Polypharmacy is widespread among older people, but the adverse outcomes associated with it are unclear. We aim to synthesize current evidence on the adverse health, social, medicines management, and health care utilization outcomes of polypharmacy in older people.
Design
A systematic review, of systematic reviews and meta-analyses of observational studies, was conducted. Eleven bibliographic databases were searched from 1990 to February 2018. Quality was assessed using AMSTAR (A Measurement Tool to Assess Systematic Reviews).
Setting and participants
Older people in any health care setting, residential setting, or country.
Results
Twenty-six reviews reporting on 230 unique studies were included. Almost all reviews operationalized polypharmacy as medication count, and few examined medication classes or disease states within this. Evidence for an association between polypharmacy and many adverse outcomes, including adverse drug events and disability, was conflicting. The most consistent evidence was found for hospitalization and inappropriate prescribing. No research had explored polypharmacy in the very old (aged ≥85 years), or examined the potential social consequences associated with medication use, such as loneliness and isolation.
Conclusions and implications
The literature examining the adverse outcomes of polypharmacy in older people is complex, extensive, and conflicting. Until polypharmacy is operationalized in a more clinically relevant manner, the adverse outcomes associated with it will not be fully understood. Future studies should work toward this approach in the face of rising multimorbidity and population aging.
Keywords
Polypharmacy
aged
multimorbidity
prescribing
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Funding sources: This paper presents independent research funded by the National Institute for Health ResearchSchool for Primary Care Research (NIHR SPCR) (SPCR-2014-10043). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.
L.E.D. received a doctoral stipend for the submitted work. No other competing interests have been declared.