Prevalence And Definitions of Polypharmacy: A Systematic Review And Meta-Analysis

Abstract

INTRODUCTION: Polypharmacy is common associated with several adverse health outcomes. There are currently no systematic reviews or meta-analyses on the prevalence of polypharmacy and associated factors. We aimed to identify population-based observational studies reporting on the prevalence of polypharmacy and factors associated with polypharmacy. METHODS: MEDLINE, EMBASE, and Cochrane databases with no restriction on date. Population-based observational studies with cross-sectional, case-control, or cohort designs using administrative databases or registries to define or measure polypharmacy among individuals over 19. Using a standardized form, two reviewers independently extracted study characteristics, a crude prevalence rate of polypharmacy and its standard error with 95% confidence intervals (CIs). The risk of bias and quality of studies was assessed using the Newcastle-Ottawa Scale. The main outcome was the prevalence of polypharmacy and factors associated with polypharmacy. Using a random-effects model, pooled prevalence estimates with 95% CI was reported. Subgroup analysis was performed if significant heterogeneity was explored. Meta-regression analysis was conducted to predict polypharmacy prevalence.RESULTS: 106 full-text articles were identifies using 21 unique terms with 138 descriptive definitions of polypharmacy. The pooled estimated prevalence polypharmacy in studies reporting all medication classes was 37% (95% CI: 31%-43%). Differences in polypharmacy prevalence were reported for studies using different numerical threshold and polypharmacy was also associated with study year in meta-regression. Sex, study geography, study design and study setting were not associated with differences in polypharmacy prevalence. DISCUSSION: Our review highlights that polypharmacy is common particularly among older adults and those in inpatient settings. A variety of definitions are used to define polypharmacy and differences in polypharmacy definitions may have implications for understanding the burden or polypharmacy and outcomes associated with polypharmacy. CONCLUSIONS AND IMPLICATIONS: Clinicians should be aware of the common occurrence of polypharmacy in all populations and undertake efforts to minimize inappropriate polypharmacy whenever possible.

Individualized Approaches to Diabetes Care in Nursing Homes

“…Many people in nursing homes are physically weak and unable to do much of anything. Diseases and conditions associated with ageing contribute to this phenomenon 76,27,19 . These include cardiovascular illness (stroke and heart failure), arthritis, sarcopenia, osteoporosis, chronic pain, disorientation, fear of falling, incontinence, iatrogenic consequences, cognitive decline, and depression 95 .…”