Polypharmacy in older adults: a narrative review of definitions, epidemiology and consequences

Abstract

Background The number of older adults has been constantly growing around the globe. Consequently, multimorbidity and related polypharmacy have become an increasing problem. In the absence of an accepted agreement on the definition of polypharmacy, data on its prevalence in various studies are not easily comparable. Besides, the evidence on the potential adverse clinical outcomes related to polypharmacy is limited though polypharmacy has been linked to numerous adverse clinical outcomes. This narrative review aims to find and summarize recent publications on definitions, epidemiology and clinical consequences of polypharmacy. Methods The MEDLINE database was used to identify recent publications on the definition, prevalence and clinical consequences of polypharmacy using their respective common terms and their variations. Systematic reviews and original studies published between 2015 and 2020 were included. Results One hundred and forty-three definitions of polypharmacy and associated terms were found. Most of them are numerical definitions. Its prevalence ranges from 4% among community-dwelling older people to over 96.5% in hospitalized patients. In addition, numerous adverse clinical outcomes were associated with polypharmacy. Conclusion The term polypharmacy is imprecise, and its definition is yet subject to an ongoing debate. The clinically oriented definitions of polypharmacy found in this review such as appropriate or necessary polypharmacy are more useful and relevant. Regardless of the definition, polypharmacy is highly prevalent in older adults, particularly in nursing home residents and hospitalized patients. Approaches to increase the appropriateness of polypharmacy can improve clinical outcomes in older adults.

Association of polypharmacy with falls among older Chinese inpatients: A nationwide cohort study

“…Thus, older adults need to take several kinds of prescription drugs to control diseases 2 . Owing to a lack of education, inappropriate drug treatment and encouragement of guidelines to take multiple medications for the management of multimorbidity, older adults often experience polypharmacy, which has been drawn to the attention of those practicing gerontology and geriatrics 3,4 . According to the common consensus, polypharmacy was termed as taking five drugs or more daily 5 .…”

Mastering the complexity: drug therapy optimization in geriatric patients

“…In the paper on definition, epidemiology and consequences of polypharmacy, Pazan et al show that there is no universally accepted definition of polypharmacy [4]. While many different definitions have been used, the majority only consider the number of drugs.…”

Epidemiological and Clinical Characteristics, Causative Drugs, and Diagnostic Challenges of Fixed Drug Eruption in Elderly Patients: Is Bullous Type a More Common Clinical Phenotype?

“…According to the World Health Organization (2019), polypharmacy is often defined as the routine use of five or more medications, including over-the-counter, prescription, and/or traditional and complementary medicines (23). A recent comprehensive review demonstrated that the prevalence of polypharmacy in older adults ranged from 4% to over 96.5% across various studies, according to the definition, age group, healthcare setting, and region (24). Yet, all studies included in that review showed an increasing prevalence of polypharmacy in older adults over time (24).…”

“…A recent comprehensive review demonstrated that the prevalence of polypharmacy in older adults ranged from 4% to over 96.5% across various studies, according to the definition, age group, healthcare setting, and region (24). Yet, all studies included in that review showed an increasing prevalence of polypharmacy in older adults over time (24). In the present study, on the other hand, half of the patients (n=7) were using ≥5 medications and 21.4% of the patients (n=3) even ≥10 medications (including both the regularly used drugs for comorbidities and intermittently used drugs for infections, pain management, etc.).…”