Polypharmacy Management in the Older Adults: A Scoping Review of Available Interventions
Background: Polypharmacy paves the way for non-adherence, adverse drug reactions, negative health outcomes, increased use of healthcare services and rising costs. Since it is most prevalent in the older adults, there is an urgent need for introducing effective strategies to prevent and manage the pr...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2021-11-01
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| Series: | Frontiers in Pharmacology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fphar.2021.734045/full |
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| author | M. Kurczewska-Michalak P. Lewek B. Jankowska-Polańska A. Giardini N. Granata M. Maffoni E. Costa L. Midão P. Kardas |
| author_facet | M. Kurczewska-Michalak P. Lewek B. Jankowska-Polańska A. Giardini N. Granata M. Maffoni E. Costa L. Midão P. Kardas |
| author_sort | M. Kurczewska-Michalak |
| collection | DOAJ |
| description | Background: Polypharmacy paves the way for non-adherence, adverse drug reactions, negative health outcomes, increased use of healthcare services and rising costs. Since it is most prevalent in the older adults, there is an urgent need for introducing effective strategies to prevent and manage the problem in this age group.Purpose: To perform a scoping review critically analysing the available literature referring to the issue of polypharmacy management in the older adults and provide narrative summary.Data sources: Articles published between January 2010–March 2018 indexed in CINHAL, EMBASE and PubMed addressing polypharmacy management in the older adults.Results: Our search identified 49 papers. Among the identified interventions, the most often recommended ones involved various types of drug reviews based on either implicit or explicit criteria. Implicit criteria-based approaches are used infrequently due to their subjectivity, and limited implementability. Most of the publications advocate the use of explicit criteria, such as e.g. STOPP/START, Beers and Medication Appropriateness Index (MAI). However, their applicability is also limited due to long lists of potentially inappropriate medications covered. To overcome this obstacle, such instruments are often embedded in computerised clinical decision support systems.Conclusion: Multiple approaches towards polypharmacy management are advised in current literature. They vary in terms of their complexity, applicability and usability, and no “gold standard” is identifiable. For practical reasons, explicit criteria-based drug reviews seem to be advisable. Having in mind that in general, polypharmacy management in the older adults is underused, both individual stakeholders, as well as policymakers should strengthen their efforts to promote these activities more strongly. |
| first_indexed | 2024-12-14T08:00:08Z |
| format | Article |
| id | doaj.art-2267d4113a8b4ed8adfd60672e88068d |
| institution | Directory Open Access Journal |
| issn | 1663-9812 |
| language | English |
| last_indexed | 2024-12-14T08:00:08Z |
| publishDate | 2021-11-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pharmacology |
| spelling | doaj.art-2267d4113a8b4ed8adfd60672e88068d2022-12-21T23:10:26ZengFrontiers Media S.A.Frontiers in Pharmacology1663-98122021-11-011210.3389/fphar.2021.734045734045Polypharmacy Management in the Older Adults: A Scoping Review of Available InterventionsM. Kurczewska-Michalak0P. Lewek1B. Jankowska-Polańska2A. Giardini3N. Granata4M. Maffoni5E. Costa6L. Midão7P. Kardas8Department of Family Medicine, Medical University of Lodz, Lodz, PolandDepartment of Family Medicine, Medical University of Lodz, Lodz, PolandDepartment of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, Wroclaw, PolandIT Department, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, ItalyPsychology Unit, Istituti Clinici Scientifici Maugeri IRCCS, Montescano Institute, Pavia, ItalyPsychology Unit, Istituti Clinici Scientifici Maugeri IRCCS, Montescano Institute, Pavia, ItalyUCIBIO/REQUIMTE, Faculty of Pharmacy and Porto4Ageing, University of Porto, Porto, PortugalUCIBIO/REQUIMTE, Faculty of Pharmacy and Porto4Ageing, University of Porto, Porto, PortugalDepartment of Family Medicine, Medical University of Lodz, Lodz, PolandBackground: Polypharmacy paves the way for non-adherence, adverse drug reactions, negative health outcomes, increased use of healthcare services and rising costs. Since it is most prevalent in the older adults, there is an urgent need for introducing effective strategies to prevent and manage the problem in this age group.Purpose: To perform a scoping review critically analysing the available literature referring to the issue of polypharmacy management in the older adults and provide narrative summary.Data sources: Articles published between January 2010–March 2018 indexed in CINHAL, EMBASE and PubMed addressing polypharmacy management in the older adults.Results: Our search identified 49 papers. Among the identified interventions, the most often recommended ones involved various types of drug reviews based on either implicit or explicit criteria. Implicit criteria-based approaches are used infrequently due to their subjectivity, and limited implementability. Most of the publications advocate the use of explicit criteria, such as e.g. STOPP/START, Beers and Medication Appropriateness Index (MAI). However, their applicability is also limited due to long lists of potentially inappropriate medications covered. To overcome this obstacle, such instruments are often embedded in computerised clinical decision support systems.Conclusion: Multiple approaches towards polypharmacy management are advised in current literature. They vary in terms of their complexity, applicability and usability, and no “gold standard” is identifiable. For practical reasons, explicit criteria-based drug reviews seem to be advisable. Having in mind that in general, polypharmacy management in the older adults is underused, both individual stakeholders, as well as policymakers should strengthen their efforts to promote these activities more strongly.https://www.frontiersin.org/articles/10.3389/fphar.2021.734045/fullpolypharmacyelderlyolder adultsadverse drug eventadverse drug reactionexplicit criteria |
| spellingShingle | M. Kurczewska-Michalak P. Lewek B. Jankowska-Polańska A. Giardini N. Granata M. Maffoni E. Costa L. Midão P. Kardas Polypharmacy Management in the Older Adults: A Scoping Review of Available Interventions Frontiers in Pharmacology polypharmacy elderly older adults adverse drug event adverse drug reaction explicit criteria |
| title | Polypharmacy Management in the Older Adults: A Scoping Review of Available Interventions |
| title_full | Polypharmacy Management in the Older Adults: A Scoping Review of Available Interventions |
| title_fullStr | Polypharmacy Management in the Older Adults: A Scoping Review of Available Interventions |
| title_full_unstemmed | Polypharmacy Management in the Older Adults: A Scoping Review of Available Interventions |
| title_short | Polypharmacy Management in the Older Adults: A Scoping Review of Available Interventions |
| title_sort | polypharmacy management in the older adults a scoping review of available interventions |
| topic | polypharmacy elderly older adults adverse drug event adverse drug reaction explicit criteria |
| url | https://www.frontiersin.org/articles/10.3389/fphar.2021.734045/full |
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