Polypharmacy Definitions for Multimorbid Older Adults Need Stronger Foundations to Guide Research, Clinical Practice and Public Health

Sirois, Caroline; Domingues, Nélia Sofia; Laroche, Marie‐Laure; Zongo, Arsène; Lunghi, Carlotta; Guénette, Line; Kröger, Edeltraut; Émond, Valérie

doi:10.3390/pharmacy7030126

Cited by 47 publications

(50 citation statements)

References 34 publications

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“…Polypharmacy and inappropriate prescribing are important clinical challenges, especially among older patients, who often have multiple chronic conditions. Polypharmacy is heterogeneously defined in studies as the use of multiple medications by the patient, although most studies agree on a threshold of at least five medications [1]. In Switzerland, one-quarter of community-dwelling patients aged > 65 years self-report taking five or more drugs [2], although higher rates have been reported based on claims data [3,4].…”

Section: Introductionmentioning

confidence: 99%

Drug Prescription in Older Swiss Men and Women Followed in Family Medicine

Schnegg

Senn

Bugnon

et al. 2019

Drugs - Real World Outcomes

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Background We sought to estimate the prevalence of polypharmacy, the most prevalent drug classes involved, and the prevalence and type of potentially inappropriate prescribing among older male and female patients in family medicine. Methods We conducted a secondary analysis of baseline data from a pragmatic cluster-randomised trial on the efficacy of a screening and management tool for geriatric syndromes among older community-dwelling patients (aged ≥ 75 years) included by 42 family physicians. Information on drug prescription and clinical diagnoses (International Classification of Primary Care-2nd Edition [ICPC-2] coded) were extracted manually from medical records. The prevalence of polypharmacy, defined as the use of at least five permanent oral or parenteral drugs, and of potentially inappropriate medications (PIMs), identified according to 2015 updated Beers criteria, were compared between men and women. Results We included 429 patients (269 women and 160 men; mean age 82.9 and 81.8 years, respectively). Polypharmacy was found in 59.9% of them. Analgesics, antithrombotic agents and agents acting on the renin-angiotensin system were the most frequently prescribed drug categories. Three-quarters of patients (76.7%) were prescribed at least one PIM according to Beers criteria, without difference by sex/gender (p = 0.760). The most frequent PIMs were proton-pump inhibitors used for > 8 weeks, diuretics, benzodiazepines, aspirin for primary prevention, and chronic use of non-steroidal anti-inflammatory drugs. Prescription patterns markedly differed by sex/gender, but the number and patterns of inappropriate prescriptions were comparable overall. Interpretation Both polypharmacy and PIMs were very common in older patients followed regularly in family medicine in Switzerland. Interestingly, most PIMs involved only a limited number of medication classes. Trial registration Clinicaltrials.gov NCT 02618291.

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Section: Introductionmentioning

confidence: 99%

Drug Prescription in Older Swiss Men and Women Followed in Family Medicine

Schnegg

Senn

Bugnon

et al. 2019

Drugs - Real World Outcomes

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“…However, there is no clear consensus. 18 , 21 This may result in difficulties in research, interpretation of literature, and, more importantly, in drawing conclusions regarding the impact of polypharmacy. In this study, a numerical approach to address polypharmacy is used, defined as the use of at least five medicines.…”

Section: Discussionmentioning

confidence: 99%

“…The association between the number of medicines, i.e., a quantitative determination of polypharmacy, and the presence of inappropriate medication is strong. 21 In an effort to deliver a more comprehensive determination of polypharmacy, two different quantitative methods are suggested in this study. Apart from determining the number of prescriptions for each patient, the number of active components prescribed per patient is also determined.…”

Section: Discussionmentioning

confidence: 99%

Defining polypharmacy: in search of a more comprehensive determination method applied in a tertiary psychiatric hospital

