Taiwan has officially entered a super-aged society, where multimorbidity and polypharmacy have become increasingly prevalent among older adults. Age-related changes in pharmacokinetics and pharmacodynamics heighten older adults’ susceptibility to adverse drug events, placing them at greater risk for falls, delirium, cognitive impairment, and recurrent hospitalizations as medication burden increases. Polypharmacy is not merely a consequence of multiple prescriptions; it also reflects fragmented prescribing practices, disease-centered clinical guidelines that inadequately account for frailty and functional status, and poor continuity of information across healthcare and long-term care settings. Drawing on perspectives from geriatric medicine and health policy, this article reviews cur-rent evidence on polypharmacy and potentially inappropriate medications in older adults. It further examines the structural impact of prescribing cascades and prevailing prescribing practices on clini-cal care while highlighting the critical role of nurse practitioners (NPs) in medication reconciliation, deprescribing, care transitions, and policy advocacy. Particular emphasis is placed on the expanding contribution of NPs to optimizing medication management through comprehensive medication review, interdisciplinary collaboration, and continuity of care. Finally, this article advocates for a paradigm shift from a culture of prescribing more medications to a governance-based approach to prescribing. It proposes redesigning National Health Insurance reimbursement policies, quality indicators, and Taiwan’s Long-Term Care 2.0 (LTC 2.0) system to institutionally empower nurse practitioners to play a greater role in medication governance for older adults. Such reforms may improve medication safe-ty, enhance the quality of integrated geriatric care, and strengthen the long-term sustainability of the healthcare system in a super-aged society.
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