Disentangling concepts of inappropriate polypharmacy in old age: a scoping review

BMC Public Health

Research

Sofie Rosenlund Lau¹  Anne Holm¹  John Sahl Andersen¹  Mette Sallerup¹  Tina Drud Due¹  Stine Søndersted Clausen¹  Frans Waldorff¹  Sarah Emilie Christensen¹  Pernille Hølmkjær¹  Anne Frølich² 

[1] The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark;The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark;Innovation and Research Centre for Multimorbidity, Slagelse Hospital, Slagelse, Denmark;

关键词: Polypharmacy;    Older adults;    Geriatrics;    Conceptualization;    Standardization;    Practices;    Politics;   

DOI  :  10.1186/s12889-023-15013-2

 received in 2022-05-13, accepted in 2023-01-10,  发布年份 2023

来源: Springer

【 摘 要 】

IntroductionPolypharmacy is a common concern, especially in the older population. In some countries more that 50% of all individuals over 60 receive five or more drugs, most often due to multimorbidity and increased longevity. However, polypharmacy is associated with multiple adverse events, and more medication may not always be the answer. The terms “appropriate” and “inappropriate” are often used to distinguish between “much” and “too much” medications in relation to polypharmacy in research and practice, but no explicit definition exists to describe what these terms encompass. The aim of this review is to unfold the different understandings of and perspectives on (in)appropriate polypharmacy and suggest a framework for further research and practice.MethodA scoping review was conducted using the framework of Arksey and O’Malley and Levac et al. Pubmed, Embase, PsycINFO, CINAHL, Cochrane database, Scopus and Web of Science were searched for references in English, Danish, Norwegian and Swedish using the search string “Polypharmacy” AND “Appropriate” OR “Inappropriate”. Data was extracted on author information, aims and objectives, methodology, study population and setting, country of origin, main findings and implications, and all text including the words “appropriate,” “inappropriate,” and “polypharmacy.” Qualitative meaning condensation analysis was used and data charted using descriptive and thematic analysis.ResultsOf 3982 references, a total of 92 references were included in the review. Most references were from 2016-2021, from fields related to medicine or pharmacy, and occurred within primary and secondary healthcare settings. Based on the qualitative analysis, a framework were assembled consisting of Context, three domains (Standardization, Practices and Values & Concerns) and Patient Perspective.ConclusionInappropriate polypharmacy is a concept loaded by its heterogeneity and the usefulness of a single definition is doubtful. Instead, the framework suggested in this article representing different dimensions of inappropriate polypharmacy may serve as an initial strategy for focusing research and practice on polypharmacy in old age.

【 授权许可】

CC BY   
© The Author(s) 2023

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