Medication Safety for Older People in Viet Nam: Polypharmacy, Medication Review, Reconciliation and Deprescribing Across Care Settings

Medication Safety for Older People in Viet Nam: Polypharmacy, Medication Review, Reconciliation and Deprescribing Across Care Settings

AGE-FRIENDLY CARE QUALITY, CARE TRANSITIONS

Last reviewed: October 2026

An older person may leave hospital with several medication changes, return home to medications prescribed before admission, continue treatment from different specialists, and also use over-the-counter products, supplements or traditional and complementary medicines that may not appear on the hospital medication list. A family member may organize the tablets, while a clinician in the community may later renew an earlier prescription without knowing exactly what changed during hospitalization.

No single decision in that sequence has to be obviously wrong for medication-related risk to develop. The problem may simply be that the medication regimen has become difficult to see as a whole. One medication may no longer be necessary, two may have overlapping effects, a new treatment may interact with an existing one, or a medication that was appropriate several years ago may no longer fit the person’s renal function, frailty, cognitive status, fall risk or current goals of care. At a transition between settings, a medication may also disappear from one list or remain on another by mistake.

For older people, medication safety is therefore not only about taking medications correctly. It is also about making sure that treatment remains appropriate, the current medication list is accurate, important changes follow the person across settings, and medications that no longer provide sufficient benefit can be reconsidered safely. That requires several related but distinct processes: recognizing and managing polypharmacy, medication review, medication reconciliation and, when appropriate, deprescribing.

Polypharmacy is not automatically inappropriate

Polypharmacy generally refers to the concurrent use of multiple medications and is commonly operationalized in research as the regular use of five or more. There is, however, no single universally accepted numerical threshold, and prescription medications are not the whole picture. Over-the-counter, traditional and complementary products may also need to be considered when understanding a person’s total medication burden. WHO’s guidance emphasizes the more important distinction between appropriate and inappropriate polypharmacy, rather than treating the medication count alone as the problem.

An older person with heart failure, diabetes, atrial fibrillation and osteoporosis may appropriately need several medications supported by good evidence. Stopping treatment merely to reduce the number of tablets could cause harm. The more useful question is therefore not simply, “Is this person taking too many medications?” but, “Does each medication still have a clear purpose, expected benefit and acceptable risk for this particular person?”

That question becomes increasingly important as health and function change over time. Multimorbidity can bring several prescribers and disease-specific treatment plans into the same person’s care. Changes in renal function, frailty, cognition, mobility, swallowing, appetite or fall risk can alter the balance between benefit and harm. A regimen that was reasonable several years earlier may need to be reconsidered as the person’s circumstances change.

Medication safety for older people therefore needs to be person-centered, not simply prescription-centered.

Medication review, reconciliation and deprescribing solve different problems

These terms are sometimes used together, but they serve different purposes. A medication review asks whether the person’s medications remain appropriate as a whole: why each medication is being used, whether it is still effective, whether the dose remains suitable, whether relevant interactions or adverse effects are present, whether necessary monitoring is occurring, whether treatment is being duplicated, and whether the regimen still fits the person’s clinical situation and priorities.

Medication reconciliation addresses a different question: do we know accurately what this person is taking and what has changed? WHO describes reconciliation as a formal, structured process for ensuring accurate and complete medication information at interfaces of care. It includes establishing the best possible medication history, comparing that history with current treatment, identifying and resolving discrepancies, updating the medication list, and communicating relevant changes to the patient and the professionals responsible for subsequent care.

Deprescribing may be one outcome of medication review. It is a planned clinical process of reducing or discontinuing a medication when its expected benefit no longer justifies its potential harm or burden for the individual. Depending on the medication, this may involve stopping treatment, reducing the dose or tapering it gradually, with appropriate follow-up after the change.

