Interventions to improve the appropriate use of polypharmacy for older people

Abstract

Interventions to improve the appropriate use of polypharmacy for older people. Cochrane database of systematic reviews (Online),

Defining, identifying and addressing problematic polypharmacy within multimorbidity in primary care: a scoping review

“…2 13–15 80 87–90 Reviews covering over 150 primary studies reported no differences in all-cause mortality and no clear evidence of benefit in reduced hospitalisations, when comparing interventions to usual care. 13 80 88 91–94 There were also no differences in quality of life, adverse drug reactions, readmission rates, primary care visits and emergency department visits. 13 80 92–94 Two reviews have highlighted some economic benefits in reducing healthcare expenditure, but others highlight inconsistencies due to low-quality evidence.…”

“…One common approach uses simple cut offs of age (commonly ≥65 years) combined with cut offs of medications (frequently ≥5) and this was the main inclusion criterion for the majority of trials. 13 Another approach adopted by multiple national recommendations advocate case finding through high-risk groups. 36–38 For instance, both NICE guidelines and the Australian Commission on Safety and Quality in Healthcare recommend greater attention for older people with frailty, and complex multimorbidity and co-existing mental and physical health problems.…”

“…Interventions to address problematic polypharmacy have covered a wide range of aims, such as reducing adverse drug reactions, increasing the appropriateness of medicines use, reducing falls, improving patient adherence and maintaining quality of life. 13 78–81 To combat overprescribing specifically, deprescribing interventions have also received significant attention, though interventions that focus on underprescribing are much less. 82–86 Several large reviews highlight good evidence of improving prescribing patterns, yet mixed and low certainty of evidence in improving patient-relevant outcome measures.…”

“…Despite numerous interventions targeting polypharmacy, there remains little evidence of improvement of health outcomes, such as hospitalisations and death. 13–15 However, some reductions in inappropriate prescribing have been observed. Successes of these interventions have been highly variable and greatly affected by differences in implementation and targeting of patients.…”

“…Successes of these interventions have been highly variable and greatly affected by differences in implementation and targeting of patients. 13–15 Further conceptualising the complex and varied approaches to targeting patients with problematic polypharmacy and multimorbidity may inform empirical research and improve future intervention design. 2 Therefore, a scoping review was performed, to adopt an effective approach for assessing a broad evidence base.…”