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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3D Printing Pharmaceuticals: Drug Development to Frontline Care

Trends in Pharmacological Sciences, Год журнала: 2018, Номер 39(5), С. 440 - 451

Опубликована: Март 11, 2018

Язык: Английский

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The relationship between frailty and polypharmacy in older people: A systematic review

British Journal of Clinical Pharmacology, Год журнала: 2018, Номер 84(7), С. 1432 - 1444

Опубликована: Март 25, 2018

Frailty is a complex geriatric syndrome resulting in decreased physiological reserves. and polypharmacy are common older adults the focus of extensive studies, although little known about impact they may have on each other. This first systematic review analysing available evidence relationship between frailty adults.Systematic quantitative studies. A comprehensive literature search for publications English or Spanish was performed MEDLINE, CINAHL, Cochrane Database PsycINFO September 2017 without applying restrictions date publication. Studies reporting any were considered.A total 25 included, all them observational Evaluation Fried's criteria most approach, followed by Edmonton Frail Scale FRAIL scale. Sixteen 18 cross-sectional analyses five seven longitudinal demonstrated significant association an increased number medications frailty. The causal unclear appears to be bidirectional. Our analysis published data suggests that could major contributor development frailty.A reduction cautious strategy prevent manage Further research needed confirm possible benefits reducing development, reversion delay

Язык: Английский

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Alzheimer’s Disease Microbiome Is Associated with Dysregulation of the Anti-Inflammatory P-Glycoprotein Pathway

mBio, Год журнала: 2019, Номер 10(3)

Опубликована: Май 6, 2019

Studies of the intestinal microbiome and AD have demonstrated associations with composition at genus level among matched cohorts. We move this body literature forward by more deeply investigating via metagenomics comparing patients against those without dementia other types. also exploit machine learning approaches that combine both metagenomic clinical data. Finally, our functional studies using stool samples from elders demonstrate how c can affect health dysregulation P-glycoprotein pathway. contributes directly to inflammatory disorders intestine. Since has been long thought be linked chronic bacterial infections as a possible etiology, findings therefore fill gap in knowledge field research identifying nexus between microbiome, loss homeostasis, inflammation may underlie neurodegenerative disorder.

Язык: Английский

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Adverse Outcomes of Polypharmacy in Older People: Systematic Review of Reviews

Journal of the American Medical Directors Association, Год журнала: 2020, Номер 21(2), С. 181 - 187

Опубликована: Янв. 8, 2020

ObjectivePolypharmacy is widespread among older people, but the adverse outcomes associated with it are unclear. We aim to synthesize current evidence on health, social, medicines management, and health care utilization of polypharmacy in people.DesignA systematic review, reviews meta-analyses observational studies, was conducted. Eleven bibliographic databases were searched from 1990 February 2018. Quality assessed using AMSTAR (A Measurement Tool Assess Systematic Reviews).Setting participantsOlder people any setting, residential or country.ResultsTwenty-six reporting 230 unique studies included. Almost all operationalized as medication count, few examined classes disease states within this. Evidence for an association between many outcomes, including drug events disability, conflicting. The most consistent found hospitalization inappropriate prescribing. No research had explored very old (aged ≥85 years), potential social consequences use, such loneliness isolation.Conclusions implicationsThe literature examining complex, extensive, Until a more clinically relevant manner, will not be fully understood. Future should work toward this approach face rising multimorbidity population aging.

