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Introduction: Polypharmacy, the use of multiple medications by one individual, is increasingly common among older adults. Caring for the growing number of older people with complex drug regimens and multimorbidity presents an important challenge in the coming years.
Areas covered: This article reviews the international trends in the prevalence of...
Citations
... This underscores a notable correlation between the prevalence of polypharmacy and the coexistence of multimorbidity, thereby indicating a connection to frailty and advancing age, particularly among those aged over 65. Consistently, many studies considered polypharmacy a global risk factor among older adults [37,38], not only to monitor the occurrence of adverse effects potentially associated with polypharmacy [39,40], but also to reduce the risk of poor treat-ment adherence and missed doses among the geriatric population [41]. Moreover, it was found that the causal relationship between frailty and polypharmacy is unclear and, in fact, appears to be bidirectional [42]. ...
Background: Potentially inappropriate polypharmacy (PIP) is among the major factors leading to adverse drug reactions, increased healthcare costs, reduced medication adherence, and worsened patient conditions. This study aims to identify existing interventions implemented to monitor and manage polypharmacy in the Italian setting. Methods: A systematic literature review (PROSPERO: CRD42023457049) was carried out according to the PRISMA statement guidelines. PubMed, Embase, ProQuest, and Web of Science were queried without temporal constraints, encompassing all published papers until October 2023. Inclusion criteria followed the PICO model: patients with polypharmacy; interventions to monitor/manage polypharmacy regimen versus no/any intervention; outcomes in terms of intervention effectiveness and cost variation. Results: After duplicate deletion, 153 potentially relevant publications were extracted. Following abstract and full-text screenings, nine articles met the inclusion criteria. Overall, 78% (n = 7) were observational studies, 11% (n = 1) were experimental studies, and 11% (n = 1) were two-phase studies. A total of 44% (n = 4) of the studies involved patients aged ≥ 65 years, while 56% (n = 5) were disease-specific. Monitoring was the most prevalent choice of intervention (67%; n = 6). Outcomes were mainly related to levels of polypharmacy (29%; n = 6) and comorbidities (29%; n = 6), effectiveness rates (14%; n = 3), and avoidable costs (9%; n = 2). Conclusions: This review outlines that Italy is still lacking in interventions to monitor/manage PIP, addressing an unmet need in developing patient-tailored strategies for reducing health-system burden.
... Polypharmacy is a prevalent medical condition among the elderly worldwide [1]. Although a threshold of 5 or 10 concurrently prescribed medications is often used to define polypharmacy, there is no consensus on its definition [2]. ...
... A simple definition that is commonly used is "the administration of more medicines than is clinically indicated, indicating unnecessary drug use" [3]. However, polypharmacy increases the risk of drug-drug interactions (DDIs), regardless of PK or PD [1]. These DDIs can lead to interindividual variability and result in severe adverse drug effects, highlighting the importance of detection and monitoring [1]. ...
... However, polypharmacy increases the risk of drug-drug interactions (DDIs), regardless of PK or PD [1]. These DDIs can lead to interindividual variability and result in severe adverse drug effects, highlighting the importance of detection and monitoring [1]. ...
Purpose
Polypharmacy is a frequent situation in older adults that increases the risk of drug-drug interactions (DDIs), both pharmacokinetic (PK) and pharmacodynamic (PD). Direct oral anticoagulants (DOACs) are frequently prescribed in older adults, mainly because of the high prevalence of atrial fibrillation (AF). DOACs are subject to cytochrome P450 3A4 (CYP3A4)- and/or P-glycoprotein (P-gp)-mediated PK DDIs and PD DDIs when co-administered with drugs that interfere with platelet function. The aim of our study was to assess the prevalence of DDIs involving DOACs in older adults and the associated risk factors at admission and discharge.
Methods
This was a cross-sectional study conducted in an acute geriatric unit between January 1, 2018 and December 31, 2022, including patients over 75 years of age treated with DOACs at admission and/or discharge, for whom a comprehensive collection of co-medications was performed.
Results
From 909 hospitalizations collected, the prevalence of PK DDIs involving DOACs was 16.9% at admission and 20.7% at discharge, and the prevalence of PD DDIs was 20.7% at admission and 20.2% at discharge. Factors associated with DDIs were bleeding history [adjusted odds ratio (ORa) 1.74, 95% confidence interval (CI) 1.13–2.68], number of drugs > 6 (ORa 2.54, 95% CI 1.88–3.46) and reduced dose of DOACs (ORa 0.39, 95% CI 0.28–0.54) at admission and age > 87 years (ORa 0.74, 95% CI 0.55–0.99), number of drugs > 6 (ORa 2.01, 95% CI 1.48–2.72) and reduced dose of DOACs (ORa 0.41, 95% CI 0.30–0.57) at discharge.
