What is polypharmacy? A systematic review of definitions

BMC Geriatrics, Год журнала: 2017, Номер 17(1)

Опубликована: Окт. 10, 2017

Multimorbidity and the associated use of multiple medicines (polypharmacy), is common in older population. Despite this, there no consensus definition for polypharmacy. A systematic review was conducted to identify summarise polypharmacy definitions existing literature. The reporting this conforms Preferred Reporting Items Systematic reviews Meta-Analyses (PRISMA) checklist. MEDLINE (Ovid), EMBASE Cochrane were systematically searched, as well grey literature, articles which defined term (without any limits on types definitions) English, published between 1st January 2000 30th May 2016. Definitions categorised i. numerical only (using number medications define polypharmacy), ii. with an duration therapy or healthcare setting (such during hospital stay) iii. Descriptive a brief description polypharmacy). total 1156 identified 110 met inclusion criteria. Articles not but terms such minor major As result, 138 obtained. There 111 (80.4% all definitions), 15 incorporated (10.9%) 12 descriptive (8.7%). most commonly reported five more daily (n = 51, 46.4% articles), ranging from two 11 medicines. Only 6.4% classified distinction appropriate inappropriate polypharmacy, using make distinction. Polypharmacy variable. Numerical did account specific comorbidities present it difficult assess safety appropriateness clinical setting.

Язык: Английский

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Diretrizes Brasileiras de Hipertensão Arterial – 2020

Arquivos Brasileiros de Cardiologia, Год журнала: 2021, Номер 116(3), С. 516 - 658

Опубликована: Март 1, 2021

Content 1. Definition, Epidemiology, and Primary Prevention 528 1.1 Definition of Hypertension […] Brazilian Guidelines – 2020

Язык: Английский

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An update on the clinical consequences of polypharmacy in older adults: a narrative review

Expert Opinion on Drug Safety, Год журнала: 2018, Номер 17(12), С. 1185 - 1196

Опубликована: Дек. 2, 2018

Polypharmacy, the use of multiple medications by one individual, is increasingly common among older adults. Caring for growing number people with complex drug regimens and multimorbidity presents an important challenge in coming years.This article reviews international trends prevalence polypharmacy, summarizes results from previous on polypharmacy negative health outcomes, updates a review clinical consequences focusing studies published after 2013. This narrative review, which based literature search MEDLINE EMBASE January 1990 to June 2018, was undertaken identify relevant articles. Search terms included variations medications.The increasing worldwide. More than half population exposed some settings. Polypharmacy associated broad range consequences. However, methods assess dangers should be refined. In our opinion, issue 'confounding multimorbidity' has been underestimated better accounted future studies. Moreover, researchers develop more clinically definitions including measures inappropriate or problematic polypharmacy.

Язык: Английский

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The feasibility and effect of deprescribing in older adults on mortality and health: a systematic review and meta‐analysis

British Journal of Clinical Pharmacology, Год журнала: 2016, Номер 82(3), С. 583 - 623

Опубликована: Апрель 15, 2016

Deprescribing is a suggested intervention to reverse the potential iatrogenic harms of inappropriate polypharmacy. The review aimed determine whether or not deprescribing safe, effective and feasible modify mortality health outcomes in older adults.

Язык: Английский

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Hypertension Management in Older and Frail Older Patients

Circulation Research, Год журнала: 2019, Номер 124(7), С. 1045 - 1060

Опубликована: Март 28, 2019

The prevalence of arterial hypertension, particularly systolic is constantly rising worldwide. This mainly the clinical expression stiffening as a result population's aging. Chronic elevation in blood pressure represents major risk factor not only for cardiovascular morbidity and mortality but also cognitive decline loss autonomy later life. Clinical evidence obtained community-dwelling older people with few comorbidities preserved supports beneficial effects lowering hypertensive subjects even after age 80 years. However, observational studies frail individuals treated hypertension have shown higher rates compared those lower levels. Clearly, very old subjects, therapeutic strategy one size fits all cannot be applied because enormous functional heterogeneity these individuals. Geriatric medicine proposes taking into account function/frailty/autonomy status people. In present review, we propose to adapt antihypertensive treatment using an easy-to-apply visual numeric scale allowing identification 3 different patient profiles according activities daily living. For function profile, strategies should proposed younger adults. function/preserved living' more detailed geriatric assessment needed define benefit/risk balance well requirements tailoring various strategies. Lastly, altered thoroughly reassessed, including deprescribing (when considered appropriate). near future, controlled trials are necessary most (ie, systematically excluded from previous trials) gain stronger regarding benefits

Язык: Английский

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The epidemiology of polypharmacy in older adults: register-based prospective cohort study

