visit. It's something that needs to continue over time, and [making sure] that patients and parents are understanding these topics, [in] an age-appropriate way, is an important part of our job as doctors in general, but especially in this area of medicine.
I think that when you mentioned the word consent, in the United States, the definition of consent is someone over 18 choosing a medical path. So when we're thinking of children, we use the word assent. And when we're talking with children and their parents about these topics, the parents are proxies for consent. They're consenting to the care that their child is receiving.
I always think [that] the person in the room that's most knowledgeable about the patient [is] the patient. The person that is second most knowledgeable is the parent or guardian, and I'm a distant third — so I really value the input from parents and conversations with parents about what makes the most sense. But we also need the child's assent, and that means that in an age-appropriate way, they're able to understand the medical decision that we're making, that they agree, and that we are continually re-evaluating that assent and understanding at each visit.
ME: Thank you for that, Dr Shumer. Dr Forcier, do you have anything you would like to add to this conversation?
MF: You all put it so well. I think the 2 things I would add are that it really is about 1) risk and perspective and 2) aspects of timing and what we know. And again, you all have addressed that in terms of risk and perspective — the risk of going through the wrong puberty and all the sequelae that we know happens to folks who are not supported in their gender identity over the years vs the risks of either puberty blockers or other gender-affirming hormones, which are usually pretty… safe and effective methods of either temporarily pausing or blocking puberty or starting an affirmation process.
I think the other piece is [that] there are things that we know and things we don't know. We know that support for youth who are wanting to affirm a diverse gender identity is really important. Whether it's family, whether it's community providers, [support is] an important part of their care. What we don't know is we can't predict anybody's fertility. I can't look at a person and say, “You're fertile, and you're not fertile.” There are things that we can't predict. I can't predict that for this 14-year-old, maybe when they're 26 there'll be an aspect of mourning that they don't have their own uterus and they can't carry their own pregnancy. There are things that we can't necessarily predict or know. And we have to act sometimes in the moment of what is the right next best course for this patient, knowing that as pediatric patients and young adult patients, following them over time and adjusting the course of care is really important.
But it comes down to what Daniel was saying, again, listening to that patient. Kids may be minors, but they also know their own experience. They also understand their own lives. And again, parents know their kids, and having those conversations about what's right for them and balancing those risks and benefits and perspective is just so important. Medicine tends to focus on risks, and when we're talking about gender care in the media, the risks are hyperbolized and overdramatized.
That's why the medicine and this type of care should stay [with] the medical provider. It should stay in the patient room with the patient, the parents, and a clinically trained person.
ME: Thank you, Dr Forcier. This next question is particularly for you, Dr Forcier.
All 3 of you have very considerable academic appointments. How would you describe the changes in the medical education system from when you were in medical school to today, regarding health care for trans youth? Are there any current gaps in the education system? What can students and educators do to close these gaps?
MF: Yes! That's an easy way to answer that question — there are lots of gaps. There's lots of opportunities as a pediatrician. I'm all about looking toward the positive and what can we do vs looking at alternatives, and there's a huge potential for change. Gender care is part of human development and we should all [know] about human development as medical providers, gender care, primary care — all of us carry gender hormones.
So, issues of gender and sexuality being a part of being human and development can be integrated into all aspects of medical training. It doesn't have to be a special unit or 3 talks on gender care. It can be integrated into the cardiology case, and it can be integrated into the prenatal care case. It can be integrated into a whole host of normative medical training experiences as we move through. It is important that there [are] times where gender care is especially attended to because it has not traditionally been included in medical curriculum, and because it is a hot topic, in terms of provision of care and in terms of resources and legislation.
Students love gender care. They are ready to go. Medical students want to learn about gender care, they want to be gender affirmative, they want to be gender savvy. And for me, that's one of the most hopeful things about that question — there is a young generation of patients who understand that gender diversity is a normal part of human development and that we are all uniquely gendered because it is a part of individual identity. And there's a whole new group of providers that are ready to go in terms of working with patients and families to provide this care.
ME: Dr Shumer, Dr Bethin, do either of you have anything to add to what Dr Forcier has already touched upon?
DS: One of the joys of my job is [that] I get to be the course director for a medical student elective called “Transgender Health.” And in that elective, our students get to hang out with me, go to the [operating room], go to adult hormone clinics, [and] have some community experiences. We're only able to offer this to 1 student at a time and it's an elective that gets full right away — almost like you're trying to book your Disney trip during spring break and you need to be the first one that logs into the website.
