All categorical variables are presented as weighted frequencies and percentages. Continuous variables that did not follow a normal distribution are presented as medians with interquartile ranges (IQR). Sampling weights were applied to all analyses to account for the complex survey design. Due to weighting procedures and rounding, the sum of frequencies was adjusted to the total sample size (N = 9,898). The total frequency for cognitive categories is 9,817 due to missing values in the K-MMSE assessment. K-ADL: Korean Activities of Daily Living; K-IADL: Korean Instrumental Activities of Daily Living; K-MMSE: Korean version of the Mini-Mental State Examination.
Declarations
Author contributions
HMK: Investigation, Writing—original draft, Writing—review & editing. MKJ: Conceptualization, Validation, Writing—original draft, Writing—review & editing, Supervision. All authors read and approved the submitted version.
Conflicts of interest
The authors declare that they have no conflicts of interest.
Ethical approval
This study analyzed anonymized secondary data from the 2023 Korean Elderly Survey, administered by the Korea Institute for Health and Social Affairs (KIHASA) under the Ministry of Health and Welfare of the Republic of Korea. In accordance with national research ethics regulations, analyses using publicly available, de-identified data are exempt from Institutional Review Board (IRB) approval.
Consent to participate
Exempted according to the institution’s policy.
Consent to publication
Not applicable.
Availability of data and materials
Data from the 2023 Korean Elderly Survey are publicly available from the KIHASA data portal [https://data.kihasa.re.kr].
Funding
This study was supported by a 2026 research grant from Dongnam Health University (2026-008). The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Open Exploration maintains a neutral stance on jurisdictional claims in published institutional affiliations and maps. All opinions expressed in this article are the personal views of the author(s) and do not represent the stance of the editorial team or the publisher.
References
Legg S. World Population Prospects 2024: Summary of Results. Melbourne: Interaction; 2024;52:27.
Skou ST, Mair FS, Fortin M, Guthrie B, Nunes BP, Miranda JJ, et al. Multimorbidity.Nat Rev Dis Primers. 2022;8:48. [DOI] [PubMed] [PMC]
Pazan F, Wehling M. Polypharmacy in older adults: a narrative review of definitions, epidemiology and consequences.Eur Geriatr Med. 2021;12:443–52. [DOI] [PubMed] [PMC]
Jennings ELM, O’Mahony D, Gallagher PF. Medication-related quality of life (MRQoL) in ambulatory older adults with multi-morbidity and polypharmacy.Eur Geriatr Med. 2022;13:579–83. [DOI] [PubMed] [PMC]
Mangoni AA, Jackson SH. Age-related changes in pharmacokinetics and pharmacodynamics: basic principles and practical applications.Br J Clin Pharmacol. 2004;57:6–14. [DOI] [PubMed] [PMC]
Sera LC, McPherson ML. Pharmacokinetics and pharmacodynamic changes associated with aging and implications for drug therapy.Clin Geriatr Med. 2012;28:273–86. [DOI] [PubMed]
Schmucker DL. Liver function and phase I drug metabolism in the elderly: a paradox.Drugs Aging. 2001;18:837–51. [DOI] [PubMed]
Gutiérrez-Valencia M, Izquierdo M, Cesari M, Casas-Herrero Á, Inzitari M, Martínez-Velilla N. The relationship between frailty and polypharmacy in older people: a systematic review.Br J Clin Pharmacol. 2018;84:1432–44. [DOI]
Al-Azayzih A, Al-Qerem W, Al-Azzam S, Alzoubi KH, Jirjees F, Al-Kubaisi K, et al. Medications Associated with Geriatric Syndromes and Prescribing Patterns: The Impact of Excessive Polypharmacy in Older Adult Patients.Ther Clin Risk Manag. 2024;20:741–8. [DOI] [PubMed] [PMC]
Yu X, Qian Y, Zhang Y, Chen Y, Wang M. Association between polypharmacy and cognitive impairment in older adults: A systematic review and meta-analysis.Geriatr Nurs. 2024;59:330–7. [DOI] [PubMed]
Calderón-Larrañaga A, Vetrano DL, Ferrucci L, Mercer SW, Marengoni A, Onder G, et al. Multimorbidity and functional impairment-bidirectional interplay, synergistic effects and common pathways.J Intern Med. 2019;285:255–71. [DOI] [PubMed] [PMC]
