An update on the clinical consequences of polypharmacy in older adults: a narrative review

Abstract

Introduction: Polypharmacy, the use of multiple medications by one individual, is increasingly common among older adults. Caring for the growing number of older people with complex drug regimens and multimorbidity presents an important challenge in the coming years.Areas covered: This article reviews the international trends in the prevalence of polypharmacy, summarizes the results from previous reviews on polypharmacy and negative health outcomes, and updates a previous review on the clinical consequences of polypharmacy by focusing on studies published after 2013. This narrative review, which is based on a literature search in MEDLINE and EMBASE from January 1990 to June 2018, was undertaken to identify relevant articles. Search terms included variations of polypharmacy and multiple medications. Expert opinion: The prevalence of polypharmacy is increasing worldwide. More than half of the older population is exposed to polypharmacy in some settings. Polypharmacy is associated with a broad range of clinical consequences. However, methods to assess the dangers of polypharmacy should be refined. In our opinion, the issue of 'confounding by multimorbidity' has been underestimated and should be better accounted for in future studies. Moreover, researchers should develop more clinically relevant definitions of polypharmacy, including measures of inappropriate or problematic polypharmacy.

Use of potentially inappropriate medication and polypharmacy in older adults: a repeated cross-sectional study

“…Multimorbidity, measured as number of chronic conditions together with number of medications, has been found to be of importance concerning the risk of hospitalisation in an older population [3,4]. However, very few studies include a morbidity measurement when evaluating quality of drug treatment [5,6].…”

Motoric Cognitive Risk Syndrome in Polypharmacy

“…An additional strength is the use of community‐dwelling older adults from a large nationally representative sample and standardized assessments. Over‐the‐counter medication use and use of medications that were not regularly scheduled was not captured, possibly leading to an underestimation of the extent of polypharmacy in this cohort . Although we adjusted for several potential confounders in our analyses, residual or unmeasured confounding may still be present.…”

Medo de cair e risco de quedas em idosos assistidos por uma clínica escola de reabilitação

“…A polifarmácia tem sido associada a prejuízo e declínio progressivo da marcha, aumento da incidência de quedas, aumento da morbidade e da mortalidade de pessoas idosas da comunidade 28,29 . A utilização de 3 ou mais medicamentos aumentou em 2,2 vezes o risco de queda de pessoas idosas, quando comparados a indivíduos que utilizam até 2 medicamentos 30 .…”