Is it possible to reduce polypharmacy in the elderly? A randomised, controlled trial.

Area of Science:

• Geriatrics
• Clinical Pharmacy
• Health Services Research

Background:

• Polypharmacy is a significant issue in elderly patients, increasing risks of adverse drug events and healthcare costs.
• Comprehensive day hospital care models aim to improve patient management and potentially reduce medication burden.

Purpose of the Study:

• To evaluate the effectiveness of day hospital care in reducing polypharmacy among chronically ill elderly patients.
• To assess the feasibility of simplifying drug regimens under tight control in a day hospital setting.

Main Methods:

• A randomized controlled trial involving 174 home care patients (mean age 77) in a rural Finnish area.
• Intervention group received 2-month day hospital care with medication review and adjustments; control group received usual care.
• Medication use (prescribed, OTC, daily doses) assessed at baseline and 10 months post-intervention.

Main Results:

• No significant reduction in the number of prescribed medications was observed.
• A significant reduction in daily doses was achieved during the day hospital period (p=0.02), but this was offset by increased over-the-counter (OTC) drug use (p=0.05).
• Medication numbers returned to baseline levels within 3 months after the intervention ceased.

Conclusions:

• Reducing polypharmacy in elderly patients in real-world settings remains challenging.
• While intensive interventions can temporarily decrease drug use, sustained reductions are difficult to achieve without ongoing support.
• The study highlights the complexity of medication management in the elderly and the potential for compensatory use of OTC drugs.