Pieper NT, Grossi CM, Chan WY, Loke YK, Savva GM, Haroulis C, et al. Anticholinergic drugs and incident dementia, mild cognitive impairment and cognitive decline: a meta-analysis.Age Ageing. 2020;49:939–47. [DOI] [PubMed] [PMC]
Richardson K, Fox C, Maidment I, Steel N, Loke YK, Arthur A, et al. Anticholinergic drugs and risk of dementia: case-control study.BMJ. 2018;361:k1315. [DOI] [PubMed] [PMC]
Roy P, Ghosh D, Sanyal R, Madhu NR, Dey A. The Controversy Surrounding Drugs Against Neurodegenerative Disorders: Benefit or Harm?Neuroprot Eff Phytochem Brain Ageing. 2024. pp. 373–86. [DOI]
Akinyemi RO, Mukaetova-Ladinska EB, Attems J, Ihara M, Kalaria RN. Vascular risk factors and neurodegeneration in ageing related dementias: Alzheimer’s disease and vascular dementia.Curr Alzheimer Res. 2013;10:642–53. [DOI] [PubMed]
Chatterji S, Byles J, Cutler D, Seeman T, Verdes E. Health, functioning, and disability in older adults—present status and future implications.Lancet. 2015;385:563–75. [DOI] [PubMed] [PMC]
Gianfredi V, Nucci D, Pennisi F, Maggi S, Veronese N, Soysal P. Aging, longevity, and healthy aging: the public health approach.Aging Clin Exp Res. 2025;37:125. [DOI] [PubMed] [PMC]
Jyrkkä J, Enlund H, Lavikainen P, Sulkava R, Hartikainen S. Association of polypharmacy with nutritional status, functional ability and cognitive capacity over a three-year period in an elderly population.Pharmacoepidemiol Drug Saf. 2011;20:514–22. [DOI] [PubMed]
Shoair OA, Nyandege AN, Slattum PW. Medication-related dizziness in the older adult.Otolaryngol Clin North Am. 2011;44:455–71, x. [DOI] [PubMed]
Kang E, Kim H, Jeong C, Kim S, Lee S, Joo B, et al. National Survey of Older Koreans. Seoul: Korean Institute for Health and Social Affairs; 2023.
Smith L, Letendre S, Erlandson KM, Ma Q, Ellis RJ, Farhadian SF. Polypharmacy in older adults with HIV infection: Effects on the brain.J Am Geriatr Soc. 2022;70:924–7. [DOI] [PubMed] [PMC]
Oyarzun-Gonzalez XA, Taylor KC, Myers SR, Muldoon SB, Baumgartner RN. Cognitive decline and polypharmacy in an elderly population.J Am Geriatr Soc. 2015;63:397–9. [DOI] [PubMed] [PMC]
Sheikh-Taha M, Asmar M. Polypharmacy and severe potential drug-drug interactions among older adults with cardiovascular disease in the United States.BMC Geriatr. 2021;21:233. [DOI] [PubMed] [PMC]
Arnold SV, de Lemos JA, Zheng L, Rosenson RS, Ballantyne CM, Alam S, et al.; GOULD Investigators. Use of optimal medical therapy in patients with diabetes and atherosclerotic cardiovascular disease: Insights from a prospective longitudinal cohort study.Diabetes Obes Metab. 2023;25:1750–7. [DOI] [PubMed]
Rojas-Solé C, Pinilla-González V, Lillo-Moya J, González-Fernández T, Saso L, Rodrigo R. Integrated approach to reducing polypharmacy in older people: exploring the role of oxidative stress and antioxidant potential therapy.Redox Rep. 2024;29:2289740. [DOI] [PubMed] [PMC]
Atuah KN, Hughes D, Pirmohamed M. Clinical pharmacology: special safety considerations in drug development and pharmacovigilance.Drug Saf. 2004;27:535–54. [DOI] [PubMed]
Peron EP, Gray SL, Hanlon JT. Medication use and functional status decline in older adults: a narrative review.Am J Geriatr Pharmacother. 2011;9:378–91. [DOI] [PubMed] [PMC]
Stuck AE, Walthert JM, Nikolaus T, Büla CJ, Hohmann C, Beck JC. Risk factors for functional status decline in community-living elderly people: a systematic literature review.Soc Sci Med. 1999;48:445–69. [DOI] [PubMed]
Bierman AS, Tinetti ME. Precision medicine to precision care: managing multimorbidity.Lancet. 2016;388:2721–3. [DOI] [PubMed]
Allen LA, Thompson JS, Stehlik J. STRONG-HF Evidence for Proactive, Patient-Centered Prescribing.JAMA Cardiol. 2024;9:103–4. [DOI] [PubMed]
Brooksbank JA, Faulkenberg KD, Tang WHW, Martyn T. Novel Strategies to Improve Prescription of Guideline-Directed Medical Therapy in Heart Failure.Curr Treat Options Cardiovasc Med. 2023;25:93–110. [DOI] [PubMed] [PMC]
Apóstolo J, Cooke R, Bobrowicz-Campos E, Santana S, Marcucci M, Cano A, et al. Effectiveness of interventions to prevent pre-frailty and frailty progression in older adults: a systematic review.JBI Database System Rev Implement Rep. 2018;16:140–232. [DOI] [PubMed] [PMC]