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Ramezani R, khalili H, Tabarraei Y, Dastjerdi M, Dastjerdi A. Association of Overt and Covert Polypharmacy With Functional Independence and Quality of Life in Older Adults. Salmand: Iranian Journal of Ageing 2026; 21 (2) :218-239
URL: http://salmandj.uswr.ac.ir/article-1-3023-en.html

Objectives The growing use of both prescribed and herbal medications among older adults in Iran has raised concerns regarding potential adverse health outcomes. This study aimed to determine the prevalence of overt polypharmacy (simultaneous use of five or more prescribed medications) and covert polypharmacy (use of self-prescribed herbal medicines), and to examine their associations with functional independence and quality of life (QoL) in Iranian older adults.
Methods & Materials In this descriptive analytical study, 384 older adults attending healthcare centers in Sabzevar, Iran, in 2023 were selected using random sampling. Data were collected using a demographic checklist, the Barthel Index (BI), and the brief Older People’s Quality of Life questionnaire (OPQOL-brief). Statistical analyses were performed in SPSS software, version 26 using linear, multivariate, and logistic regression analyses, with a significance level set at P≤0.05.
Results Participants had a mean age of 68.7±7.2 years (ranging 60–92 years), and 55.7% were women. The prevalence of overt and covert polypharmacy was 22.9% (n=88) and 32% (n=123), respectively. The mean total QOL score was 48.41, and the mean BI score was 91.21. Both overt polypharmacy (β=–0.109, P=0.041) and covert polypharmacy (β=–0.096, P=0.045) were significantly associated with lower functional independence and QOL. They also had a significant negative association with physical, emotional, and social domains of QOL (P<0.05). Logistic regression model indicated that number of underlying diseases (OR=5.86; 95% CI: 3.79–9.06, P<0.001), complete financial dependency (OR=2.74; 95% CI: 1.07–7.02, P=0.036), history of hospitalization (OR=2.97; 95% CI: 1.42–6.17, P=0.004), and health insurance coverage (OR=2.72; 95% CI: 1.04–7.09, P=0.041) were significant predictors overt polypharmacy. Also, age (OR=1.05; 95% CI: 1.00–1.10, P=0.043), number of underlying diseases (OR=4.70; 95% CI: 3.24–6.82, P<0.001), female gender (OR=3.84; 95% CI: 1.65–7.20, P=0.001), and hospitalization history (OR=2.95; 95% CI: 1.55–5.62, P=0.001) were significant predictors of covert polypharmacy.
Conclusion Both overt and covert polypharmacy negatively affect functional independence and QoL of older adults. These findings highlight the importance of medication management in the elderly, particularly regarding covert polypharmacy, and underscore the need for targeted health and educational interventions for this population in Iran.