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

• Autores: Terri R. Fried, John R. O'Leary, Virginia Towle, Mary K. Goldstein, Mark Trentalange, Deanna K. Martin
• Localización: Journal of the American Geriatrics Society, ISSN 0002-8614, Vol. 62, Nº. 12, 2014, págs. 2261-2272
• Idioma: inglés
• Enlaces
  • Texto completo
• Dialnet Métricas: 3 Citas
• Resumen

  • 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.