Health Outcomes Associated with Polypharmacy in Community‐Dwelling Older Adults: A Systematic Review

Journal of the American Geriatrics Society - Tập 62 Số 12 - Trang 2261-2272 - 2014
Terri R. Fried1,2, John R. O’Leary3, Virginia Towle3, Mary K. Goldstein4,5, Mark Trentalange3, Deanna K. Martin1
1Clinical Epidemiology Research Center Veterans Affairs Connecticut Healthcare System West Haven Connecticut
2Department of Medicine, Yale University
3Program on Aging School of Medicine Yale University New Haven Connecticut
4Center for Primary Care and Outcomes Research; School of Medicine; Stanford University; Stanford California
5Geriatrics Research Education and Clinical Center Veterans Affairs Palo Alto Health Care System Palo Alto California

Tóm tắt

ObjectivesTo summarize evidence regarding the health outcomes associated with polypharmacy, defined as number of prescribed medications, in older community‐dwelling persons.DesignSystematic review of MEDLINE (OvidSP 1946 to May, Week 3, 2014).SettingCommunity.ParticipantsObservational studies examining health outcomes according to number of prescription medications taken.MeasurementsAssociation 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.ResultsOf 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.ConclusionData 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.

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Journal of the American Geriatrics Society

Tập 62 Số 12

2261-2272

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