Volume 62, Issue 12 p. 2261-2272
Clinical Investigations

Health Outcomes Associated with Polypharmacy in Community-Dwelling Older Adults: A Systematic Review

Terri R. Fried MD

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 author
John O'Leary MS

John O'Leary MS

Program on Aging, School of Medicine, Yale University, New Haven, Connecticut

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Virginia Towle MPhil

Virginia Towle MPhil

Program on Aging, School of Medicine, Yale University, New Haven, Connecticut

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Mary K. Goldstein MD, MS

Mary 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

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Mark Trentalange MD, MPH

Mark Trentalange MD, MPH

Program on Aging, School of Medicine, Yale University, New Haven, Connecticut

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Deanna K. Martin MPH

Deanna K. Martin MPH

Clinical Epidemiology Research Center, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut

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First published: 17 December 2014
Citations: 443

Abstract

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.