Polypharmacy and pattern of medication use in community-dwelling older adults: A systematic review

Abstract

Aim: To synthesise current study findings on the diseases and the corresponding medications that are potentially associated with polypharmacy in community-dwelling older adults.

Background: Polypharmacy is receiving increased attention as a potential problem for the older population. Although several scientific investigations have studied polypharmacy, most of them were carried out in long-term care facilities or mixed settings rather than in community settings solely.

Methods: This systematic review followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Relevant studies published in the English language in peer-reviewed journals were identified from searches of seven electronic databases for the period of January 2000 through December 2019. Inclusion criteria were: (1) Participants were older adults aged 65 years and older; (2) Polypharmacy was defined by medication count; (3) Medication classes associated with polypharmacy were revealed; (4) Studies were conducted in outpatient care or community settings. The Joanna Briggs Institute critical appraisal checklists for cross-sectional studies and for cohort studies were used to assess the methodological quality.

Results: Ten studies were considered having appropriate and acceptable quality to be reviewed, comprising nine cross-sectional studies and one cohort study. Polypharmacy was most defined as concurrently using five or more medications. Polypharmacy prevalence ranged between 7%-45%. Older age, comorbidity, poor self-perceived health status, limitations in physical activity, history of falls, depression, and pain were positively associated with polypharmacy. The most prevalent medication taken by older adults with polypharmacy was cardiovascular drugs.

Conclusions: The prevalence of polypharmacy in older adults varying widely may be due to geographical locations, clinical practice guidelines, and polypharmacy definition used.

Relevance to clinical practice: Validated measurements to investigate medications associated with polypharmacy are required. How polypharmacy develops over time needs to be investigated in longitudinal studies in order to formulate strategies for reducing polypharmacy.

Keywords: medications; older adults; polypharmacy; systematic review.