I think that just goes to show that the learners of today are really interested in making care better for gender-diverse populations. And I think a lot of the new initiatives — with regards to including more and more gender training in medical school — have been driven by the medical students themselves because they see that the training is lacking and they know that they need to know this stuff. But the old people — we didn't learn it, and so we don't know how to teach it. So they're trying to find people, like the 3 of us, to step up and be teachers because they want to do better.
I think that, historically, transgender patients have received poor care in our country, [and] people that are transgender are afraid to present to care because they feel like they may be mistreated, or misgendered. In studies of trans folks, [trans people] mentioned that when they go to the doctor, sometimes it feels like they're teaching the doctor, rather than the other way around, about their gender identity; and patients [that are transgender] are sicker before going to the hospital because they wait longer to go because they're afraid of the interactions with the medical community, which had been poor in the past.
In order to do better, we need to teach that youngest generation. But the good news is they're really eager to learn.
KB: And I would have to say that I am so proud of our medical students because they came to us and asked about a trans elective, and we put together something for them and it's a great experience. The young people that have done this rotation are not necessarily going into gender care, but all kinds of different specialties. But they want to learn more about gender health. They formed a group called “OUTpatient,” and at least once a year they have this big get-together where they educate [people] in the community, and it's really nice to see.
ME: Thank you, Dr Bethin. My next question is actually geared toward you specifically.
Some of your presentation and service activities seem to surround helping physicians better understand patients in the context of their community, or where they are in their lives. What do you feel is an overlooked part of the patient-physician discussion surrounding transgender care?
KB: I want to answer a question that I'm not sure that you asked, but I think providers need to ask their patients what they want to be called and how they want to be identified. I think that that's a big missing part of it.
And I'm also answering another question that I don't think you asked, but one of the things I noted was that there [were] a lot of problems because the medical record reflects somebody's dead name if they haven't legally changed it yet. So, I educated our entire Department of Pediatrics, including the registration people and all of the nursing staff and all of the physicians about how important it is to ask people what their preferred name is, what their pronouns are, and to respect that and to look for that in their record.
ME: Dr Shumer, my next question is for you.
How has the current climate surrounding care of trans and gender-divergent youth in the US impacted you or your institution’s approach to working with this population?
DS: I think that the most important tenet that I always think about is that I need to be practicing evidence-based medicine. In this field, we do have evidence to support the notion that patients [who] are struggling with gender dysphoria do better when provided access to gender-affirming care. There [are] longitudinal studies — following patients from before puberty, through pubertal suppression, through hormones, and following outcomes of quality of life and wellbeing — demonstrating improvement in these things. There [are] comparisons of patients that do and do not have access to the care, demonstrating better outcomes for those who do. Retrospective studies of folks that reflect back on whether or not they had access to this care in the past and how they're doing today [are] influenced by that historical access.
And so, when you ask about the climate, I think I always have to go back to keeping the patients front and center in my mind and figuring out with each and every patient what the best course of action may be. While I'm saying that access to gender-affirming care is helpful, it's also not needed for everyone, as I said in the beginning. So really understanding when to apply the care and work with patients about really understanding what they need.
I think that it is hard when there's a lot of misinformation, that patients living in places that are having access problems, I think, are struggling. But what I'll continue to do is point to the evidence and apply appropriate care to the patients that I'm seeing.
"
Yes, do we have lots to learn? Of course, that's just medicine 101. This is patient-centered, consent-based care. That's what we do. We talk to a patient, we figure out what their goals are, what their needs are, how to minimize harm, how to maximize benefit.
Michelle Forcier, MD, MPH
ME: Thank you Dr Shumer. Dr Bethin, Dr Forcier, do either of you have any comments you'd like to add?
KB: I have seen a lot of families moving here from other states where they can't get their treatment any longer. And it's just very heartwarming to see that families are getting up and changing their entire [lives] to help their child affirm their gender.
MF: I think it's also heartbreaking to see persons that don't know medicine, that don't know the evidence — or are outright making misstatements, untruthful statements, for political or personal gain — creating such an atmosphere of distrust, of hatred, of fear. It's not okay to bully children. And a lot of this environment — if we're going to talk about the environment question — is about preventing kids and families from having access to information, from having access to safe and effective therapeutics, from having access to being acknowledged as being an important person as themselves and part of the community. That's an incredible, I think, harm and assault on a particular group of people in our society and our families and lives. And it's wrong.
And I think it's really so scary for kids and families, even if they're not in a state where there's an access problem, they're hearing about it all over the country and all over the world. And even if they have the privilege of being able to move their family, there are people who cannot move. It's always going to be the most disadvantaged that get caught and have the worst end of the deal. And so I think, as a society, as parents, as civic members, as medical providers, that duty to continue to advocate for children, to continue to advocate for particularly vulnerable group[s] of children and [families] is so important.
