A scoping review of pharmacist-led prescribing interventions in hospitalised older patients (65 years) with polypharmacy to inform and improve practice

Abstract Introduction Patient transfer across care settings is often associated with errors including unintentional inappropriate prescribing. This is particularly true for those with multimorbidity and its related polypharmacy (5 or more medicines). These patients are often older members of the population (65 years) with complex medication regimens and medicines handling capacity.1 In the United Kingdom (UK), the role of the pharmacist is evolving beyond supply and counselling on medicines, to include active clinical decision-making and prescribing.2 As of summer 2026 all newly registered (UK trained) pharmacists will be annotated as prescribers at the point of registration. This is a substantial shift in the profession and will increase pharmacist involvement and influence in prescribing. But what impact do pharmacist prescribers have? Aim This study aimed to collate, via a scoping review, the evidence around pharmacist prescribing interventions for hospitalised older patients (aged 65+) with polypharmacy. Methods A scoping review of the literature was conducted in a systematic fashion using PubMed and Google Scholar. Key terms and Medical Subject Headings relating to the research question were used including polypharmacy, medications, elderly, hospitalisations, etc. The inclusion criteria were all relevant studies published in the English language, between 2020–2025 capturing the latest evidence, with patients aged 65 years or older. The exclusion criteria were studies not published in the English language, published pre-2020, and where patients were of mixed ages and data for those aged 65+ could not be differentiated. Titles and abstracts were screened for relevance prior to full-text review. A narrative synthesis was prepared of studies deemed suitable for inclusion and key themes emerging from the literature identified and collated. Results Overall, 13 studies from Europe, the United States, and Asia were deemed suitable for inclusion demonstrating that this is a global issue. No relevant studies from the UK met the inclusion criteria. Pharmacist interventions were reported as positively impacting patient care with several validated tools used to identify potentially inappropriate prescribing (PRISCUS, STOPP and Beers). Patient education and counselling on why medication had been prescribed, and appropriate medication use, were deemed key in improving patient understanding and adherence. There was evidence of confusion and fear around deprescribing among both patients and practitioners, potentially highlighting a need for education around stopping medications in multimorbid patients prescribed several medicines. Conclusion Overall, the study is interesting from a global healthcare perspective and reflects the increasing level of pharmacist involvement in prescribing worldwide. However, it is limited in terms of relevance to UK practice in that no UK studies were included. Similarly, by only capturing those published in the English language, good practice from non-English publications may have been missed. Pharmacist interventions positively influence older polypharmacy patient medication use and outcomes, and effective and validated tools can assist with this. Patient and practitioner education around prescribing and deprescribing is necessary. A current UK perspective would be useful; therefore, future work will include development and dissemination of a questionnaire in hospitals to achieve this and further contribute to this important area of practice.