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Syst Rev. 2017 May 19;6(1):104. doi: 10.1186/s13643-017-0492-9.

Polypharmacy in multimorbid older adults: protocol for a systematic review.

Sirois C1,2,3,4,5, Laroche ML6,7, Guénette L8,9, Kröger E10,8,9, Cooper D11,9, Émond V12.

Author information

1
Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, Québec, Canada. caroline.sirois@fmed.ulaval.ca.
2
Centre d'excellence sur le vieillissement de Québec, Centre de recherche du CHU de Québec, Québec, Canada. caroline.sirois@fmed.ulaval.ca.
3
Institut national de santé publique du Québec, Québec, Canada. caroline.sirois@fmed.ulaval.ca.
4
Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec, Québec, Canada. caroline.sirois@fmed.ulaval.ca.
5
Centre d'excellence sur le vieillissement de Québec, Hôpital du St-Sacrement, 1050 Chemin Ste-Foy, Local L2-28, Québec, (Qc) G1S 4L8, Canada. caroline.sirois@fmed.ulaval.ca.
6
Service de Pharmacologie, Toxicologie et Pharmacovigilance, Centre Régional de Pharmacovigilance, de Pharmacoépidémiologie et d'information sur les médicaments, Centre Hospitalier Universitaire de Limoges, Limoges, France.
7
Faculté de Médecine, Université de Limoges, Limoges, France.
8
Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec, Québec, Canada.
9
Faculté de pharmacie, Université Laval, Québec, Canada.
10
Centre d'excellence sur le vieillissement de Québec, Centre de recherche du CHU de Québec, Québec, Canada.
11
Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, Québec, Canada.
12
Institut national de santé publique du Québec, Québec, Canada.

Abstract

BACKGROUND:

Polypharmacy, the concurrent use of multiple medications, consistently evokes a negative connotation, notably because it is associated with a plethora of adverse events. Nonetheless, the number of individuals exposed to polypharmacy is increasing steeply, especially for older people with multiple diseases. There is a need to carefully study the phenomenon at the population scale to full assess the associated health outcomes. Yet, this reveals a complex task because there exists no consensus indicator of polypharmacy. In fact, the definitions of polypharmacy are heterogeneous and its predisposing factors and associated outcomes are not well defined. The goal of this systematic review is to summarize the literature on polypharmacy in multimorbid individuals aged 65 years and over, targeting three objectives: (1) to identify the definitions of polypharmacy that are used in the context of multimorbidity among older individuals (≥65 years); (2) to ascertain predisposing and concurrent factors associated with polypharmacy; and (3) to describe positive and negative outcomes of polypharmacy among older individuals, including hospitalizations, mortality and costs.

METHODS:

We will include publications from 2004 to 2016 that target four concepts: polypharmacy, older individuals, multimorbidity and positive/negative outcomes. The search will be performed using EBM Reviews, Embase, Global Health, MEDLINE, AgeLine, CINAHL, Health Policy Reference Center, Public Affairs Index, SocINDEX and Google Scholar. Two independent reviewers will screen the articles, extract the information and evaluate the methodological quality of included studies. The results will be presented in tables and narrative summaries will be performed. We will perform meta-analyses (objective 3) if the heterogeneity is not important.

DISCUSSION:

This review will help describe the various ways of conceptualizing polypharmacy and how it is associated with health outcomes. We have selected outcomes most relevant for public surveillance performed with administrative databases. Other positive and negative outcomes have been associated with polypharmacy but may not be included in the review.

SYSTEMATIC REVIEW REGISTRATION:

PROSPERO CRD42014014989.

KEYWORDS:

Chronic diseases; Multimorbidity; Older adults; Polypharmacy; Prescription drugs; Surveillance

PMID:
28526062
PMCID:
PMC5438541
DOI:
10.1186/s13643-017-0492-9
[Indexed for MEDLINE]
Free PMC Article

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