And like Daniel said, there is evidence. There's evidence that support and listening and authentic self and affirmation have benefits. When people say there's no research and there's no data — that is untrue. And we need to counter it as strongly as the myths and the misinformation that [are] being promoted. Yes, do we have lots to learn? Of course, that's just medicine 101. This is patient-centered, consent-based care. That's what we do. We talk to a patient, we figure out what their goals are, what their needs are, how to minimize harm, how to maximize benefit. It’s nothing shocking or experimental or new. It's taking care of kids and families. It's taking care of patients. And I think it's been waylaid for other purposes.
ME: Thank you all for sharing your experiences and insights today.
Before we wrap up, do any of you have any final thoughts you'd like to share for the group?
DS: I can just share that it's been a privilege to take care of this patient population throughout my career. I think that being a teenager is hard enough by itself, and when you have a difference in your gender identity, that's really hard. So the patients that I'm seeing, especially in light of some of the things we just talked about, are some of the bravest and most courageous people that I've met. And the joy that I get from seeing a patient that was struggling the first time we met, launching out and becoming a happy, healthy, well-adjusted young adult, making their mark on the world — it makes it a pleasure to go to work every single day.
KB: That was so well said and I 100% agree. They come in and they're struggling and after a conversation, you can already see that they're glad that they came. And yes, thank you for saying it so elegantly.
DS: Thank you.
MF: Daniel, you said it very eloquently. It's about being human. It's about being real, and it's about being yourself. We all do better when we're able to be loved and accepted and safe. And gender diverse patients can come see us in these clinical environments to get the medical care and the services they need. But it's also about our community helping kids feel loved and accepted and safe, so every child has the potential to thrive and grow into a super happy, healthy, and wonderful young person and adult.
Disclosures: Michelle Forcier, MD, MPH reported affiliations as a consultant with Folx Health, Planned Parenthood League of Massachusetts, ConferMED, New York University Student Health, and Transhealth. No other speakers declared any potential conflicts of interest.
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As the global population becomes older, physicians are increasingly navigating the complexities of geriatric medicine. Older adults often have multiple chronic conditions that require ongoing treatment, which frequently results in the practice of polypharmacy — typically defined as the concurrent use of 5 or more medications.1
Although polypharmacy begins as a well-intentioned effort to manage cooccurring conditions, the interaction of these different medications can become a health hazard instead of an optimal solution. Given the increased risks for adverse drug interactions, medication errors, and cognitive impairment, addressing polypharmacy and developing a nuanced approach to geriatric care is crucial to safeguarding the health of older adults.
Increasing Prevalence of Polypharmacy in Older Adults
In a chapter on polypharmacy published in Geriatric Rehabilitation, co-authors Parulekar and Rogers noted that while only 13% of the United States population was aged 65 years and older, this age group accounted for 33% of total prescription medications.2 More than 50% of older adults with multimorbid conditions receive 5 or more medications, with the rate varying between 10% and 55% globally.3 Furthermore, a study of survey data from the Centers for Disease Control and Prevention (CDC) found that the majority of older adults in the US had major polypharmacy and nonsteroidal anti-inflammatory drugs (NSAIDs) were the most common medication type.4
The prevalence of polypharmacy is even higher among women. Research suggests that women are more likely than men to require more than 1 or more specialized medications,1 and older women have higher rates of multimorbidity relative to men — with a consequently higher prevalence of polypharmacy.5
"
Managing polypharmacy requires careful monitoring and coordination by health care providers to deprescribe, optimize medication regimens, and minimize risks for patients.
Erika Ramsdale, MD, an associate professor at the Department of Medicine, Hematology/Oncology at the University of Rochester Medicine, has studied the effects of polypharmacy on older adults initiating cancer treatment6 and spoke about this issue. “Polypharmacy and potentially inappropriate medications are very, very common in older adults, and especially within certain populations, such as older adults with cancer. [However], there is not an easy way to estimate the burden of medication-related adverse effects on patients and the health care system as a whole,” she remarked.
