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J Am Geriatr Soc. 2014 Dec;62(12):2261-72. doi: 10.1111/jgs.13153.

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

Author information

1
Clinical Epidemiology Research Center, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut; Department of Medicine, Yale University.

Abstract

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).

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.

KEYWORDS:

observational studies; polypharmacy; systematic review

PMID:
25516023
PMCID:
PMC4270076
DOI:
10.1111/jgs.13153
[Indexed for MEDLINE]
Free PMC Article

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