Interventions to improve the appropriate use of polypharmacy for older people

Guidance to manage inappropriate polypharmacy in older people: systematic review and future developments

“…Furthermore, polypharmacy impacts significantly health outcomes and healthcare resources. While traditionally polypharmacy has been classified in terms of the number of medicines (usually defined as the use of five or more medicines) [14], Patterson et al suggested, as part of a Cochrane review in 2012 (later updated in 2014), that there should be a change in emphasis from 'inappropriate polypharmacy' (prescribing of multiple medicines which are either inappropriate or no longer indicated) to 'appropriate' or 'optimal polypharmacy' (appropriate prescribing of multiple medicines) [15][16][17].…”

“…The review findings were based upon ten papers, with the authors concluding that, while there is uncertainty about the elements of intervention that impact positively appropriate polypharmacy, pharmaceutical care appears to improve prescribing [16,17].…”

“…Several published systematic literature reviews have focused on aspects of polypharmacy management [15][16][17], but with little emphasis on grey literature, notably policies and guidelines. The aim of this review was to summarise and review critically current policies and guidelines on polypharmacy management in older people (publications dated: 01 January 2010 -30 June 2015).…”

“…The definitions of appropriate and inappropriate polypharmacy were expanded from those of Patterson et al [15][16][17]. Appropriate polypharmacy is present when: all medicines are prescribed for the purpose of achieving specific therapeutic objectives that have been agreed with the patient; therapeutic objectives are actually being achieved or there is a reasonable chance they will be achieved in the future; medicines have been optimised to minimise the risk of ADRs; and the patient is motivated and able to take all medicines as intended.…”

An exploration of health professionals’ experiences of medicines management in elderly, hospitalised patients in Abu Dhabi

“…4 Patterson et al suggest a change in emphasis from inappropriate polypharmacy (prescribing of many medicines which are either inappropriate or no longer indicated) to appropriate or optimal polypharmacy (appropriate prescribing of many medicines). 5 There is a wealth of evidence of inappropriate polypharmacy in the elderly. United Kingdom (UK) data highlight that 20.8% of patients with two clinical conditions are prescribed four to nine medicines, and 1.1% prescribed ten or more; in patients with six or more comorbidities, values are 47.7% and 41.7 %, respectively.…”