Polypharmacy Management in the Older Adults: A Scoping Review of Available Interventions

Abstract

Background: Polypharmacy paves the way for non-adherence, adverse drug reactions, negative health outcomes, increased use of healthcare services and rising costs. Since it is most prevalent in the older adults, there is an urgent need for introducing effective strategies to prevent and manage the problem in this age group.Purpose: To perform a scoping review critically analysing the available literature referring to the issue of polypharmacy management in the older adults and provide narrative summary.Data sources: Articles published between January 2010–March 2018 indexed in CINHAL, EMBASE and PubMed addressing polypharmacy management in the older adults.Results: Our search identified 49 papers. Among the identified interventions, the most often recommended ones involved various types of drug reviews based on either implicit or explicit criteria. Implicit criteria-based approaches are used infrequently due to their subjectivity, and limited implementability. Most of the publications advocate the use of explicit criteria, such as e.g. STOPP/START, Beers and Medication Appropriateness Index (MAI). However, their applicability is also limited due to long lists of potentially inappropriate medications covered. To overcome this obstacle, such instruments are often embedded in computerised clinical decision support systems.Conclusion: Multiple approaches towards polypharmacy management are advised in current literature. They vary in terms of their complexity, applicability and usability, and no “gold standard” is identifiable. For practical reasons, explicit criteria-based drug reviews seem to be advisable. Having in mind that in general, polypharmacy management in the older adults is underused, both individual stakeholders, as well as policymakers should strengthen their efforts to promote these activities more strongly.

Prevalence of Chronic Polypharmacy in Community-Dwelling Elderly People in Poland: Analysis of National Real-World Database Helps to Identify High Risk Group

“…Considering the above, it seems to be much more realistic to implement simpler, explicit criteria-based interventions aimed at deprescribing, such as drug reviews using validated tools (e.g. STOPP/START or Beers criteria) ( Kurczewska-Michalak et al, 2021 ). Such interventions may be further developed by dedicated applications or computer-assisted decision support systems, in order to promote their applicability.…”

Medication Adherence Among Patients with Multimorbidity in the United Arab Emirates

“… 15 Research has documented that low adherence to medications is multifactorial and multidimensional related to patients, physicians, and healthcare systems. 10 , 11 Furthermore, the current pandemic has had a negative effect and several constrains on the patients, public and the healthcare system. 16–19 Though the expenses are due to increased medication costs, there is evidence that there is a reduction in overall health care with medication adherence costs.…”

Reimbursed Medication Adherence Enhancing Interventions in European Countries: Results of the EUREcA Study

“…Medication non-adherence has a serious negative impact on health outcomes and results in increased health care utilization and costs (Breekveldt-Postma et al, 2008;Cutler et al, 2018;Kleinsinger, 2018;Mongkhon et al, 2018;Inotai et al, 2021). It should be also noted that the trend of accelerated aging society in the 21 st century increases the burden of multimorbidity and polypharmacy and consequently the likelihood and negative consequences of poor adherence (Midao et al, 2018;Kardas et al, 2021;Kurczewska-Michalak et al, 2021).…”