These processes are complementary but not interchangeable. Medication reconciliation can produce a perfectly accurate list that still contains inappropriate medications. Medication review can identify a treatment that should be reconsidered without ensuring that the decision reaches the next provider. Deprescribing may be clinically appropriate but become unsafe if the change is poorly communicated or inadequately monitored.

WHO places polypharmacy and care transitions at the center of medication safety

Medication safety is a major patient-safety priority within WHO’s Medication Without Harm initiative. WHO identifies three priority action areas: high-risk situations, polypharmacy and transitions of care. Its polypharmacy guidance emphasizes person-centered medication review, involvement of patients and multidisciplinary working across the health and care system.

Transitions deserve particular attention because medication discrepancies can arise whenever a person moves between providers or settings. WHO calls for formal and structured processes, stronger information quality and availability, workforce capability, patient and family engagement, and measurement to reduce medication-related harm during transitions.

This is especially relevant to older-person care. Hospital admission can lead to medications being added, stopped, temporarily withheld or dose-adjusted. At discharge, some changes are intended to continue while others are temporary. The person then returns to medications already stored at home, previous prescriptions, other specialists and perhaps a family caregiver who has been following the earlier regimen. Medication safety can fail even when every professional involved is acting with good intentions if the medication story does not remain coherent across the journey.

The issue has gained further attention in 2026. WHO is developing its first global guideline on the prevention, diagnosis and management of delirium in older adults, explicitly including medication safety and deprescribing. WHO identifies medication-related factors, including polypharmacy and inappropriate prescribing, as important contributors to delirium risk alongside other factors such as infection, dehydration and acute physiological disturbances.

The guideline is still under development. As of 22 September 2026, WHO was seeking a guideline methodologist to refine the scope and questions, facilitate the initial Guideline Development Group work and establish the evidence-review process; residual methodological activities are expected to continue in 2027. It should therefore not yet be presented as a completed WHO recommendation. Its development is nevertheless important because it reflects a broader shift toward considering how medication use interacts with cognition, function and vulnerability in older people. Medication-related harm can contribute to problems such as dizziness, falls, confusion, sedation, reduced mobility or poor appetite, all of which may affect independence and quality of life.

Viet Nam has a stronger foundation for medication safety in older-person care

Viet Nam’s 2026 professional guidance for home- and community-based older-person care provides an important starting point. Ministry of Health Decision No. 1976/QĐ-BYT of 1 July 2026 includes specific guidance on supporting older people to use prescribed medications safely. It calls for adherence to prescribed treatment, advises against independently changing medications or doses or stopping treatment, and includes practical guidance on medication use, storage and monitoring for abnormal signs after administration.

The assessment material included in Decision 1976 also explicitly identifies concurrent use of multiple medications as an issue requiring attention in older people. It notes that certain medications may adversely affect mobility or balance and states that removing unnecessary, ineffective or duplicative medications can reduce polypharmacy, while advising consultation with an appropriate specialist physician when considering whether a medication can be stopped.

This is significant because medication use is being connected with function rather than treated only as a pharmaceutical issue. At the same time, the scope of the guidance needs to be interpreted carefully. Decision 1976 addresses professional care for older people at home and in the community; it does not itself establish a medication-reconciliation pathway spanning hospital admission, discharge, specialist care, primary care, home care and long-term care. Nor should its discussion of unnecessary or ineffective medications be treated as a complete national deprescribing protocol.

Viet Nam also has an established regulatory framework for clinical pharmacy within healthcare facilities. Decree No. 131/2020/NĐ-CP, effective since 1 January 2021 and currently listed in the national legal database as still in force, regulates clinical-pharmacy organization and activities in healthcare facilities that use medications. At the individual-patient level, the Decree includes taking a medication-use history and reviewing prescribed treatment for issues such as indication, contraindications, medication selection, dosage, route, duration and clinically relevant interactions.

Decision 1976 and Decree 131 therefore provide complementary pieces of the medication-safety landscape: one addresses important aspects of medication support and polypharmacy in home and community older-person care, while the other provides a framework for clinical-pharmacy practice within healthcare facilities. Neither instrument, by itself, creates a single cross-setting medication-management pathway. The quality challenge is how to connect these pieces more reliably as older people move through the care continuum.

