Conscientious family physicians and polypharmacy.

One of the traditional goals of internist geriatricians and of family physicians providing care for elderly patients has been to review and reduce the amount of medication patients are taking. This can be one of the great pleasures of geriatric medicine, with obvious and proven benefits for older patients. Polypharmacy can be defined as the concomitant use of many medications. The more medications older patients take, the greater the risk of drug interactions and hospitalizations due to adverse drug reactions. Medication compliance is a serious issue for older patients and decreases when patients take many medications. In a recent study of a frail elderly population attending a geriatric day hospital, patients were taking in the last month, on average, 10.5 medications, which included over-the-counter medications. For all these reasons, decreasing medications remains an important part of geriatric care. In the last few years, physicians working with elderly patients have emphasized health promotion and prevention and have attempted to apply evidencebased medicine to geriatric care. These positive strategies have, however, paradoxically affected the relationship between conscientious family physicians and polypharmacy. Two examples of the relationship between health promotion, evidence-based medicine, and medication use can be found in managing osteoporosis and heart disease.