Conclusion
This study provides an indication of the prevalence of DDIs as well as the profile of DDIs and patients treated with DOACs.
... However, the complexity of managing multiple medications, commonly referred to polypharmacy, 3 can lead to complications such as drug interactions, medication errors, and adverse reactions, all of which can impact the health and overall quality of life of the elderly. 4,5 Of particular concern are the distinctive challenges that elderly individuals encounter in the realm of medication management. These challenges include cognitive decline, the intricacies of managing multiple medications, and the need for coordination among various healthcare providers. ...
Purpose
Long-term care facilities are increasingly challenged with meeting the diverse healthcare needs of the elderly population, particularly concerning medication management. Understanding medication information literacy and behavior among this demographic is imperative. Therefore, this qualitative study aims to explore medication information literacy and develop distinct medication profiles among elderly long-term care residents.
Material and Methods
In this study, we conducted in-depth semi-structured interviews with 32 participants aged 65 or older residing in a long-term care facility. The interviews were designed to explore participants’ understanding of medication information, medication management practices, and experiences with healthcare providers. Thematic analysis was employed to analyze the interview data, allowing for the identification of common patterns and themes related to medication-taking behavior among the elderly residents.
Results
The thematic analysis revealed four distinct medication behavior profiles among the elderly long-term care residents: (1) Proactive Health Self-Managers, (2) Medication Information Adherents, (3) Experience-Based Medication Users, and (4) Nonadherent Medication Users. These findings provide valuable insights into the diverse approaches to medication management within long-term care facilities and underscore the importance of tailored interventions to support the specific needs of each profile.
Conclusion
This study highlights the necessity for tailored medication education and support to optimize medication management for the elderly. With the aging population expansion, addressing the unique medication challenges within long-term care facilities becomes increasingly critical. This research contributes to ongoing endeavors to enhance healthcare services for the elderly, striving for safer and more effective medication-taking behavior.
... Furthermore, bioactive compounds have abundant inflammatory-based biological effects, going far beyond CVDs, including antitumor, anti-inflammatory, anticarcinogenic, antiviral, antimicrobial, antidiarrheal, antioxidant and other effects [4]. From this aspect, it is recognized that fruits and vegetables are important to healthy eating because they are made up of micronutrients, fibers and bioactive compounds [5][6][7]. However, according to the Household Budget Survey (POF) of the Brazilian Institute of Geography and Statistics ...
Epidemiological studies have shown that a diet rich in bioactive components significantly reduces cardiovascular disease incidence and mortality. In this sense, there is a need for meta-analytical research that confirms this phenomenon and increases specific knowledge about certain bioactive compounds such as carotenoids. Thus, this systematic review and meta-analysis aim to disseminate knowledge about the sources of carotenoids in fruit consumed in the north of Brazil which are outside the Brazilian trade balance. A systematic review and a meta-analysis following the PRISMA guidelines were conducted based on a random effects synthesis of multivariable-adjusted relative risks (RRs). Searches of seven sources were carried out, including PubMed, Science Direct from Elsevier, Web of Science, Scielo, Eric Research and Google Scholar databases. The systematic review was guided by a systematic review protocol based on the POT strategy (population, outcome and type of study) adapted for use in this research. Mendeley was a resource used to organize and manage references and exclude duplicates of studies selected for review. In this review, we present the potential bioactive compounds concentrated in little-known fruit species from the Amazon and their benefits. Consuming fruits that are rich in notable constituents such as carotenoids is important for the prevention of chronic non-communicable diseases through anti-inflammatory and anticoagulant properties, as well as antivirals, immunomodulators and antioxidants agents that directly affect the immune response.
... A potential modifiable risk factor of dementia is medication exposure; in several studies, polypharmacy, the use of potentially inappropriate medications (PIMs), as well as the use of medications with anticholinergic and/ or sedative properties-defined herein as medication exposure-were associated with a cognitive iatrogenic risk and dementia [8][9][10][11][12]. The cognitive iatrogenic risk is defined as a decrease in the cognitive reserve, as well as an onset or worsening of cognitive disorders [10]. ...
