Summary
Polypharmacy characterizes ongoing prescription of multiple medications in a patient. Following the demographic change and growing number of elderly patients, polypharmacy is of major concern due to the associated risks and even mortality. Many causes made this geriatric syndrome more common in the past decade. First, the management of comorbidities is often lacking in disease-specific guidelines. Second, multimorbidity is rising due to the ageing population. Third, deprescribing methods are sparse, and results are conflicting. This mini review integrates the effects of polypharmacy on mortality and morbidity, the causes and confounders of polypharmacy, and presents a practical stepwise manual of deprescribing. The work is based on a literature search for randomized control trials and reviews in English and German from 2015 onwards in the PubMed database, with integration of relevant citations as a result of this search.
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References
Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. What is polypharmacy? A systematic review of definitions. BMC Geriatr. 2017;17(1):230.
Hughes LD, McMurdo ME, Guthrie B. Guidelines for people not for diseases: the challenges of applying UK clinical guidelines to people with multimorbidity. Age Ageing. 2013;42(1):62–9.
Hsu HF, Chen KM, Belcastro F, Chen YF. Polypharmacy and pattern of medication use in community-dwelling older adults: a systematic review. J Clin Nurs. 2021;30(7–8):918–28.
O’Dwyer M, Peklar J, McCallion P, McCarron M, Henman MC. Factors associated with polypharmacy and excessive polypharmacy in older people with intellectual disability differ from the general population: a cross-sectional observational nationwide study. BMJ Open. 2016;6(4):e10505.
Morin L, Laroche ML, Texier G, Johnell K. Prevalence of potentially inappropriate medication use in older adults living in nursing homes: a systematic review. J Am Med Dir Assoc. 2016;17(9):862.e1–862.e9.
Tommelein E, Mehuys E, Petrovic M, Somers A, Colin P, Boussery K. Potentially inappropriate prescribing in community-dwelling older people across Europe: a systematic literature review. Eur J Clin Pharmacol. 2015;71(12):1415–27.
Bradley MC, Motterlini N, Padmanabhan S, Cahir C, Williams T, Fahey T, et al. Potentially inappropriate prescribing among older people in the United Kingdom. BMC Geriatr. 2014;14:72.
Cooper JA, Cadogan CA, Patterson SM, Kerse N, Bradley MC, Ryan C, et al. Interventions to improve the appropriate use of polypharmacy in older people: a Cochrane systematic review. BMJ Open. 2015;5(12):e9235.
Palmer K, Villani ER, Vetrano DL, Cherubini A, Cruz-Jentoft AJ, Curtin D, et al. Association of polypharmacy and hyperpolypharmacy with frailty states: a systematic review and meta-analysis. Eur Geriatr Med. 2019;10(1):9–36.
Abe N, Kakamu T, Kumagai T, Hidaka T, Masuishi Y, Endo S, et al. Polypharmacy at admission prolongs length of hospitalization in gastrointestinal surgery patients. Geriatr Gerontol Int. 2020;20(11):1085–90.
Davies LE, Spiers G, Kingston A, Todd A, Adamson J, Hanratty B. Adverse outcomes of polypharmacy in older people: systematic review of reviews. J Am Med Dir Assoc. 2020;21(2):181–7.
Jennings ELM, Murphy KD, Gallagher P, O’Mahony D. In-hospital adverse drug reactions in older adults; prevalence, presentation and associated drugs—a systematic review and meta-analysis. Age Ageing. 2020;49(6):948–58.
Chang TI, Park H, Kim DW, Jeon EK, Rhee CM, Kalantar-Zadeh K, et al. Polypharmacy, hospitalization, and mortality risk: a nationwide cohort study. Sci Rep. 2020;10(1):18964.
Fialová D, Brkić J, Laffon B, Reissigová J, Grešáková S, Dogan S, et al. Applicability of EU(7)-PIM criteria in cross-national studies in European countries. Ther Adv Drug Saf. 2019;10:2042098619854014.
Halli-Tierney AD, Scarbrough C, Carroll D. Polypharmacy: evaluating risks and deprescribing. Am Fam Physician. 2019;100(1):32–8.
