The Process of Polypharmacy Management in Older Adults: A Grounded Theory

BACKGROUND: In developed countries, the growing population of older adults is accompanied by increasing multimorbidity and medication use. Polypharmacy, commonly defined as the use of five or more medications, is associated with adverse outcomes and presents a complex daily management challenge. OBJECTIVE: This study aimed to explore and describe the key components of polypharmacy management in older adults within the Italian context. METHODS: A qualitative study using Charmaz’s constructivist Grounded Theory approach was conducted. Participants were patients (n=25) from medical wards or day hospitals in an Italian hospital. Data were analysed through initial and focused coding, leading to category development and construction of the conceptual framework. RESULTS: Twenty-five older adults (median age 77 years) were interviewed, yielding five interrelated categories: “having knowledge and monitoring skills”, “having a strategy to manage and take medications”, “interpreting symptoms and modifying therapy”, “having caregiver support” “engaging with healthcare professionals”. These categories described the process of polypharmacy management. DISCUSSION AND CONCLUSION: The findings indicate that management begins with acquiring knowledge and monitoring skills, followed by implementing strategies, interpreting symptoms, and adjusting medications. Caregivers provide essential support, while engagement with healthcare professionals ensures safe and appropriate management. Clinically, these results highlight the need for multidisciplinary interventions to address fragmented polypharmacy management and enhance communication with patients and caregivers.