Язык: Английский

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An overview of prevalence, determinants and health outcomes of polypharmacy

Therapeutic Advances in Drug Safety, Год журнала: 2020, Номер 11

Опубликована: Янв. 1, 2020

A high rate of polypharmacy is, in part, a consequence the increasing proportion multimorbidity ageing population worldwide. Our understanding potential harm taking multiple medications an older, multi-morbid population, who are likely to be on regime, is limited. This narrative literature review that aims appraise and summarise recent studies published about polypharmacy. We searched MEDLINE using search terms (and its variations, e.g. prescriptions, inappropriate drug use, etc.) titles. Systematic reviews original English between 2003 2018 were included. In this review, we provide current definitions identify determinants prevalence reported different studies. Finally, some findings regarding association health outcomes older adults, with focus frailty, hospitalisation mortality. Polypharmacy was most often defined number being taken by individual at any given time. showed varied 10% as around 90% populations. Chronic conditions, demographics, socioeconomics self-assessed factors independent predictors associated various adverse after adjusting for conditions. Optimising care valid, reliable measures, relevant all patients, will improve adult population.

Язык: Английский

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The silent epidemic of chronic pain in older adults

Progress in Neuro-Psychopharmacology and Biological Psychiatry, Год журнала: 2019, Номер 93, С. 284 - 290

Опубликована: Апрель 17, 2019

Язык: Английский

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Polypharmacy in older adults: a narrative review of definitions, epidemiology and consequences

European Geriatric Medicine, Год журнала: 2021, Номер 12(3), С. 443 - 452

Опубликована: Март 10, 2021

Abstract Background The number of older adults has been constantly growing around the globe. Consequently, multimorbidity and related polypharmacy have become an increasing problem. In absence accepted agreement on definition polypharmacy, data its prevalence in various studies are not easily comparable. Besides, evidence potential adverse clinical outcomes to is limited though linked numerous outcomes. This narrative review aims find summarize recent publications definitions, epidemiology consequences polypharmacy. Methods MEDLINE database was used identify definition, using their respective common terms variations. Systematic reviews original published between 2015 2020 were included. Results One hundred forty-three definitions associated found. Most them numerical definitions. Its ranges from 4% among community-dwelling people over 96.5% hospitalized patients. addition, with Conclusion term imprecise, yet subject ongoing debate. clinically oriented found this such as appropriate or necessary more useful relevant. Regardless highly prevalent adults, particularly nursing home residents Approaches increase appropriateness can improve adults.

Язык: Английский

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Culture as a cure

OECD health working papers, Год журнала: 2020, Номер unknown

Опубликована: Май 30, 2020

While health care quality has been improving on average in OECD members countries, patient safety remains a central priority for policy makers and leaders. A growing research body found that PSC is associated with numerous positive outcomes, including improved experience, organisational productivity staff satisfaction. Tools to measure have proliferated recent decades are now wide-spread use. This report includes findings from countries the state of art measurement practices related PSC. Overall, prevalent across though application, purpose, tools vary. International learning benchmarking significant potential better understanding improvement quality.

Язык: Английский

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Prevalence and factors associated with polypharmacy: a systematic review and meta-analysis

BMC Geriatrics, Год журнала: 2022, Номер 22(1)

Опубликована: Июль 19, 2022

Abstract Introduction Polypharmacy is commonly associated with adverse health outcomes. There are currently no meta-analyses of the prevalence polypharmacy or factors polypharmacy. We aimed to estimate pooled and in a systematic review meta-analysis. Methods MEDLINE, EMBASE, Cochrane databases were searched for studies restrictions on date. included observational that reported among individuals over age 19. Two reviewers extracted study characteristics including definitions, design, setting, geography, participant demographics. The risk bias was assessed using Newcastle-Ottawa Scales. main outcome prevalence. estimates 95% confidence intervals determined random effects Subgroup analyses undertaken evaluate such as design geography. Meta-regression conducted assess associations between year. Results 106 full-text articles identified. estimated 54 reporting all medication classes 37% (95% CI: 31-43%). Differences different numerical thresholds, publication Sex, geographical location not differences Discussion Our highlights common particularly older adults those inpatient settings. Clinicians should be aware populations who have an increased likelihood experiencing efforts made appropriateness prescribed medications occurrence potentially Conclusions implications undertake minimize inappropriate whenever possible.

Язык: Английский

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