Isn't it time we stop counting the number of drugs to define polypharmacy in this new era of deprescribing and what related outcomes should be measured?

In this issue appears a paper titled “Association of Polypharmacy With 1-Year Trajectories of Cognitive and Physical Function in Nursing Home Residents: Results From a Multicentre European Study.” The authors defined polypharmacy by medication count as either 5 to 9 drugs or ≥10 drugs, with 0 to 4 drugs as the reference. They found a relationship between polypharmacy and decline in cognitive function as measured by the Cognitive Performance Scale but not with functional status decline as measured by the Activities of Daily Living (ADL) Hierarchy scale. The choice to use the interRAI–Long Term Care Facilities (interRAI-LTCF) as opposed to the Minimum Data Set Version 3.0 (MDS 3.0) to derive their cognitive function measures limits the clinical application of the findings, as the MDS 3.0 has perhaps a more clinically interpretable cognitive function measure: the Brief Interview for Mental Status. 1 Moreover, the measure of functional status used in this study (observed ADL) is not as sensitive to change as are performance measures such as the Short Physical Performance Battery. 2