Background: Polypharmacy is common in the elderly population and is associated with an increased risk of adverse drug events. To diminish this risk, the guideline 'Polypharmacy in the Elderly' has been developed in 2012. This study examines, to what extent Dutch pharmacotherapeutic practice amongst elderly with polypharmacy mirrors the best practice described in this guideline and which barriers threaten it. Methods: An observational study was conducted in 2013/14 using a questionnaire distributed amongst Dutch healthcare professionals and elderly patients with polypharmacy. Healthcare professionals were asked about their current practice and the presence of five significant barriers, selected through a literature review and from expert opinion. These barriers are: inadequate transfer of patient records; insufficient documentation of prescribed drugs; a lack of collaboration between professionals; a failure to take a full control of the medication and insufficient involvement of the patient. The patients were asked about their experience with pharmacotherapeutic care. Results: No more than 26% of the healthcare professionals indicated that they use the guideline. The five barriers threatening the pharmacotherapeutic care were found to be present. Fortythree percent of the patients mentioned that their medication was assessed last year. Conclusion: The guideline is not used frequently by the healthcare professionals, but there is a will to improve the care by following this guideline. However, the presence of the five barriers hampers its implementation. Good management of those barriers is necessary in order to improve the collaboration between primary and secondary care and to enhance the documentation of prescribed drugs.