A good medication review starts with purpose, not with the pill count

Medication review can easily become a numerical exercise: a person takes nine medications, so the goal becomes reducing the number to seven. That is not what medication optimization is for. A useful review starts with the whole regimen and the whole person.

What is each medication for? Is the indication still present? Is the treatment producing a meaningful benefit? Is the dose still appropriate? Could a medication be contributing to dizziness, falls, confusion, constipation, bleeding, hypotension, poor appetite or another problem? Are there important medication–medication or medication–disease interactions? Is necessary monitoring actually occurring?

Medication optimization should also look for undertreatment. An older person may be missing a treatment that could provide meaningful benefit. Focusing only on deprescribing risks confusing “fewer medications” with “better prescribing.”

A complete medication history matters for the same reason. WHO’s polypharmacy guidance emphasizes looking beyond prescription medications to include relevant over-the-counter, traditional and complementary products. This becomes particularly important when information is scattered across different prescribers, pharmacies, supplies kept at home and the knowledge of family members.

Medication review should also consider the person’s goals and likely time to benefit. A treatment whose expected benefit accrues over years may have a different place in the care plan of a robust older adult than in someone living with advanced frailty, severe functional dependence or limited life expectancy. Conversely, chronological age alone is not sufficient reason to withdraw an otherwise appropriate and beneficial treatment.

Medication appropriateness is individualized.

Deprescribing is a clinical process, not simply stopping medications

Deprescribing can sound deceptively simple. In practice, it requires clinical judgment. The clinician needs to understand why a medication was originally prescribed, reassess its current benefit and potential harm, consider what could happen if it is withdrawn, discuss the decision with the older person and, where appropriate, the caregiver, and decide how the person will be monitored afterward.

Some medications can be discontinued directly, while others may require gradual dose reduction. Symptoms occurring after withdrawal may represent recurrence of the underlying condition, a withdrawal effect or an unrelated change. Older people and family caregivers should therefore not independently stop prescribed treatment simply because they are concerned about polypharmacy. Decision 1976 appropriately advises older people to follow prescribed treatment and not independently change medications, doses or stop treatment partway through.

Recent evidence also supports a measured view of deprescribing. A 2026 systematic review of 17 randomized studies in primary care found that automated approaches and pharmacist-led interventions were relatively consistent in reducing potentially inappropriate medications, while other intervention types produced more mixed results. No significant mortality effect was identified across the included interventions.

In long-term-care facilities, a 2026 systematic review and meta-analysis of 38 studies found that medication-review and deprescribing interventions reduced both the number of medications and potentially inappropriate medications. However, pooled analyses did not show significant effects on falls, hospitalizations or mortality, and the evidence showed substantial methodological heterogeneity and generally moderate-to-high risk of bias.

This distinction matters. Deprescribing should not be presented as an intervention that automatically prevents hospitalizations, falls or death. Its immediate value may often lie in improving medication appropriateness and reducing exposure to treatment that no longer provides sufficient benefit. It is better understood as part of medication optimization than as a campaign to minimize medication use.

Transitions are where medication plans become vulnerable

An older person can receive an excellent medication review in hospital and still experience medication-related harm after discharge if the decisions made there do not survive the transition.

Imagine that a sedating medication is stopped after a fall, another medication is reduced because renal function has deteriorated, and a short-term treatment is added for seven days. The person returns home with the new list, but the family still has several months of the old medications in the medicine cabinet. The primary-care clinician later receives incomplete discharge information, and a subsequent specialist consultation generates another prescription. The problem is no longer simply whether one prescription is correct; it is whether everyone is working from the same current medication plan.

Medication reconciliation is intended to reduce this uncertainty. WHO’s approach begins with the best possible medication history, compares that information with current prescribed treatment, identifies and resolves discrepancies, updates the medication list and communicates the current treatment and relevant changes to the patient and the professionals who will provide care next.

