Benefits, risks and impacts on quality of life of medications used in multimorbid older adults: a Delphi study

  • Caroline SiroisEmail author
  • Carlotta Lunghi
  • William Berthelot
  • Marie-Laure Laroche
  • Anissa Frini
Research Article


Background Multimorbidity and polypharmacy are common in older people. Despite the existence of quality criteria for medication use among this population, there is little guidance for managing the complex pharmacological arsenal in a multimorbidity context. Objective To establish consensus on benefits, risks and impacts on quality of life of medications used in an older adult with three chronic diseases that require complex pharmacotherapy. Setting International experts in pharmacology. Method A panel of experts responded to three rounds of a Delphi survey. They assessed the benefits, risks and positive impacts on quality of life of 50 different medications or medication classes that could be used by a hypothetical multimorbid older patient aged 65–75 years, with type 2 diabetes, heart failure and chronic obstructive pulmonary disease. Each aspect was evaluated on a 5-level Likert scale. Main outcome measure Percentage of agreement on each of the three aspects for all medication. Results Consensus was reached on 95% of items (166/174). Only two medication classes were associated with both the highest category of benefits and positive impacts on quality of life, and the lowest risk category: long-acting anticholinergics and long-acting beta-2-agonists. Nine other medications/classes of medications were categorized within the highest benefits level (metformin, DPP-4-inhibitors, short-acting beta-2-agonists, ACE inhibitors, beta-blockers, warfarin, non-vitamin K oral anticoagulants, nitrates and acetaminophen). Fifteen medications were included in the highest level of risks, among which warfarin and Non-vitamin K oral anticoagulants. Conclusions Medications recommended in clinical guidelines for individual diseases are generally considered positive for multimorbid older patients. Nevertheless, a non-negligible number of medications was deemed negative or very negative by our panelists. For multimorbid patients, individualizing treatment according to their preferences seems of utmost importance.


Benefits Multimorbidity Polypharmacy Quality of life Risks 



We sincerely thank all the participants who generously responded to our lengthy Delphi survey and provided valuable comments. We also thank Myles Gaulin who edited our document.


The study was supported by a Grant from the Université du Québec à Rimouski and a grant by the Research Centre in Patient Care and Front Line Services at Laval University (Centre de recherche sur les soins et les services de première ligne de l’Université Laval). Caroline Sirois is a recipient of a Junior 1 Research Scholar from the Quebec Research Funds in Health (Fonds de recherche du QuébecSanté, FRQS).

Conflicts of interest

The authors declare no conflict of interest.


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Social and Preventive MedicineLaval UniversityQuebecCanada
  2. 2.Centre d’excellence sur le vieillissement de Québec, CIUSSS-CNHôpital St-SacrementQuebecCanada
  3. 3.Centre de recherche sur les soins et les services de première ligne de l’Université LavalQuebecCanada
  4. 4.Department of NursingUQARLévisCanada
  5. 5.Faculty of MedicineLaval UniversityQuebecCanada
  6. 6.Service de Pharmacologie, Toxicologie et Pharmacovigilance, Centre Régional de Pharmacovigilance, de Pharmacoépidémiologie et d’information sur les médicamentsCentre Hospitalier Universitaire de LimogesLimogesFrance
  7. 7.Faculty of MedicineLimoges UniversityLimogesFrance
  8. 8.INSERM 1248Limoges UniversityLimogesFrance
  9. 9.Department of ManagementUQARLévisCanada

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