Asian Journal of Advances in Research

Polypharmacy is common in later life because multimorbidity, guideline-concordant disease management and transitions between care settings accumulate medicines over time. Yet medication count is an imperfect proxy for medication-related harm: some multidrug regimens are appropriate and beneficial, whereas a smaller regimen can still be hazardous when it contains high-risk, interacting or poorly indicated medicines. This critical narrative review examines how polypharmacy relates to hospitalisation and health-related quality of life (HRQoL) in older adults, and whether medication optimisation can modify those outcomes. Literature published from 2000 to 17 July 2026 was identified through major open scholarly databases and citation searching, with older foundational evidence retained when conceptually necessary. The evidence consistently shows that higher medication burden is associated with greater hospital use, but the magnitude of association varies substantially with multimorbidity, frailty, prescribing appropriateness, anticholinergic and sedative burden, medication complexity and the definition of polypharmacy. Observational studies support dose-response relationships, yet residual confounding and confounding by indication make simple causal interpretations unsafe. The HRQoL literature is smaller and methodologically more heterogeneous. Persistent or incident polypharmacy, hyperpolypharmacy and medication complexity are generally associated with poorer physical or global HRQoL, but disease burden, function, mood and social vulnerability often explain more variation than medicine count alone. Intervention trials reliably reduce potentially inappropriate prescribing and medicine numbers, whereas effects on hospitalisation and HRQoL are smaller, inconsistent and sensitive to setting, outcome instrument, follow-up duration and implementation fidelity. The most defensible synthesis is therefore that problematic polypharmacy, rather than polypharmacy per se, is the clinically relevant exposure. Geriatric medication management should prioritise indication, benefit-harm balance, treatment burden, patient goals and transition safety rather than numerical deprescribing targets. Future studies need longitudinal, patient-centred designs that integrate appropriateness, medication burden, frailty and repeated HRQoL measurement while using hospital outcomes that distinguish drug-related from all-cause events.