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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Interventions to improve the appropriate use of polypharmacy for older people

Cochrane library, Год журнала: 2014, Номер unknown

Опубликована: Окт. 7, 2014

Язык: Английский

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Interventions to improve the appropriate use of polypharmacy for older people

Cochrane library, Год журнала: 2018, Номер 2018(9)

Опубликована: Сен. 3, 2018

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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Interventions to improve the appropriate use of polypharmacy for older people

Cochrane library, Год журнала: 2023, Номер 2023(10)

Опубликована: Окт. 11, 2023

Язык: Английский

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Potentially inappropriate prescribing and its associations with health‐related and system‐related outcomes in hospitalised older adults: A systematic review and meta‐analysis

British Journal of Clinical Pharmacology, Год журнала: 2021, Номер 87(11), С. 4150 - 4172

Опубликована: Май 18, 2021

Aims To synthesise associations of potentially inappropriate prescribing (PIP) with health‐related and system‐related outcomes in inpatient hospital settings. Methods Six electronic databases were searched: Medline Complete, EMBASE, CINAHL, PyscInfo, IPA Cochrane library. Studies published between 1 January 1991 31 2021 investigating PIP older adults settings, included. A random effects model was employed using the generic inverse variance method to pool risk estimates. Results Overall, 63 studies included . Pooled estimates did not show a significant association all‐cause mortality (adjusted odds ratio [AOR] 1.10, 95% confidence interval [CI] 0.90–1.36; adjusted hazard 1.02, 83% CI 0.90–1.16), readmission (AOR 1.11, 0.76–1.63; 0.89–1.18). associated 91%, 60% 26% increased adverse drug event‐related admissions 1.91, 1.21–3.01), functional decline 1.60, 1.28–2.01), reactions events 1.26, 1.11–1.43), respectively. falls (2/2 studies). The impact on emergency department visits, length stay, quality life inconclusive. Economic cost reported 3 studies, comprised various estimation methods. Conclusions significantly range outcomes. It is important optimise adults' prescriptions facilitate improved care.

Язык: Английский

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Deprescribing in older adults with polypharmacy

BMJ, Год журнала: 2024, Номер unknown, С. e074892 - e074892

Опубликована: Май 7, 2024

Abstract Polypharmacy is common in older adults and associated with adverse drug events, cognitive functional impairment, increased healthcare costs, risk of frailty, falls, hospitalizations, mortality. Many barriers exist to deprescribing, but efforts have been made develop implement deprescribing interventions that overcome them. This narrative review describes intervention components summarizes findings from published randomized controlled trials tested polypharmacy, as well reports on ongoing trials, guidelines, resources can be used facilitate deprescribing. Most were medication reviews primary care settings, many contained such shared decision making and/or a focus patient priorities, training for professionals, facing education materials, involvement family members, representing great heterogeneity addressing polypharmacy adults. Just over half study found perform better than usual at least one their outcomes, most assessed 12 months or less.

Язык: Английский

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Association of polypharmacy and hyperpolypharmacy with frailty states: a systematic review and meta-analysis

European Geriatric Medicine, Год журнала: 2018, Номер 10(1), С. 9 - 36

Опубликована: Ноя. 7, 2018

Язык: Английский

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Polypharmacy as a Risk Factor for Clinically Relevant Sarcopenia: Results From the Berlin Aging Study II

The Journals of Gerontology Series A, Год журнала: 2017, Номер 73(1), С. 117 - 122

Опубликована: Май 6, 2017

Sarcopenia affects more than 10% of older adults. Next to age-associated physiologic changes, diseases like diabetes or inflammatory, neurological, malignant and endocrine disorders may contribute the development sarcopenia. Likewise, polypharmacy, i.e., multiple drug use, is common among Although two conditions frequently co-occur, association polypharmacy with sarcopenia has not yet been examined. We investigated in a large cohort community-dwelling adults (60–84 years). Thousand five hundred participants from Berlin Aging Study II were included. Polypharmacy was defined as concurrent use 5 drugs (prescription nonprescription). Body composition assessed dual-energy X-ray absorptiometry, appendicular lean mass (ALM) calculated sum four limbs' mass. low ALM-to-body index (BMI)-ratio using validated sex-specific cutoffs. Mean age 68.7 ± 3.7 years, 50.7% female. The median (interquartile range) number 2 (1–4); 21.1% subjects reported regular ≥5 drugs. Subjects often sarcopenic according applied ALM/BMI-cutoffs (16.3% vs 6.9%, p < 0.001), higher BMI (p 0.001) lower ALM/BMI but no significant difference mean ALM. Notably, also associated rates reduced gait speed exhaustion. Even after multivariable adjustment (sex, age, comorbid physical activity) consistently significantly increased likelihood (odds ratio = 2.24, 95% confidence interval [CI] 1.33–3.75). clinically relevant sarcopenia, by ALM/BMI.

Язык: Английский

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A modified Delphi study to determine the level of consensus across the European Union on the structures, processes and desired outcomes of the management of polypharmacy in older people

PLoS ONE, Год журнала: 2017, Номер 12(11), С. e0188348 - e0188348

Опубликована: Ноя. 20, 2017

Background Inappropriate use of multiple medicines (inappropriate polypharmacy) is a major challenge in older people with consequences increased prevalence and severity adverse drug reactions interactions, reduced adherence. The aim this study was to determine the levels consensus amongst key stakeholders European Union (EU) relation aspects management polypharmacy people. Methods Forty-six statements were developed on healthcare structures, processes desired outcomes, defined at ≥ 80% agreement. Panel members strategists (e.g. directors, leading clinicians commissioners) from each 28 EU member states, target recruitment five per state. Three Delphi rounds conducted via email, panel being provided summative results collated, anonymised comments commencement Rounds 2 3. Results Ninety recruited (64.3% target), high participation throughout three (91.1%, 83.3%, 72.2%). During Round 1, obtained for 27/46 (58.7%), an additional two none Consensus relating to: potential gain arising (3/4 statements); strategic development (7/7); change (5/7) indicator measures (4/6); legislation (0/3); awareness raising (5/5); reviews (5/7); vision (0/7). Analysis free text indicated that too ambitious not achievable by specified timeframe 2025. Conclusion around many Notably, no achieved need alter areas delivery, remuneration practitioner scope practice. While 2025 considered rather ambitious, there great clear opportunity advance beyond.

Язык: Английский

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