Health Outcomes Associated with Polypharmacy in Community-Dwelling Older Adults: A Systematic Review.
Fried, Terri R. MD 1,2; O'Leary, John MS 3; Towle, Virginia MPhil 3; Goldstein, Mary K. MD, MS 4,5; Trentalange, Mark MD, MPH 3; Martin, Deanna K. MPH 1
Journal of the American Geriatrics Society.
62(12):2261-2272, December 2014.
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OBJECTIVES: To summarize evidence regarding the health outcomes associated with polypharmacy, defined as number of prescribed medications, in older community-dwelling persons.
DESIGN: Systematic review of MEDLINE (OvidSP 1946 to May, Week 3, 2014).
PARTICIPANTS: Observational studies examining health outcomes according to number of prescription medications taken.
MEASUREMENTS: Association between number of medications and health outcomes. Because of the importance of comorbidity as a potential confounder of the relationship between polypharmacy and health outcomes, articles were assessed regarding the quality of their adjustment for confounding.
RESULTS: Of the 50 studies identified, the majority that were rated good in terms of their adjustment for comorbidity demonstrated relationships between polypharmacy and a range of outcomes, including falls, fall outcomes, fall risk factors, adverse drug events, hospitalization, mortality, and measures of function and cognition. However, a number of these studies failed to demonstrate associations, as did a substantial proportion of studies rated fair or poor.
CONCLUSION: Data are mixed regarding the relationship between polypharmacy, considered in terms of number of medications, and adverse outcomes in community-dwelling older persons. Because of the challenge of confounding, randomized controlled trials of medication discontinuation may provide more-definitive evidence regarding this relationship than observational studies can provide.
(C) 2014 by the American Geriatrics Society