Jokanovic N, Tan EC, Dooley MJ, Kirkpatrick CM, Bell JS. Prevalence and factors associated with polypharmacy in long-term care facilities: a systematic review. J Am Med Dir Assoc. 2015;16(6):535.e1–535.12.
Pesante-Pinto JL. Clinical pharmacology and the risks of polypharmacy in the geriatric patient. Phys Med Rehabil Clin N Am. 2017;28(4):739–46.
Cheng X, Yang Y, Schwebel DC, Liu Z, Li L, Cheng P, et al. Population ageing and mortality during 1990–2017: a global decomposition analysis. PLoS Med. 2020;17(6):e1003138.
Curtin D, O’Mahony D, Gallagher P. Drug consumption and futile medication prescribing in the last year of life: an observational study. Age Ageing. 2018;47(5):749–53.
Hsu CC, Hsu YC, Chang KH, Lee CY, Chong LW, Lin CL, et al. Depression and the risk of peptic ulcer disease: a nationwide population-based study. Medicine. 2015;94(51):e2333.
Jyrkkä J, Enlund H, Korhonen MJ, Sulkava R, Hartikainen S. Patterns of drug use and factors associated with polypharmacy and excessive polypharmacy in elderly persons: results of the Kuopio 75+ study: a cross-sectional analysis. Drugs Aging. 2009;26(6):493–503.
Lunsky Y, Modi M. Predictors of psychotropic polypharmacy among outpatients with psychiatric disorders and intellectual disability. Psychiatr Serv. 2018;69(2):242–6.
Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005;353(5):487–97.
Hanlon JT, Schmader KE. The medication appropriateness index at 20: where it started, where it has been, and where it may be going. Drugs Aging. 2013;30(11):893–900.
Hanlon JT, Schmader KE, Samsa GP, Weinberger M, Uttech KM, Lewis IK, et al. A method for assessing drug therapy appropriateness. J Clin Epidemiol. 1992;45(10):1045–51.
Rongen GA, Marquet P, van Gerven JMA, EACPT research working group. The scientific basis of rational prescribing. A guide to precision clinical pharmacology based on the WHO 6‑step method. Eur J Clin Pharmacol. 2021;77(5):677–83.
Scordo KA. Teaching students about the WHO guide to good prescribing. Nurse Pract. 2014;39(3):51–4.
Kane RL, Shamliyan T, Talley K, Pacala J. The association between geriatric syndromes and survival. J Am Geriatr Soc. 2012;60(5):896–904.
Wallace E, McDowell R, Bennett K, Fahey T, Smith SM. Impact of potentially inappropriate prescribing on adverse drug events, health related quality of life and emergency hospital attendance in older people attending general practice: a prospective cohort study. J Gerontol A Biol Sci Med Sci. 2017;72(2):271–7.
AGS Choosing Wisely Workgroup. American geriatrics society identifies another five things that healthcare providers and patients should question. J Am Geriatr Soc. 2014;62(5):950–60.
Cassel CK, Guest JA. Choosing wisely: helping physicians and patients make smart decisions about their care. JAMA. 2012;307(17):1801–2.
Gallagher P, Lang PO, Cherubini A, Topinková E, Cruz-Jentoft A, Montero Errasquín B, et al. Prevalence of potentially inappropriate prescribing in an acutely ill population of older patients admitted to six European hospitals. Eur J Clin Pharmacol. 2011;67(11):1175–88.
Gallagher P, O’Mahony D. STOPP (screening tool of older persons’ potentially inappropriate prescriptions): application to acutely ill elderly patients and comparison with beers’ criteria. Age Ageing. 2008;37(6):673–9.
Mann E, Bohmdorfer B, Fruhwald T, Roller-Wirnsberger RE, Dovjak P, Duckelmann-Hofer C, et al. Potentially inappropriate medication in geriatric patients: the Austrian consensus panel list. Wien Klin Wochenschr. 2012;124(5–6):160–9.
Holt S, Schmiedl S, Thürmann PA. Potentially inappropriate medications in the elderly: the PRISCUS list. Dtsch Arztebl Int. 2010;107(31–32):543–51.
