Clinical Investigations
Health Outcomes Associated with Polypharmacy in Community-Dwelling Older Adults: A Systematic Review
Terri R. Fried MD,
John O'Leary MS,
Virginia Towle MPhil,
Mary K. Goldstein MD, MS,
Mark Trentalange MD, MPH,
Deanna K. Martin MPH,
Corresponding Author
Terri R. Fried MD
Clinical Epidemiology Research Center, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
Department of Medicine, Yale University
Address correspondence to Terri Fried, CERC 151B, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT 06516. E-mail: [email protected]Search for more papers by this authorJohn O'Leary MS
Program on Aging, School of Medicine, Yale University, New Haven, Connecticut
Search for more papers by this authorVirginia Towle MPhil
Program on Aging, School of Medicine, Yale University, New Haven, Connecticut
Search for more papers by this authorMary K. Goldstein MD, MS
Geriatrics Research Education and Clinical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
Center for Primary Care and Outcomes Research, School of Medicine, Stanford University, Stanford, California
Search for more papers by this authorMark Trentalange MD, MPH
Program on Aging, School of Medicine, Yale University, New Haven, Connecticut
Search for more papers by this authorDeanna K. Martin MPH
Clinical Epidemiology Research Center, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
Search for more papers by this authorTerri R. Fried MD,
John O'Leary MS,
Virginia Towle MPhil,
Mary K. Goldstein MD, MS,
Mark Trentalange MD, MPH,
Deanna K. Martin MPH,
Corresponding Author
Terri R. Fried MD
Clinical Epidemiology Research Center, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
Department of Medicine, Yale University
Address correspondence to Terri Fried, CERC 151B, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT 06516. E-mail: [email protected]Search for more papers by this authorJohn O'Leary MS
Program on Aging, School of Medicine, Yale University, New Haven, Connecticut
Search for more papers by this authorVirginia Towle MPhil
Program on Aging, School of Medicine, Yale University, New Haven, Connecticut
Search for more papers by this authorMary K. Goldstein MD, MS
Geriatrics Research Education and Clinical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
Center for Primary Care and Outcomes Research, School of Medicine, Stanford University, Stanford, California
Search for more papers by this authorMark Trentalange MD, MPH
Program on Aging, School of Medicine, Yale University, New Haven, Connecticut
Search for more papers by this authorDeanna K. Martin MPH
Clinical Epidemiology Research Center, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
Search for more papers by this authorAbstract
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.
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