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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Autores principales:	M. Kurczewska-Michalak, P. Lewek, B. Jankowska-Polańska, A. Giardini, N. Granata, M. Maffoni, E. Costa, L. Midão, P. Kardas
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	polypharmacy elderly older adults adverse drug event adverse drug reaction explicit criteria Therapeutics. Pharmacology RM1-950
Acceso en línea:	https://doaj.org/article/2267d4113a8b4ed8adfd60672e88068d
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spelling	oai:doaj.org-article:2267d4113a8b4ed8adfd60672e88068d2021-12-01T06:49:00ZPolypharmacy Management in the Older Adults: A Scoping Review of Available Interventions1663-981210.3389/fphar.2021.734045https://doaj.org/article/2267d4113a8b4ed8adfd60672e88068d2021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fphar.2021.734045/fullhttps://doaj.org/toc/1663-9812Background: 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.M. Kurczewska-MichalakP. LewekB. Jankowska-PolańskaA. GiardiniN. GranataM. MaffoniE. CostaL. MidãoP. KardasFrontiers Media S.A.articlepolypharmacyelderlyolder adultsadverse drug eventadverse drug reactionexplicit criteriaTherapeutics. PharmacologyRM1-950ENFrontiers in Pharmacology, Vol 12 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	polypharmacy elderly older adults adverse drug event adverse drug reaction explicit criteria Therapeutics. Pharmacology RM1-950
spellingShingle	polypharmacy elderly older adults adverse drug event adverse drug reaction explicit criteria Therapeutics. Pharmacology RM1-950 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
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.
format	article
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
title	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_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_sort	polypharmacy management in the older adults: a scoping review of available interventions
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/2267d4113a8b4ed8adfd60672e88068d
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Polypharmacy Management in the Older Adults: A Scoping Review of Available Interventions

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