Abstract
Polypharmacy among older adults represents a major global healthcare challenge, contributing to adverse drug events, increased hospitalization, and compromised therapeutic outcomes, particularly in underserved rural communities. This cross-sectional study evaluated the prevalence of polypharmacy and medication adherence patterns among 642 geriatric patients (aged ≥ 65 years) across six rural primary care health centers and affiliated community pharmacies over a 12-month observation period. Dispensing records were utilized to quantify medication regimen characteristics and assess adherence via the Proportion of Days Covered (PDC) metric, with optimal adherence defined as PDC ≥ 0.80. Overall, polypharmacy (≥ 5 concurrent medications) was present in 68.4% of the cohort, while hyperpolypharmacy (≥ 10 medications) was identified in 22.1%. Optimal adherence across all chronic therapeutic classes was observed in only 51.6% of patients. Multivariable logistic regression revealed that hyperpolypharmacy (adjusted odds ratio [aOR] = 0.41, 95% CI: 0.27–0.62, p < 0.001), high medication regimen complexity, multiple prescribers (≥ 3 prescribers: aOR = 0.54, 95% CI: 0.36–0.81, p = 0.003), and greater geographic distance from the dispensing pharmacy were independently associated with suboptimal adherence. These findings underscore the urgent necessity for decentralized clinical pharmacy interventions, systematic deprescribing frameworks, and continuous medication therapy management within rural primary healthcare infrastructures to optimize therapeutic safety and adherence in geriatric populations.
