What is polypharmacy? A systematic review of definitions
Nashwa Masnoon,Nashwa Masnoon,Sepehr Shakib,Sepehr Shakib,Lisa Kalisch-Ellett,Gillian E. Caughey,Gillian E. Caughey,Gillian E. Caughey +7 more
TLDR
Numerical definitions of polypharmacy did not account for specific comorbidities present and make it difficult to assess safety and appropriateness of therapy in the clinical setting, according to a systematic review of existing literature.Abstract:
Multimorbidity and the associated use of multiple medicines (polypharmacy), is common in the older population. Despite this, there is no consensus definition for polypharmacy. A systematic review was conducted to identify and summarise polypharmacy definitions in existing literature. The reporting of this systematic review conforms to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) checklist. MEDLINE (Ovid), EMBASE and Cochrane were systematically searched, as well as grey literature, to identify articles which defined the term polypharmacy (without any limits on the types of definitions) and were in English, published between 1st January 2000 and 30th May 2016. Definitions were categorised as i. numerical only (using the number of medications to define polypharmacy), ii. numerical with an associated duration of therapy or healthcare setting (such as during hospital stay) or iii. Descriptive (using a brief description to define polypharmacy). A total of 1156 articles were identified and 110 articles met the inclusion criteria. Articles not only defined polypharmacy but associated terms such as minor and major polypharmacy. As a result, a total of 138 definitions of polypharmacy and associated terms were obtained. There were 111 numerical only definitions (80.4% of all definitions), 15 numerical definitions which incorporated a duration of therapy or healthcare setting (10.9%) and 12 descriptive definitions (8.7%). The most commonly reported definition of polypharmacy was the numerical definition of five or more medications daily (n = 51, 46.4% of articles), with definitions ranging from two or more to 11 or more medicines. Only 6.4% of articles classified the distinction between appropriate and inappropriate polypharmacy, using descriptive definitions to make this distinction. Polypharmacy definitions were variable. Numerical definitions of polypharmacy did not account for specific comorbidities present and make it difficult to assess safety and appropriateness of therapy in the clinical setting.read more
Citations
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3D Printing Pharmaceuticals: Drug Development to Frontline Care
TL;DR: This review provides a timely perspective on the motivations and potential applications of 3DP pharmaceuticals, as well as a practical viewpoint on how 3DP could be integrated across the pharmaceutical space.
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An update on the clinical consequences of polypharmacy in older adults: a narrative review
TL;DR: The issue of ‘confounding by multimorbidity’ has been underestimated and should be better accounted for in future studies, and researchers should develop more clinically relevant definitions of polypharmacy, including measures of inappropriate or problematic polyPharmacy.
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Alzheimer's Disease Microbiome Is Associated with Dysregulation of the Anti-Inflammatory P-Glycoprotein Pathway.
John P. Haran,Shakti K. Bhattarai,Sage E. Foley,Protiva Dutta,Doyle V. Ward,Vanni Bucci,Vanni Bucci,Beth A. McCormick +7 more
TL;DR: A potential nexus between the intestinal microbiome and AD is the modulation of intestinal homeostasis by increases in inflammatory, and decreases in anti-inflammatory, microbial metabolism that may underlie this neurodegenerative disorder.
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The relationship between frailty and polypharmacy in older people: A systematic review
Marta Gutiérrez-Valencia,Mikel Izquierdo,Matteo Cesari,Matteo Cesari,Alvaro Casas-Herrero,Marco Inzitari,Nicolás Martínez-Velilla +6 more
TL;DR: This is the first systematic review analysing the available evidence on the relationship between frailty and polypharmacy in older adults.
Journal ArticleDOI
An overview of prevalence, determinants and health outcomes of polypharmacy:
TL;DR: It was showed that the prevalence of polypharmacy varied between 10% to as high as around 90% in different populations, and chronic conditions, demographics, socioeconomics and self-assessed health factors were independent predictors of polyPharmacy.
References
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Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts.
Donna M. Fick,James W. Cooper,William E. Wade,Jennifer L. Waller,J. Ross Maclean,Mark H. Beers +5 more
TL;DR: The application of the Beers criteria and other tools for identifying potentially inappropriate medication use will continue to enable providers to plan interventions for decreasing both drug-related costs and overall costs and thus minimize drug- related problems.
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Aging with multimorbidity: a systematic review of the literature
Alessandra Marengoni,Sara Angleman,René J. F. Melis,René J. F. Melis,Francesca Mangialasche,Anita Karp,Annika Garmen,Bettina Meinow,Laura Fratiglioni +8 more
TL;DR: Methodological issues in evaluating multimorbidity are discussed as well as future research needs, especially concerning etiological factors, combinations and clustering of chronic diseases, and care models for persons affected by multiple disorders.
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Explicit Criteria for Determining Potentially Inappropriate Medication Use by the Elderly: An Update
TL;DR: In this article, a panel of experts agreed on the validity of 28 criteria describing the potentially inappropriate use of medication by general populations of the elderly as well as 35 criteria defining potentially inappropriate medication use in older persons known to have any of 15 common medical conditions.
Journal ArticleDOI
Clinical consequences of polypharmacy in elderly
TL;DR: It is shown that well-designed interprofessional intervention studies that focus on enrolling high-risk older patients with polypharmacy have shown that they can be effective in reducing aspects of unnecessary prescribing with mixed results on distal health outcomes.
Journal ArticleDOI
Reducing Inappropriate Polypharmacy: The Process of Deprescribing
Ian A Scott,Ian A Scott,Sarah N. Hilmer,Sarah N. Hilmer,Emily Reeve,Emily Reeve,Kathleen N. Potter,David G. Le Couteur,Debbie Rigby,Debbie Rigby,Danijela Gnjidic,Chris Del Mar,Elizabeth E. Roughead,Amy Page,Jesse Jansen,Jennifer H. Martin +15 more
TL;DR: A deprescribing protocol is proposed comprising 5 steps: ascertain all drugs the patient is currently taking and the reasons for each one, and prioritize drugs for discontinuation that have the lowest benefit-harm ratio and lowest likelihood of adverse withdrawal reactions or disease rebound syndromes.
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