International Journal of Clinical Case Reports, 2025, Vol.15, No.4, 159-170 http://medscipublisher.com/index.php/ijccr 160 safety and quality of life, and is also necessary for alleviating the medical burden and enabling the elderly to receive more balanced health services. 2 Definition and Evaluation Criteria of Comprehensive Pharmacy 2.1 Common definitions of combined medication and their clinical applicability Multidrug is the most common numerical definition. Using five or more drugs per day is the most commonly used standard in the literature (Khezrian et al., 2020; Beezer et al., 2021). However, the definitions vary greatly. Some say two or more, some say eleven or more, and may also include the time of medication or specific medical scenarios. The lack of a unified view complicates the comparison between research and clinical Settings, as prevalence estimates and related risks can vary significantly depending on different definitions (Masnoon et al., 2017; Guillot et al., 2019; Taghy et al., 2020). Although digital standards are convenient to use and can assist in large-scale disease investigations, they do not take into account the applicability of each drug in clinical practice or the different conditions of each patient. Therefore, these standards may not fully reflect the complexity of medication regimens for the elderly, and may not pay attention to the problems of undertreatment and overtreatment in this population (Masnoon et al., 2017; Guillot et al., 2019; Pazan and Wehling, 2021). 2.2 Criteria for differentiating appropriate from inappropriate polypharmacy Appropriate multi-medication refers to the use of drugs that have clinical evidence, are in line with the evidence, are suitable for an individual's health condition, can maximize benefits, and minimize harm. On the contrary, inappropriate multi-medication is the use of unnecessary, repetitive or potentially harmful drugs, with risks outweighing benefits. This distinction is important because not all multiple medications are bad-some are necessary for optimizing disease management in patients with multiple medications (Khaitovych, 2021; Pazan and Wehling, 2021). Although this is important, only a few studies have clearly distinguished between appropriate and inappropriate polypharmacy, usually using descriptive definitions rather than numerical definitions. This gap indicates that more detailed standards and clinical judgments are needed when evaluating medication regimens. People cannot merely focus on the quantity of drugs; they also need to consider the necessity of treatment, drug interactions, and the specific conditions of the patients (Masnoon et al., 2017; Khaitovych, 2021; Pazan and Wehling, 2021). 2.3 Main evaluation tools for multidrugs Some explicit and implicit tools have been developed to evaluate multiple drugs and identify those that may not be suitable for the elderly. The Beers standard and the STOPP/START standard are among the most commonly used explicit tools, listing the medications or prescription practices that the elderly should avoid. These tools help clinicians systematically examine medication regiments, identify high-risk drugs, and guide the reduction of prescription medication (Gnjidic et al., 2017; Khaitovych, 2021). Other assessment tools include the drug suitability index and scales for specific drug types, such as the Anticholinergic Affordability tool. Although these tools enable people to better identify problems existing in the use of various drugs, there are still difficulties in using them, such as different definitions, inconsistent opinions on certain drug types, and the need to make clinical judgments based on individual patient conditions. Continuous improvement and refinement of these tools are of great significance for enhancing the medication safety and therapeutic effect of the elderly with multiple diseases (Gnjidic et al., 2017; Khaitovych, 2021). 3 Clinical Characteristics of Elderly Patients with Multiple Diseases 3.1 Common patterns of multiple diseases and overlapping medication in the elderly The elderly often have various multiple diseases, such as a combination of cardiovascular, metabolic, musculoskeletal, respiratory and neurodegenerative diseases (Zemedikun et al., 2018; Guisado-Clavero et al., 2018; Marengoni et al., 2019). For instance, common combinations include hypertension plus diabetes or arthritis. Cardiovascular diseases often occur concurrently with metabolic or musculoskeletal disorders (Kirchberger et al.,
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