Thiem U, Theile G, Junius-Walker U, Holt S, Thürmann P, Hinrichs T, et al. Prerequisites for a new health care model for elderly people with multimorbidity: the PRISCUS research consortium. Z Gerontol Geriatr. 2011;44(2):115–20.
Kuhn-Thiel AM, Weiß C, Wehling M, FORTA authors/expert panel members. Consensus validation of the FORTA (fit fOR the aged) list: a clinical tool for increasing the appropriateness of pharmacotherapy in the elderly. Drugs Aging. 2014;31(2):131–40. https://doi.org/10.1007/s40266-013-0146-0.
Garfinkel D, Zur-Gil S, Ben-Israel J. The war against polypharmacy: a new cost-effective geriatric-palliative approach for improving drug therapy in disabled elderly people. Isr Med Assoc J. 2007;9(6):430–4.
Dovjak P. Tools in polypharmacy. Current evidence from observational and controlled studies. Z Gerontol Geriatr. 2012;45(6):468–72.
Thompson W, Lundby C, Graabaek T, Nielsen DS, Ryg J, Søndergaard J, et al. Tools for deprescribing in frail older persons and those with limited life expectancy: a systematic review. J Am Geriatr Soc. 2019;67(1):172–80.
Castelino RL, Hilmer SN, Bajorek BV, Nishtala P, Chen TF. Drug burden index and potentially inappropriate medications in community-dwelling older people: the impact of home medicines review. Drugs Aging. 2010;27(2):135–48.
Hilmer SN, Mager DE, Simonsick EM, Cao Y, Ling SM, Windham BG, et al. A drug burden index to define the functional burden of medications in older people. Arch Intern Med. 2007;167(8):781–7.
O’Connell J, Burke É, Mulryan N, O’Dwyer C, Donegan C, McCallion P, et al. Drug burden index to define the burden of medicines in older adults with intellectual disabilities: an observational cross-sectional study. Br J Clin Pharmacol. 2018;84(3):553–67.
Rudolph JL, Salow MJ, Angelini MC, McGlinchey RE. The anticholinergic risk scale and anticholinergic adverse effects in older persons. Arch Intern Med. 2008;168(5):508–13.
Weir KR, Ailabouni NJ, Schneider CR, Hilmer SN, Reeve E. Consumer attitudes towards deprescribing: a systematic review and meta-analysis. J Gerontol A Biol Sci Med Sci. 2021; https://doi.org/10.1093/gerona/glab222.
Iyer S, Naganathan V, McLachlan AJ, Le Couteur DG. Medication withdrawal trials in people aged 65 years and older: a systematic review. Drugs Aging. 2008;25(12):1021–31.
Scott IA, Hilmer SN, Reeve E, Potter K, Le Couteur D, Rigby D, et al. Reducing inappropriate polypharmacy: the process of deprescribing. JAMA Intern Med. 2015;175(5):827–34.
Patterson SM, Cadogan CA, Kerse N, Cardwell CR, Bradley MC, Ryan C, et al. Interventions to improve the appropriate use of polypharmacy for older people. Cochrane Database Syst Rev. 2014;10:CD8165.
Garfinkel D, Mangin D. Feasibility study of a systematic approach for discontinuation of multiple medications in older adults: addressing polypharmacy. Arch Intern Med. 2010;170(18):1648–54.
Bain KT, Holmes HM, Beers MH, Maio V, Handler SM, Pauker SG. Discontinuing medications: a novel approach for revising the prescribing stage of the medication-use process. J Am Geriatr Soc. 2008;56(10):1946–52.
Alzner R, Benvenuti-Falger U, Böhmdorfer B et al. Austrian Geriatric Society, Polypharmazie, facultas.wuv. Universitätsverlag, Vienna; 2016.
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P. Dovjak declares that he has no competing interests.
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Dovjak, P. Polypharmacy in elderly people. Wien Med Wochenschr 172, 109–113 (2022). https://doi.org/10.1007/s10354-021-00903-0
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DOI: https://doi.org/10.1007/s10354-021-00903-0