In older patients, medication exposure [i.e. polypharmacy, potentially inappropriate medications (PIMs), medications with anticholinergic and/or sedative properties] is a modifiable risk factor associated with cognitive iatrogenic risk and dementia.
To assess the potential clinical impact of the implementation of an individualised clinical pharmacy programme at the initiation of the Memory care pathway in older patients with a cognitive complaint.
This prospective observational study included older patients with high-risk of adverse drug event (HR) admitted in a French geriatric university hospital to explore the cognitive complaint or the cognitive disorder between January and November 2021. Drug-related problems (DRPs) were identified during a medication review performed in HR patients, and pharmaceutical interventions (PIs) notified in the patient’s hospitalisation report were collected. The clinical impact of PIs was assessed by an expert panel (geriatricians and clinical pharmacists) using the Clinical, Economic, and Organisational (CLEO) tool.
Overall, 326 patients were eligible and 207 (63.5%) were considered as HR patients. Among HR patients, 88.9% (n = 184) were treated using at least 5 medications (polypharmacy), and 36.7% (n = 76) received at least one PIM with cognitive iatrogenic risk. During the medication review, 490 PIs were provided and their clinical impact was rated as minor for 57.3% (n = 281), moderate for 26.7% (n = 131), and major for 2.5% (n = 12).
The integration of clinical pharmacist secured the Memory care pathway of older patients with a cognitive complaint by identifying an important number of DRPs and PIMs with potential cognitive iatrogenic risk.
... Given the high prevalence of comorbid medical conditions and frailty among people with dementia (PwD), the risks of polypharmacy, drug-drug and drug-disease interactions are greater than among their older counterparts [8][9][10][11][12]. Polypharmacy may increase the possibility of adverse drug reactions, reduced medication adherence, and potentially inappropriate prescribing (PIP) [13]. PIP is the prescribing of medications where the risk of potential harm exceeds the potential benefit, and a safer option is available to treat the condition [14]. ...
Background
Studies have shown that potentially inappropriate prescribing (PIP) is highly prevalent among people with dementia (PwD) and linked to negative outcomes, such as hospitalisation and mortality. However, there are limited data on prescribing appropriateness for PwD in Saudi Arabia. Therefore, we aimed to estimate the prevalence of PIP and investigate associations between PIP and other patient characteristics among PwD in an ambulatory care setting.
Methods
A cross-sectional, retrospective analysis was conducted at a tertiary hospital in Saudi Arabia. Patients who were ≥ 65 years old, had dementia, and visited ambulatory care clinics between 01/01/2019 and 31/12/2021 were included. Prescribing appropriateness was evaluated by applying the Screening Tool of Older Persons Potentially Inappropriate Prescriptions (STOPP) criteria. Descriptive analyses were used to describe the study population. Prevalence of PIP and the prevalence per each STOPP criterion were calculated as a percentage of all eligible patients. Logistic regression analysis was used to investigate associations between PIP, polypharmacy, age and sex; odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Analyses were conducted using SPSS v27.
Results
A total of 287 PwD were identified; 56.0% (n = 161) were female. The mean number of medications prescribed was 9.0 [standard deviation (SD) ± 4.2]. The prevalence of PIP was 61.0% (n = 175). Common instances of PIP were drugs prescribed beyond the recommended duration (n = 90, 31.4%), drugs prescribed without an evidence-based clinical indication (n = 78, 27.2%), proton pump inhibitors (PPIs) for > 8 weeks (n = 75, 26.0%), and acetylcholinesterase inhibitors with concurrent drugs that reduce heart rate (n = 60, 21.0%). Polypharmacy was observed in 82.6% (n = 237) of patients and was strongly associated with PIP (adjusted OR 24.1, 95% CI 9.0–64.5).
Conclusions
Findings have revealed a high prevalence of PIP among PwD in Saudi Arabia that is strongly associated with polypharmacy. Future research should aim to explore key stakeholders’ experiences and perspectives of medicines management to optimise medication use for this vulnerable patient population.
... Leading up to the most recent years, there have been emerging suggestions that specific combinations of antipsychotics could offer benefits under certain conditions [22,23]. As early as 2009, a meta-analysis of randomized controlled trials by Correl et al. highlighted the intricate challenges in directly comparing APP with APM, suggesting possible advantages of APP [24]. ...