Risk factors for polypharmacy include both patient-level factors (eg, increased age, difficulty self-managing medications, multimorbidity, disabilities) as well as health care system-level components, such as poor continuity of care, prescribing cascades, the use of multiple pharmacies, and inadequately updated medical records.7,8
While polypharmacy is often deemed necessary to treat multimorbidity, the concurrent use of medications has been shown to cause harm in and of itself. In a retrospective cohort study published in 2023, older adults who received multiple medications experienced significantly higher rates of severe comorbidity relative to those who did not experience polypharmacy. Patients with polypharmacy also had a greater rate of all-cause hospitalizations and emergency department (ED) visits.9
Polypharmacy also carries specific neurologic and psychiatric risks. Older adults with polypharmacy and multimorbidity demonstrate greater levels of cognitive impairment, relative to their peers with fewer comorbidities and medications,10 and has been associated with worse self-reported health and depression in older adults.11
Given the risks associated with multiple medications in older adults, many experts have called into question the “appropriate” vs “inappropriate” use of polypharmacy.2 To this aim, Mohamed and colleagues conducted a study to examine the associations between polypharmacy, potentially inappropriate medications, and adverse treatment outcomes in a large national cohort of older adults with advanced cancer. They found that 67% of patients received 1 or more inappropriate medications, and the use of inappropriate medications increased the odds of unplanned treatment-related hospitalization. Additionally, polypharmacy overall was associated with increased risk for postoperative complications, hospitalizations, and mortality risk.8
Dr Ramsdale emphasized the importance of not just the number of medications prescribed to a patient, but also their appropriateness. “Some patients have polypharmacy by number, but all their medications are needed and appropriate.”
Further complicating this medication management issue, Dr Ramsdale addressed the challenge of differentiating between patients who develop symptoms from polypharmacy vs a root cause issue, such as comorbidities/disease. “Often, there is not one ‘root cause’ for a symptom or adverse effect in older adults. There are generally multiple contributing factors and you have to look at all of them and also how the factors interact with each other. One thing you can say is that medications are very often contributing and need to be considered each time something happens.”
Concerns & Barriers in the Management of Polypharmacy in Clinical Practice
Although a wealth of evidence has demonstrated the adverse health risks associated with polypharmacy, the question remains as to how health care systems should best manage this issue. Researchers conducted a study across 14 countries, including the US and UK, to identify the barriers associated with addressing polypharmacy in primary care. They found the most common barriers were a lack of evidence-based guidance, a lack of communication and decision-making systems, and gaps in support.12
From a clinician’s perspective, Dr Ramsdale stated,
Older adults tend to have many doctors who are all prescribing [medications], sometimes in different health systems, leading to fragmentation of care. Providers also may not want to alter [a medication] that another provider has prescribed.
In-depth review of medications takes a lot of time and thought, as each patient’s situation is unique and everyone has different goals and preferences. In addition, clinicians often do not have the time or resources to accomplish this for all patients because of the way our health care system is set up and [the type] of care it prioritizes.
Because one of the major concerns regarding polypharmacy is the increased risk for drug-to-drug interactions that are associated with adverse events and even death,13 there is a critical need to support physicians in these complicated — but increasingly common — cases of medication management.
How Can Providers Manage Polypharmacy in Older Adults?
Researchers have agreed that screening and interventional tools to optimize medication usage for improved outcomes may be beneficial.9 However, the frequency of prescribing multiple medications needs to be evaluated to reduce adverse events and medication burden in this patient population.4 Clinical studies have shown that one of the ways of reducing exposure to polypharmacy is through the practice of “deprescribing” medications.12
Deprescribing medications involves the identification of inappropriate or unnecessary medications to ultimately taper or discontinue their use. In 2019, the American Academy of Family Physicians (AAFP) developed recommendations for clinicians to help in deprescribing medications and reducing the risks for polypharmacy.7 Some of the key guidelines include the identification and prioritization of medications to discontinue, conducting informed decision-making with the patient, ensuring routine follow-up visits, and considering the risks vs benefits when refilling medications.
“Patients and their caregivers can be excellent advocates. All older adults should be [encouraged to] ask questions about the [safety] of their medications. The US Deprescribing Research Network and the Canadian Medication Appropriateness and Deprescribing Network have excellent patient resources available,” Dr Ramsdale recommended.
One of the key aspects in reducing polypharmacy is medication reconciliation, which can be more effectively achieved by improving the communication between provider and patient and the process of discharge from hospitalization. With the increased use of artificial intelligence and clinical decision support systems, the risks for polypharmacy may be minimized.14
Given that many older patients experience some degree of polypharmacy, pharmacists, specialist nurses, and physician assistants play a vital role in medication management, quality prescribing practices, and safety monitoring.4 Managing polypharmacy requires careful monitoring and coordination by health care providers to deprescribe, optimize medication regimens, and minimize risks for patients. Overall, polypharmacy in older adults is directly related to health care service outcomes,9 which warrants the need for a multidisciplinary, holistic approach to address and evaluate its use among patients.
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