Aim To synthesise current study findings on the diseases and the corresponding medications that are potentially associated with polypharmacy in community‐dwelling older adults. Background Polypharmacy is receiving increased attention as a potential problem for the older population. Although several scientific investigations have studied polypharmacy, most of them were carried out in long‐term care facilities or mixed settings rather than in community settings solely. Methods This systematic review followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA). Relevant studies published in the English language in peer‐reviewed journals were identified from searches of seven electronic databases for the period of January 2000 through December 2019. Inclusion criteria were: (1) Participants were older adults aged 65 years and older; (2) Polypharmacy was defined by medication count; (3) Medication classes associated with polypharmacy were revealed; (4) Studies were conducted in outpatient care or community settings. The Joanna Briggs Institute critical appraisal checklists for cross‐sectional studies and for cohort studies were used to assess the methodological quality. Results Ten studies were considered having appropriate and acceptable quality to be reviewed, comprising nine cross‐sectional studies and one cohort study. Polypharmacy was most defined as concurrently using five or more medications. Polypharmacy prevalence ranged between 7%–45%. Older age, comorbidity, poor self‐perceived health status, limitations in physical activity, history of falls, depression, and pain were positively associated with polypharmacy. The most prevalent medication taken by older adults with polypharmacy was cardiovascular drugs. Conclusions The prevalence of polypharmacy in older adults varying widely may be due to geographical locations, clinical practice guidelines, and polypharmacy definition used. Relevance to Clinical Practice Validated measurements to investigate medications associated with polypharmacy are required. How polypharmacy develops over time needs to be investigated in longitudinal studies in order to formulate strategies for reducing polypharmacy.

Background High-need older adults have multiple needs and require different types of care services. Care coordinators in community care centers in Taiwan, however, often experience difficulties in providing sufficient care services because of the inadequate capacity of case management. Objective The aim of this study was to develop a realistic care delivery model for the care coordinators to manage the care of high-need, community-dwelling older adults. Methods Focus-group interviews concerning elements and process for establishing a care delivery model were conducted with 12 care management experts in two groups: the practical work group (three registered nurses and three social workers) and the care management group (three care managers and three care management supervisors). The interviews were video-recorded and subjected to content analysis. Results A five-stage care delivery model was formulated: case screening, case assessment, care plan, care delivery, and follow-up evaluation. Six types of high-need older adults were identified: those living with disability, solitude, dementia, depression, elder abuse, and poverty. A list of categorized care services, including care resources, social welfare resources, and caregiver resources, was then used as a guide for case management and care delivery. Discussion The developed model—consisting a classification of services for different types of high-need older adults—serves as a guide for care coordinators in community care centers to make better decisions on service linkages, resource management, and care plan monitoring.

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