A 2026 systematic review of strategies to maintain medication changes after hospital discharge in older adults reinforces this point. Among 49 included studies, common strategies included providing discharge medication lists, discharge counseling and medication reconciliation, usually within multicomponent and often multidisciplinary interventions. Most studies that measured continuity found improvement in at least one continuity-related outcome, while effects on clinical outcomes and healthcare utilization were far less consistent.

For Viet Nam, this distinction is important. A discharge prescription is valuable, but medication reconciliation is more than generating another prescription. It requires knowing what the person was actually using before admission, clarifying what changed and why, and ensuring that the older person, family where appropriate and next providers understand the current regimen.

The older person eventually takes the medication at home, so understanding matters as much as documentation. People need practical answers about which medications continue, which have stopped, which doses have changed, which treatments are temporary, what important adverse effects to watch for and whom to contact when instructions appear inconsistent. Support should also reflect cognitive impairment, vision or hearing problems, literacy, dexterity and the person’s ability to manage medications independently.

Family caregivers can be essential partners in this process, but they should not have to decide which of several conflicting medication lists is correct. Resolving that uncertainty is a healthcare-system responsibility.

Medication safety should follow the person across settings

Different parts of the care continuum create different medication-safety risks. In hospital, admission is an opportunity to establish an accurate medication history and reassess treatment during acute illness, while discharge is a critical point for reconciliation and communication. During transitional or rehabilitation care, medication effects on alertness, balance, cognition, blood pressure, pain and physical performance can directly affect recovery.

At home, practical problems often become visible: old prescriptions, duplicate supplies, confusing packaging, missed doses, products obtained without prescription and reliance on family support. In primary and community care, the challenge is maintaining a longitudinal view when medications originate from several specialists or hospital episodes. In long-term care, medication review needs to be integrated into ongoing clinical assessment rather than occurring only after a serious problem emerges.

Across all of these settings, the same basic questions remain relevant: Can someone see the complete current medication regimen? Does each medication have a clear purpose? Are significant changes visible to the next provider? Is responsibility clear when something needs to be reviewed or changed?

The 2026 evidence from long-term-care facilities suggests that structured review and deprescribing can improve prescribing appropriateness, although effects on major clinical outcomes remain less certain. That is an important reminder that medication safety should be judged by more than the number of tablets or the presence of a completed review form.

Viet Nam can start with practical system changes and measure what matters

A future interoperable medication record could make continuity easier, but organizations do not need to wait for complete national digital integration before improving medication safety.

Hospitals could identify older people at higher medication-related risk, for example, those with substantial polypharmacy, frailty, cognitive impairment, falls, renal impairment, repeated admissions or multiple prescribers—and prioritize structured medication review and reconciliation for them. A practical discharge process could make clear the medication list on admission, the list at discharge, what changed, why it changed, which medications are temporary, what monitoring is needed and who should follow up.

Primary-care and community services could incorporate medication review into broader older-person assessment, particularly after hospitalization or when function, cognition or fall risk changes. Decision 1976 already provides a useful foundation by recognizing concurrent medication use within older-person assessment and by addressing safe medication support at home and in the community.

Clinical pharmacists can also contribute within their professional roles. Decree 131/2020/NĐ-CP already provides a regulatory framework for clinical-pharmacy activities in Vietnamese healthcare facilities, while international evidence suggests that pharmacist-led deprescribing approaches can reduce potentially inappropriate medication use in primary care. The implementation model still needs to fit Viet Nam’s workforce, service organization and professional scope rather than simply copying an approach developed in another health system.

Measurement should also go beyond medication counts. Reducing the average number of medications does not prove that prescribing became safer, just as taking many medications does not prove that treatment is inappropriate. Organizations could examine whether higher-risk older people receive medication review, whether an accurate medication history is established at admission, whether reconciliation occurs at discharge, whether unexplained discrepancies are resolved, whether the reasons for medication changes reach the next provider, and whether the older person or caregiver understands the current regimen.

