Polypharmacy Definitions for Multimorbid Older Adults Need Stronger Foundations to Guide Research, Clinical Practice and Public Health

被引:47
作者
Sirois, Caroline [1 ,2 ,3 ,4 ]
Domingues, Nelia Sofia [3 ]
Laroche, Marie-Laure [5 ,6 ]
Zongo, Arsene [7 ,8 ]
Lunghi, Carlotta [8 ,9 ,10 ]
Guenette, Line [3 ,7 ,8 ]
Kroger, Edeltraut [2 ,7 ,8 ]
Emond, Valerie [4 ]
机构
[1] Laval Univ, Fac Med, Dept Social & Prevent Med, Quebec City, PQ G1V 0A6, Canada
[2] CIUSSS CN, Ctr Excellence Aging Quebec, Quebec City, PQ G1S 4L8, Canada
[3] Univ Laval, Ctr Rech Soins & Serv Premiere Ligne, Quebec City, PQ G1J 0A4, Canada
[4] Inst Natl Sante Publ Quebec, Quebec City, PQ G1V 5B3, Canada
[5] CHU Limoges, Ctr Reg Pharmacovigilance Pharmacoepidemiol & Inf, Serv Pharmacol Toxicol & Pharmacovigilance, F-87042 Limoges, France
[6] Univ Limoges, Fac Med, INSERM 1248, F-87032 Limoges, France
[7] Univ Laval, Fac Pharm, Quebec City, PQ G1V 0A6, Canada
[8] CHU Quebec, Ctr Rech, Sante Populat & Prat Optimales Sante, Quebec City, PQ G1S 4L8, Canada
[9] Univ Quebec Rimouski, Dept Nursing, Levis, PQ G6V 0A6, Canada
[10] CISSS Chaudiere Appalaches, Ctr Rech, Levis, PQ G6V 3Z1, Canada
关键词
polypharmacy; older adults; multimorbidity; population health; research; clinical practice; medications; scoping review; MEDICATION USE; RISK; POPULATION; INDICATOR; OUTCOMES; CANCER; PEOPLE; CARE;
D O I
10.3390/pharmacy7030126
中图分类号
R9 [药学];
学科分类号
1007 ;
摘要
There are numerous definitions of polypharmacy to describe the use of many medications among older adults, but there is a need to clarify if they are purposive and meaningful. By means of a systematic review, we identified definitions of polypharmacy used in multimorbid older adults (>= 65 years). We evaluated if the definitions align among the domains of research, clinical practice, and public health and appraised whether concepts of polypharmacy are based on strong foundations. More than 46 definitions of polypharmacy were retrieved from 348 publications (research: n = 243; clinical practice: n = 88; public health: n = 17). Several thresholds based on the number of medications were mentioned. The majority of the publications (n = 202, 58%) used a minimal threshold of five medications. Heterogeneous qualitative definitions were identified, mostly stating that polypharmacy is more drugs than needed. There was no significant divergence between domains as to the type of definitions used, although qualitative definitions were more common in clinical practice. Nearly half (n = 156, 47%) of the publications provided no justification for the polypharmacy definition used. The wide variety of definitions for polypharmacy precludes comparisons, appropriate identification and management of polypharmacy in multimorbid older adults. Standardized definitions would allow more coherent judgments regarding the individual and collective stakes of polypharmacy.
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页数:14
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