Abstract
Background: With an increase in life expectancies and advancements in pharmaceutical therapies, polypharmacy, defined as the use of multiple (>5) drugs concurrently, has become an increasingly prevalent issue among older adults (>65 years) within the United States. Polypharmacy can result in medication overload, financial burden, and higher risk of adverse drug events. However, more research is needed on whether polypharmacy levels in older adults differ between urban and rural populations given the disparate barriers in these populations, e.g., access to providers, specialists, health literacy levels, etc.

Objective: Use a nationally representative survey of ambulatory care visits within the United States to investigate polypharmacy levels in metropolitan and non-metropolitan older adults.

Methods: Data from the 2016 National Ambulatory Medical Care Survey was used to analyze polypharmacy levels in older adult patients. Survey weight-adjusted logistic regression analysis was used to examine predisposing, enabling, and need factors, and their association with polypharmacy visits.

Results: Enabling (region and patient provider) factors and need (number of diagnoses, type of primary diagnosis, major reason for the visit, and total chronic disorders) factors were found to be significantly associated with polypharmacy visits for patients ages 65 and older. Several factors that were found to be significant in previous research at the turn of the century were not found to be associated in the current dataset.

Conclusion: The current research provides evidence-based cross-sectional findings on factors associated with increased polypharmacy levels in older adults in the US.