Clinical Epidemiology, Год журнала: 2018, Номер Volume 10, С. 289 - 298

Опубликована: Март 1, 2018

Objective: Polypharmacy is the concomitant use of several drugs by a single person, and it increases risk adverse drug-related events in older adults. Little known about epidemiology polypharmacy at population level. We aimed to measure prevalence incidence investigate associated factors. Methods: A prospective cohort study was conducted using register data with national coverage Sweden. total 1,742,336 individuals aged ≥65 years baseline (November 1, 2010) were included followed until death or end (December 20, 2013). Results: On average, exposed 4.6 (SD =4.0) baseline. The (5+ drugs) 44.0%, excessive (10+ 11.7%. rate among without 19.9 per 100 person-years, ranging from 16.8% 65–74 33.2% those ≥95 (adjusted hazard ratio [HR] =1.49, 95% confidence interval [CI] 1.42–1.56). 8.0 person-years. Older adults multi-dose dispensing significantly higher developing incident compared receiving ordinary prescriptions (HR =1.51, CI 1.47–1.55). When adjusting for confounders, living nursing home found be lower risks =0.79 HR =0.86, p <0.001, respectively). Conclusion: are high Interventions reducing should also target potential users as they ones who fuel future polypharmacy. Keywords: drugs, adults, polypharmacy, prescribing, medication, elderly

Язык: Английский

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Effect of a Pharmacist-Led Educational Intervention on Inappropriate Medication Prescriptions in Older Adults

JAMA, Год журнала: 2018, Номер 320(18), С. 1889 - 1889

Опубликована: Ноя. 13, 2018

Importance

High rates of inappropriate prescribing persist among older adults in many outpatient settings, increasing the risk adverse drug events and drug-related hospitalizations.

Objective

To compare effectiveness a consumer-targeted, pharmacist-led educational intervention vs usual care on discontinuation medication community-dwelling adults.

Design, Setting, Participants

A cluster randomized trial (D-PRESCRIBE [Developing Pharmacist-Led Research to Educate Sensitize Community Residents Inappropriate Prescriptions Burden Elderly]) that recruited community pharmacies Quebec, Canada, from February 2014 September 2017, with follow-up until 2018, randomly allocated them or control groups. Patients included were aged 65 years who prescribed 1 4 Beers Criteria medications (sedative-hypnotics, first-generation antihistamines, glyburide, nonsteroidal anti-inflammatory drugs), 69 pharmacies. screened enrolled before randomization.

Interventions

Pharmacists group encouraged send patients an deprescribing brochure parallel sending their physicians evidence-based pharmaceutical opinion recommend deprescribing. The pharmacists provided care. Randomization occurred at pharmacy level, 34 (248 patients) 35 (241 patients). Patients, physicians, pharmacists, evaluators blinded outcome assessment.

Main Outcomes Measures

Discontinuation prescriptions for 6 months, ascertained by renewal profiles.

Results

Among 489 (mean age, 75 years; 66% women), 437 (89%) completed (219 [88%] 218 [91%] group). At 106 248 (43%) no longer filled compared 29 241 (12%) (risk difference, 31% [95% CI, 23% 38%]). In group, 63 146 sedative-hypnotic users (43.2%) 14 155 (9.0%), respectively 34% 25% 43%]); 19 62 glyburide (30.6%) 8 58 (13.8%), 17% 2% 31%]); 33 (57.6%) 5 23 (21.7%), 35% 10% 55%]) (Pfor interaction = .09). Analysis antihistamine class was not possible because small sample size (n 12). No requiring hospitalization reported, although 77 (38%) attempted taper sedative-hypnotics reported withdrawal symptoms.

Conclusions Relevance

resulted greater after months. generalizability these findings other settings requires further research.

Trial Registration

ClinicalTrials.gov Identifier:NCT02053194

Язык: Английский

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Polypharmacy in the Aging Patient

JAMA, Год журнала: 2016, Номер 315(10), С. 1034 - 1034

Опубликована: Март 8, 2016

Importance

There is substantial uncertainty about optimal glycemic control in older adults with type 2 diabetes mellitus.

Observations

Four large randomized clinical trials (RCTs), ranging size from 1791 to 11 440 patients, provide the majority of evidence used guide therapy. Most RCTs intensive vs standard excluded than 80 years, surrogate end points evaluate microvascular outcomes and provided limited data on which subgroups are most likely benefit or be harmed by specific therapies. Available suggest that does not reduce major macrovascular events for at least 10 years. Furthermore, lead improved patient-centered 8 Data consistently immediately increases risk severe hypoglycemia 1.5- 3-fold. Based these observational studies, 65 harms associated a hemoglobin A_1c(HbA_1c) target lower 7.5% higher 9% outweigh benefits. However, depends patient factors, medications reach target, life expectancy, preferences treatment. If only low treatment burden (such as metformin) required, HbA_1ctarget may appropriate. patients strongly prefer avoid injections frequent fingerstick monitoring, obviates need insulin

Conclusions Relevance

High-quality lacking. Optimal decisions made collaboratively incorporating likelihood benefits burden. For adults, an between will maximize minimize harms.

Язык: Английский

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Too much medicine in older people? Deprescribing through shared decision making

BMJ, Год журнала: 2016, Номер unknown, С. i2893 - i2893

Опубликована: Июнь 3, 2016

Jansen and colleagues explore the role of shared decision making in tackling inappropriate polypharmacy older adults

Язык: Английский

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Deprescribing: A narrative review of the evidence and practical recommendations for recognizing opportunities and taking action

European Journal of Internal Medicine, Год журнала: 2017, Номер 38, С. 3 - 11

Опубликована: Янв. 5, 2017

Язык: Английский

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