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Health outcomes associated with polypharmacy in community-dwelling older adults: a systematic review.

AbstractOBJECTIVES:
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).
SETTING:
Community.
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.
AuthorsTerri R Fried, John O'Leary, Virginia Towle, Mary K Goldstein, Mark Trentalange, Deanna K Martin
JournalJournal of the American Geriatrics Society (J Am Geriatr Soc) Vol. 62 Issue 12 Pg. 2261-72 (Dec 2014) ISSN: 1532-5415 [Electronic] United States
PMID25516023 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't, Review, Systematic Review)
Copyright© 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.
Chemical References
  • Prescription Drugs
Topics
  • Accidental Falls
  • Aged
  • Aged, 80 and over
  • Chronic Disease (drug therapy)
  • Comorbidity
  • Drug-Related Side Effects and Adverse Reactions
  • Geriatric Assessment
  • Humans
  • Polypharmacy
  • Prescription Drugs (administration & dosage, adverse effects)
  • Risk Factors

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