Outcome measures might include medication-related adverse events, falls potentially associated with medication use, medication-related readmissions or unplanned contacts after discharge. But even a simple process question can reveal a great deal:

At the next point of care, can the team tell which medication list is current and why it changed?

If the answer is often no, this is not only a medication-management problem. It is a continuity-of-care and patient-safety problem.

Safer medication use is about better care, not fewer medications

As Viet Nam’s population ages, more older people will live with multiple chronic conditions, receive care from several services and use multiple medications over long periods. Polypharmacy will not disappear simply by encouraging clinicians to prescribe less, nor should that be the goal.

Some older people genuinely need multiple medications. The challenge is ensuring that every medication continues to earn its place in the regimen.

Medication review asks whether treatment is still appropriate. Medication reconciliation helps ensure that the treatment plan remains accurate when care moves between settings. Deprescribing provides a structured way to reduce or stop treatment when its expected benefit no longer justifies its risk or burden. Patient and caregiver involvement helps make the regimen understandable and workable in daily life.

Viet Nam already has useful foundations. Decision 1976 recognizes safe medication use and concurrent use of multiple medications within home- and community-based older-person care, while Decree 131/2020/NĐ-CP provides a regulatory framework for clinical-pharmacy activities within healthcare facilities. The next challenge is to connect medication safety more reliably across hospital → transitional care → home → community → long-term care.

For healthcare organizations, the most useful question is therefore not simply, “How many medications is this older person taking?” It is:

“Does every medication still have a clear purpose for this person, is everyone working from the same current medication plan, and will that plan remain safe when the person moves to the next setting?”

When those questions are answered consistently, medication management becomes more than prescribing. It becomes part of the infrastructure for safer, more person-centered and better coordinated older-person care.

References

1. World Health Organization. Medication safety in polypharmacy: technical report. Geneva: World Health Organization; 2019. WHO/UHC/SDS/2019.11.

2. World Health Organization. Medication safety in transitions of care. Geneva: World Health Organization; 2019. WHO/UHC/SDS/2019.9.

3. World Health Organization. Medication without harm: policy brief. Geneva: World Health Organization; 2023.

4. World Health Organization. Call for Experts: WHO Guideline on the Prevention, Diagnosis and Management of Delirium in Older Adults (including Medication Safety and Deprescribing). 22 June 2026.

5. World Health Organization. Guideline Methodologist: WHO guideline on the prevention, diagnosis and management of delirium in older adults, including medication safety and deprescribing. 22 September 2026.

6. Ministry of Health of Viet Nam. Decision No. 1976/QĐ-BYT issuing professional guidance on care for older people at home and in the community. 1 July 2026.

7. Government of Viet Nam. Decree No. 131/2020/NĐ-CP regulating the organization and activities of clinical pharmacy in medical examination and treatment facilities. 2 November 2020; effective 1 January 2021.

8. Oliveira EM, Ferreira LC, Silva MC, Hattori WT. Optimizing Medication Use in Older Adults in Primary Care: A Systematic Review of the Effectiveness of Deprescribing Interventions. Geriatrics & Gerontology International. 2026;26(7):e70677. doi:10.1111/ggi.70677.

9. Johnstone KJR, Hilmer SN, Lo S, et al. Bridging the Gap: Systematic Review of Strategies to Facilitate Post-Discharge Continuity of In-Hospital Medication Changes in Older Adults. Drugs & Aging. 2026;43(2):137–152. doi:10.1007/s40266-025-01270-w.

10. Carollo M, Cristini I, Crisafulli S, et al. Evaluating the impact of medication review and deprescribing on prescribing appropriateness and clinical outcomes in older people residing in long-term care facilities: a systematic review and meta-analysis. Age and Ageing. 2026;55(4):afag084. doi:10.1093/ageing/afag084.