... Indeed, our analysis suggests that the higher mortality risk associated with antipsychotic polypharmacy is not fully accounted for by factors like antipsychotic dosage or metabolic disturbances alone. Our hypothesis, rooted in extensive evidence on the mental illness mortality gap and serious adverse effects associated with AP use, posited poorer outcomes with higher doses and polypharmacy [23][24][25]27,28,[43][44][45][46][47]. Several observational studies have assessed the impact of these medications on general mortality rates for various diagnoses and age groups, and many of them found an association between AP use and mortality [48][49][50][51][52][53][54][55][56]. ...
Background: Differences in survival between patients treated with antipsychotic monotherapy vs. polytherapy are debated. This study aimed to examine the association of antipsychotic polytherapy with 2-year all-cause mortality in a population-based cohort. Methods: Data were retrieved from healthcare databases of four local health units of Lombardy, Italy. Subjects aged 18–79 years who received continuous antipsychotic prescriptions in 2018 were identified. Overall survival among patients with antipsychotic monotherapy vs. polytherapy was compared. A multivariate Cox PH model was used to estimate the association between antipsychotic therapy, or antipsychotic use (continuous vs. non-continuous), and all-cause mortality. Adjustments were made for the presence of metabolic disturbances, total antipsychotic dosage amount (olanzapine equivalent doses), age, and sex. Results: A total of 49,875 subjects receiving at least one prescription of antipsychotics during 2018 were identified. Among the 33,221 patients receiving continuative antipsychotic prescriptions, 1958 (5.9%) experienced death from any cause at two years. Patients with continuous antipsychotic use had a 1.13-point increased mortality risk compared with non-continuous users. Patients treated with antipsychotic polytherapy showed an adjusted mortality risk increased by 17% (95% CI: 2%, 33%) compared to monotherapy. Conclusions: The study highlights the potential risks associated with antipsychotic polypharmacy, emphasizing the importance of optimizing drug prescriptions to improve patient safety and reduce mortality rates in individuals receiving antipsychotic therapy.
... Polypharmacy describes the use of multiple medicines, 1 and its prevalence is increasing, especially in high-income countries. 2 However, polypharmacy, especially in older people, poses risks of adverse drug reactions, cognitive and physical changes, increased hospital admissions, and even death. 2 Deprescribing is an important concept that aims to reduce adverse outcomes due to polypharmacy. 2 Reeve et al 3 defined deprescribing as the process of withdrawal of an inappropriate medication, supervised by a healthcare professional, with the goal of managing polypharmacy and improving outcomes. ...
... 2 However, polypharmacy, especially in older people, poses risks of adverse drug reactions, cognitive and physical changes, increased hospital admissions, and even death. 2 Deprescribing is an important concept that aims to reduce adverse outcomes due to polypharmacy. 2 Reeve et al 3 defined deprescribing as the process of withdrawal of an inappropriate medication, supervised by a healthcare professional, with the goal of managing polypharmacy and improving outcomes. Indeed, deprescribing has been shown to improve patient outcomes. ...
... 2 Deprescribing is an important concept that aims to reduce adverse outcomes due to polypharmacy. 2 Reeve et al 3 defined deprescribing as the process of withdrawal of an inappropriate medication, supervised by a healthcare professional, with the goal of managing polypharmacy and improving outcomes. Indeed, deprescribing has been shown to improve patient outcomes. ...
Purpose
Deprescribing is a complex process that requires active patient involvement, so the patient’s attitude to deprescribing is crucial to its success. This study aimed to assess predictors of Saudi Arabian patients’ willingness to deprescribe.
Patients and Methods
In this cross-sectional study, adult patients from two hospitals in Riyadh completed a self-administered questionnaire gathering data on demographic information and the Arabic revised Patients’ Attitudes Towards Deprescribing (rPATD) questions. Descriptive analysis and binary logistic regression were used to analyze the data.
Results
A total of 242 patients were included (mean age 59.8 (SD 11.05) years, range 25–87 years; 40% 60–69 years; 54.1% female). The majority (90%) of participants were willing to have medications deprescribed. Willingness to deprescribe was significantly associated with the rPATD involvement factor (OR=1.866, 95% CI 1.177–2.958, p=0.008) and the patient’s perception of their health status (OR=2.08, CI=1.058–4.119, p=0.034).
Conclusion
The majority of patients were willing to have one or more medications deprescribed if recommended by their doctors. Patient perceptions about their own health and their involvement in deprescribing were important predictive factors that could shape counseling and education strategies to encourage deprescribing.
