Background/Objectives Polypharmacy is receiving increased attention as a potential problem for older persons, who frequently have multiple chronic conditions. The purpose of this study was to summarize evidence regarding the health outcomes associated with polypharmacy, defined as number of prescribed medications,among older community-dwelling persons. Design Systematic review of MEDLINE (OvidSP 1946 to May Week 3 2014). Setting Community Participants Observational studies examining health outcomes according to the number of prescription medications taken. Measurements Association of number of medications with health outcomes. Because of the importance of comorbidity as a potential confounder of the relationship between polypharmacy and health outcomes, articles were assessed regarding the quality of their adjustment for confounding. Results Of the total of 50 studies identified, the majority studies that were rated as “good” in terms of their adjustment for comorbidity demonstrated relationships between polypharmacy and a range of outcomes, including falls/fall outcomes/fall risk factors; adverse drug events, hospitalization, mortality, and measures of function and cognition. However, a number of these studies failed to demonstrate associations, as did a substantial proportion of those studies rated as “fair” or “poor.” Conclusions Data are mixed regarding the relationship between polypharmacy, considered in terms of number of medications, and adverse outcomes among community-dwelling older persons. Because of the challenge of confounding, randomized controlled trials of medication discontinuation may provide more definitive evidence regarding this relationship.

QI strategies are associated with improved hypertension control. A focus on hypertension by someone in addition to the patient's physician was associated with substantial improvement. Future research should examine the contributions of individual QI strategies and their relative costs.

clinicaltrials.gov Identifier: NCT00237692.

Rapid clinical screening using specific geriatric criteria is effective in identifying frail older subjects at risk for mortality and nursing home utilization. Our findings suggest that geriatric syndromes are more predictive of adverse outcomes than diagnosis per se. This well operationalized screening process is inexpensive as well as effective and could easily be introduced into other hospital settings.

Multimorbidity-the presence of multiple chronic conditions in a patient-has a profound impact on health, health care utilization, and associated costs. Definitions of multimorbidity in clinical care and research have evolved over time, initially focusing on a patient's number of comorbidities and the associated magnitude of required care processes, and later recognizing the potential influence of comorbidity characteristics on patient care and outcomes. In this article, we review the relationship between multimorbidity and quality of care, and discuss how this relationship may be mediated by the degree to which conditions interact with one another to generate clinical complexity (comorbidity interrelatedness). Drawing on established theoretical frameworks from cognitive engineering and biomedical informatics, we describe how interactions among conditions result in clinical complexity and may affect quality of care. We discuss how this comorbidity interrelatedness influences the value of existing quality guidelines and performance metrics, and describe opportunities to quantify this construct using data widely available through electronic health records. Incorporating comorbidity interrelatedness into conceptualizations of multimorbidity has the potential to enhance clinical and research efforts that aim to improve care for patients with multiple chronic conditions.