Govaerts

Boeyckens

Lammens

et al. 2021

Therapeutic Advances in Psychopharmacology

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Aims: This cross-sectional pharmacoepidemiologic study examined the prevalence of polypharmacy and psychotropic polypharmacy among inpatients in a tertiary psychiatric hospital in Belgium. Methods: Current prescriptions of all inpatients suffering from mental disorders were extracted from the hospital Computerized Physician Order Entry. Two methods were used to examine definitive polypharmacy (defined as the concomitant use of at least five medicines): number of medicines per active component and per prescription. Psychotropic polypharmacy was defined as the concomitant use of at least two psychotropic medicines, based on the first counting, i.e., per active component. Results: In 292 included patients, the prevalence of definitive polypharmacy was 65.8%, with a mean number of 6.8 ± 4.2 medicines per patient. The most prevalent medicines were related to the central nervous system (55.7%), followed by medicines related to the gastro-intestinal (17.6%) and cardiovascular (9.4%) systems. A prevalence of psychotropic polypharmacy of 78.1% was observed, with a mean of 3.0 ± 1.7 psychotropic medicines per patient. Psychotropic polypharmacy was classified in same-class (71.5%), multi-class (82.5%), augmentation (20.6%), and adjuvant (35.5%) polypharmacy. Conclusion: These findings are consistent with previous reports of highly prevalent polypharmacy in patients with mental disorders. Although, in some cases, polypharmacy can be an important part of good clinical practice, the high prevalence of both polypharmacy and psychotropic polypharmacy emphasizes that attention must be paid to the potentially associated risks. Consensus on the definition and method of determination of polypharmacy is needed to support further research.

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“…We collected the demographic characteristics of subjects present in the BLHA database (gender; age group; area of residence) and the information on prescriptions claimed: first antidepressant drug claimed [fifth level of the ATC system]; the presence of polytherapy (yes/no), defined as the presence of more than one antidepressant during follow-up; polypharmacy (yes/no), defined as the presence of claims for at least five different drugs 32,33 (third level of the ATC system), other than antidepressants, during each year of follow-up; specialty of the first prescriber.…”

Section: Independent Variablesmentioning

confidence: 99%

<p>Prevalence and Determinants of Long-Term Utilization of Antidepressant Drugs: A Retrospective Cohort Study</p>

Lunghi¹,

Antonazzo²,

Burato³

et al. 2020

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Purpose: Antidepressant consumption has risen in recent years, driven by longer treatment duration. The objective of this study was to measure the prevalence of antidepressant longterm and chronic use in the Bologna area, Italy, and to identify their main determinants. Materials and Methods: We conducted a retrospective claims-based cohort study by using the Bologna Local Health Authority data. A cohort of 18,307 incident users of antidepressant drugs in 2013 was selected, and subjects were followed for three years. A long-term utilization was defined as having at least one prescription claimed during each year of follow-up, while chronic utilization was defined as claiming at least 180 defined daily doses per year. Factors associated with chronic and long-term use were identified by univariate and multivariate logistic regressions. Results: In our cohort, 5448 (29.8%) and 1817 (9.9%) subjects were dispensed antidepressants for a long-term course and in a chronically way, respectively. Older age, antidepressant polytherapy, polypharmacy, and being prescribed the first antidepressant by a hospital physician were all factors independently associated with chronic and long-term prescriptions of antidepressant drugs. Results were reported separately for men and women. Conclusion: Antidepressant long-term and chronic prescriptions are common in the Bologna area. Because longer treatment should be clinically motivated, these results strongly prompt the need to evaluate the actual relevance, as they may indicate potentially inappropriate prescription patterns.

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Polypharmacy Definitions for Multimorbid Older Adults Need Stronger Foundations to Guide Research, Clinical Practice and Public Health

Cited by 47 publications

References 34 publications

Drug Prescription in Older Swiss Men and Women Followed in Family Medicine

Drug Prescription in Older Swiss Men and Women Followed in Family Medicine

Defining polypharmacy: in search of a more comprehensive determination method applied in a tertiary psychiatric hospital

<p>Prevalence and Determinants of Long-Term Utilization of Antidepressant Drugs: A Retrospective Cohort Study</p>

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