Background <p>Polypharmacy, defined as the inappropriate use of multiple concomitant medications, represents a major concern in elderly care and is associated with drug–drug interactions, adverse effects, and poor medication adherence. Previous studies have emphasized the importance of proactive pharmacist involvement in addressing polypharmacy. However, evidence regarding patient outcomes following pharmaceutical interventions remains limited. This study aimed to evaluate whether community pharmacists could contribute to optimizing medication therapy among elderly patients living in the community. Pharmaceutical interventions targeting polypharmacy were implemented with consideration of patient characteristics and caregiver perspectives.</p> Methods <p>Questionnaire surveys were conducted among elderly patients receiving six or more daily medications and among caregivers, including helpers and visiting nurses. Cases involving potentially inappropriate prescriptions were identified in elderly outpatients, and deprescribing proposals were communicated to the respective prescribing physicians with patient consent. Follow-up assessments were conducted at least four weeks after intervention in patients whose medications had been deprescribed.</p> Results <p>Among elderly respondents, 32.7% expressed a desire to reduce the number of oral medications. Caregivers frequently reported challenges associated with patients receiving multiple prescriptions. Following pharmacist-led interventions, the number of prescribed medications decreased, particularly within the gastrointestinal and pain medication categories. Most patients reported no worsening of symptoms, and some indicated that medication administration had become easier.</p> Conclusions <p>These findings suggest that community pharmacists may contribute to improving the quality of medication therapy in elderly outpatients through community-based interventions targeting polypharmacy.</p> Graphical Abstract <p></p>