Multi-Morbidity and Polypharmacy in Older People: Challenges and Opportunities for Clinical Practice

Aggarwal, Pritti; Woolford, Stephen J; Patel, Harnish P.

doi:10.3390/geriatrics5040085

Cited by 94 publications

(59 citation statements)

References 63 publications

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“…Where two or more health conditions coexist in this way, medical and social care needs are greater. This results in higher levels of service utilisation and costs [ 2 ] to a wide range of health and social care providers [ 3 , 4 ], for example, those living with MLTC have higher rates of unplanned hospital admission, longer durations of hospitalisation, require higher rates of polypharmacy and are more likely to be affected by adverse drug reactions [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

Multiple Long-Term Conditions (MLTC) and the Environment: A Scoping Review

Dambha‐Miller

Cheema

Saunders

et al. 2022

IJERPH

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Background: Multiple Long Term conditions (MLTC) are a major health care challenge associated with high service utilisation and expenditure. Once established, the trajectory to an increased number and severity of conditions, hospital admission, increased social care need and mortality is multifactorial. The role of wider environmental determinants in the MLTC sequelae is unclear. Aim: the aim of this review was to summarise and collate existing evidence on environmental determinants on established MLTC. Methods: comprehensive search of Medline, Embase, Cochrane, CINAHL and Bielefeld Academic Search Engine (BASE), from inception to 4th June 2022 in addition to grey literature. Two authors independently screened and extracted papers. Disagreements were resolved with a third author. Results: searches yielded 9079 articles, 12 of which met the review’s inclusion criteria. Evidence of correlations between some environmental determinants and increased or decreased risks of MLTC were found, including the quality of internal housing/living environments, exposure to airborne environmental hazards and a beneficial association with socially cohesive, accessible and greener neighbourhood environments. Conclusions: The majority of the 12 included papers focused on the built and social environments. The review uncovered very limited evidence, indicating a need for further research to understand the role of environmental determinants in MLTC.

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Section: Introductionmentioning

confidence: 99%

Multiple Long-Term Conditions (MLTC) and the Environment: A Scoping Review

Dambha‐Miller

Cheema

Saunders

et al. 2022

IJERPH

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“…Older people presenting to secondary care with hip fracture are likely to be osteoporotic, sarcopenic, and also have several markers of frailty. As such their assessment and management should be multidisciplinary (orthopaedic, older people’s specialist teams, pharmacy, therapy, nursing, mental health, dietetics, speech and language) and be driven by the process of comprehensive geriatric assessment (CGA) [ 69 ]. Whilst this is the gold standard for patients presenting with a hip fracture, for less frail and more ambulant individuals presenting with other fragility fractures, i.e., wrist, shoulder and vertebral, fracture liaison services (FLS), which are typically multidisciplinary co-ordinated models of care systematically assess, identify and advise on risk factor management.…”

Section: Osteoporosis: Diagnosis and Managementmentioning

confidence: 99%

“…In this regard, fracture risk undoubtedly increases commensurate with the incidence of dementia. CGA for such patients may just identify achievable goals to attain in the short and medium term when risks and benefits of treatment are considered in context of the wider social, physical and psychological domains [ 69 ].…”

Section: Osteoporosis: Diagnosis and Managementmentioning

confidence: 99%

Pathophysiology and treatment of osteoporosis: challenges for clinical practice in older people

et al. 2021

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Osteoporosis, a common chronic metabolic bone disease is associated with considerable morbidity and mortality. As the prevalence of osteoporosis increases with age, a paralleled elevation in the rate of incident fragility fractures will be observed. This narrative review explores the origins of bone and considers physiological mechanisms involved in bone homeostasis relevant to management and treatment. Secondary causes of osteoporosis, as well as osteosarcopenia are discussed followed by an overview of the commonly used pharmacological treatments for osteoporosis in older people.

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“…With increasing polypharmacy again, the risk for the occurrence of drug interactions increases inevitably and could thus lead to multiple unwanted side effects for the patient. A review in 2020 indicated that multimorbidity and polypharmacy are associated with a progressive loss of resilience and impaired homeostasis contributing to a significant burden on health and social care [ 10 ]. Furthermore, a retrospective, single-centre study in 2017 revealed that patients with potential inappropriate discharge medications showed an increased risk for readmission [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

The Impact of Drug Interactions in Patients with Community-Acquired Pneumonia on Hospital Length of Stay

et al. 2022

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(1) Background: An aging society is frequently affected by multimorbidity and polypharmacy, which, in turn, leads to an increased risk for drug interaction. The aim of this study was to evaluate the influence of drug interactions on the length of stay (LOS) in hospitals. (2) Methods: This retrospective, single-centre study is based on patients treated for community-acquired pneumonia in the hospital. Negative binomial regression was used to analyse the association between drug interactions and the LOS in the hospital. (3) Results: The total cohort contained 503 patients, yet 46 inpatients (9%) that died were not included in the analyses. The mean age was 74 (±15.3) years, 35% of patients older than 65 years were found to have more than two drug interactions, and 55% had a moderate, severe, or contraindicated adverse drug reaction. The regression model revealed a significant association between the number of drug interactions (rate ratio (RR) 1.02; 95%-CI 1.01–1.04) and the severity of drug interactions (RR 1.22; 95%-CI 1.09–1.37) on the LOS for the overall cohort as well as for the subgroup of patients aged 80 years and older. (4) Conclusion: Drug interactions are an independent risk factor for prolonged hospitalisation. Standardised assessment tools to avoid drug interactions should be implemented in clinical routines.

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Multi-Morbidity and Polypharmacy in Older People: Challenges and Opportunities for Clinical Practice

Cited by 94 publications

References 63 publications

Multiple Long-Term Conditions (MLTC) and the Environment: A Scoping Review

Multiple Long-Term Conditions (MLTC) and the Environment: A Scoping Review

Pathophysiology and treatment of osteoporosis: challenges for clinical practice in older people

The Impact of Drug Interactions in Patients with Community-Acquired Pneumonia on Hospital Length of Stay

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