Global prevalence of polypharmacy and potentially inappropriate medication in older patients with dementia: a systematic review and meta-analysis

Abstract

Background: Older patients with dementia always need multiple drugs due to comorbidities and cognitive impairment, further complicating drug treatment and increasing the risk of potentially inappropriate medication. The objective of our study is to estimate the global prevalence of polypharmacy and potentially inappropriate medication (PIM) and explore the factors of PIM for older patients with dementia.Methods: We searched PubMed, Embase (Ovid), and Web of Science databases to identify eligible studies from inception to 16 June 2023. We conducted a meta-analysis for observational studies reporting the prevalence of potentially inappropriate medication and polypharmacy in older patients with dementia using a random-effect model. The factors associated with PIM were meta-analyzed.Results: Overall, 62 eligible studies were included, of which 53 studies reported the prevalence of PIM and 28 studies reported the prevalence of polypharmacy. The pooled estimate of PIM and polypharmacy was 43% (95% CI 38–48) and 62% (95% CI 52–71), respectively. Sixteen studies referred to factors associated with PIM use, and 15 factors were further pooled. Polypharmacy (2.83, 95% CI 1.80–4.44), diabetes (1.31, 95% CI 1.04–1.65), heart failure (1.17, 95% CI 1.00–1.37), depression (1.45, 95% CI 1.14–1.88), history of cancer (1.20, 95% CI 1.09–1.32), hypertension (1.46, 95% CI 1.05–2.03), ischemic heart disease (1.55, 95% CI 0.77–3.12), any cardiovascular disease (1.11, 95% CI 1.06–1.17), vascular dementia (1.09, 95% CI 1.03–1.16), chronic obstructive pulmonary disease (1.39, 95% CI 1.13–1.72), and psychosis (1.91, 95% CI 1.04–3.53) are positively associated with PIM use.Conclusion: PIM and polypharmacy were highly prevalent in older patients with dementia. Among different regions, the pooled estimate of PIM use and polypharmacy varied widely. Increasing PIM in older patients with dementia was closely associated with polypharmacy. For other comorbidities such as heart failure and diabetes, prescribing should be cautioned.

The current view of potentially inappropriate medications (PIMs) among older adults in Saudi Arabia: a systematic review

“…In our systematic review, the most prevalent PIMs were proton pump inhibitors (PPI), non-steroidal anti-inflammatory drugs (NSAIDs), antidepressants, and diuretics, which corresponds with the outcomes of prior studies with similar objectives (Tian et al, 2022;Zhao et al, 2023). We recommend the implementation of educational programs for all healthcare providers directly involved in the care of older adults.…”

“…Numerous prior research investigations have documented the global prevalence of PIM use in older adult populations (Saqlain et al, 2020a). For instance, one study found that 60% of dementia patients documented having at least 1 PIMs in European countries, compared to 40% in China among similar patient population (Zhao et al, 2023). In Saudi Arabia, the prevalence of older adults who have been prescribed at least one PIM in their lifetime varies within the range of 45%-66% (Alwhaibi, 2022).…”

“…As a result, there are various assessment tools available for evaluating PIMs, including explicit, implicit, or combined methodologies. The explicit methodology has gained widespread adoption among researchers and clinicians due to its straightforwardness and widespread recognition (Zhao et al, 2023). The widely employed explicit tools in clinical practice and prior research include the Beer's criteria established by the American Geriatrics Society (By the 2023 American Geriatrics Society Beers Criteria ® Update Expert Panel, 2023), as well as STOPP (Screening Tool of Older Persons' Prescriptions) and START (Screening Tool to Alert to Right Treatment).…”

Polypharmacy and associated factors in South Korean elderly patients with dementia: An analysis using National Health Insurance claims data

“…The study of polypharmacy in patients with dementia could provide valuable information not only for clinical practitioners and policy makers in Korea, where the population is aging rapidly, but also in other countries with slower population aging rates. In addition, a recent systematic literature review found that the prevalence of polypharmacy in patients with dementia varied considerably between regions [ 23 ]. This may reflect the influence of region-specific healthcare systems and the different settings of each study.…”

Deprescribing in Older Poly-Treated Patients Affected with Dementia

“…However, notwithstanding the large efforts to develop criteria for assessing medication appropriateness in older people in recent years, few studies focused on people with dementia [ 4 ]. People affected by dementia and comorbidities are a huge problem both in old outpatient and in hospitalized or residential patient drug prescriptions, because old age and cognitive impairment make them extremely vulnerable to various drugs side effects [ 5 ]. In a recent systematic review and meta-analysis, 62 eligible studies were included, of which 53 studies reported the prevalence of potentially inappropriate medications (PIM), and 28 studies reported the prevalence of polypharmacy.…”