... Полипрагмазия получает всё более широкое распространение. Так, шведское популяционное исследование лиц в возрасте старше 75 лет показало, что распространённость полипрагмазии увеличилась с 27% в 1988 г. до 54% в 2001 г. и до 65% в 2006 г. [3]. Одновременное применение нескольких препаратов увеличивает риск межлекарственного взаимодействия (DDI). ...
... Например, пациенты с сердечнососудистыми заболеваниями более подвержены воздействию неблагоприятных DDI, примерно у каждого десятого пациента, госпитализированного с сердечно-сосудистыми заболеваниями, может быть неблагоприятное DDI, приведшее госпитализации [7]. Неблагоприятные лекарственные реакции являются основной причиной около 10% госпитализаций у пожилых людей, и почти 90% пожилых людей, госпитализированных по поводу ADR, имеют полипрагмазию при поступлении в больницу [3]. ...
... Однако согласованы по информации о DDI наиболее общеупотребительных ЛП, достаточно согласованны в рейтинге оценки тяжести DDI. Отмечается необходимость проведения работ по стандартизации политики и доказательств для включения DDI в базу данных, чтобы уменьшить различия между источниками знаний и повысить актуальность для терапевтической практики [3,19]. ...
Drug-drug interactions (DDIs) are a major cause of hospital admissions, accounting for 16.6% of ADRs and about 1% of all hospital admissions. Polypharmacy is on the rise, with a Swedish population-based study of people aged ;;;75 years showing that the prevalence of polypharmacy increased from 27% in 1988 to 54% in 2001 and to 65% in 2006. The aim of the study was to analyze the databases on DDI and to assess the possibility of their use in managing the risks of pharmacotherapy in the Russian Federation and the EAEU. Results. The main DDI databases are characterized. The degree of inconsistency in data on the number of DDI, severity and clinical recommendations was determined. The basic requirements for the completeness of information in databases are formulated. The necessity to harmonize approaches to providing information about DDI, as well as the need to create local databases for medical organizations were revealed. A computer program has been created to minimize the risks of DDI in clinical practice, for expert and scientific purposes. Conclusions. Databases and programs for DDI have different goals, a different set of data on DDI with varying degrees of evidence, differences in assessment of severity, likelihood of occurrence, clinical recommendations for treatment and correction of DDI. The variability of information is due to the lack of a unified system for assessing the severity and likelihood of potential negative consequences of DDI; different purposes for creation; difference in budgets at creation. This situation leads to warning redundancy and physician fatigue from insignificant or unproven DDIs. Based on the identified requirements for local databases, a computer program for modeling rational pharmacotherapy for lower respiratory tract infections was created and received a certificate of state registration.
... Elderly patients with HF represent a vulnerable group with a wide range of somatic and mental comorbidities (3,4) leading to low health related quality of life (5). This complicated clinical picture may result in complex drug-to-drug interactions due to polypharmacy (6)(7)(8), poor medical adherence (6) and increased hospitalizations and mortality rates (8,9). All of these factors contribute to a higher dependency in self-care and daily activities (10). ...
Introduction
Few studies explored healthcare needs of elderly heart failure (HF) patients with comorbidities in view of a personalized intervention conducted by Care Managers (CM) in the framework of Blended Collaborative Care (BCC). The aims of the present study were to: (1) identify perceived healthcare needs/preferences in elderly patients with HF prior to a CM intervention; (2) investigate possible associations between healthcare needs/preferences, sociodemographic variables (age; sex) and number of comorbidities.
Method
Patients aged 65 years or more affected by HF with at least 2 medical comorbidities were enrolled in the study. They were assessed by structured interviewing with colored cue cards that represented six main topics including education, individual tailoring of treatment, monitoring, support, coordination, and communication, related to healthcare needs and preferences.
Results
Thirty-three patients (Italy = 21, Denmark = 7, Germany = 5; mean age = 75.2 ± 7.7 years; males 63.6%) were enrolled from June 2021 to February 2022. Major identified needs included: HF information (education), patients' involvement in treatment-related management (individual tailoring of treatment), regular checks of HF symptoms (monitoring), general practitioner update by a CM about progression of symptoms and health behaviors (coordination), and telephone contacts with the CM (communication). Regarding communication modalities with a CM, males preferred phone calls (χ2 = 6.291, p = 0.043) and mobile messaging services (χ2 = 9.647, p = 0.008), whereas females preferred in-person meetings and a patient dashboard. No differences in needs and preferences according to age and number of comorbidities were found.
Discussion
The findings highlight specific healthcare needs and preferences in older HF multimorbid patients, allowing a more personalized intervention delivered by CM in the framework of BCC.
