Decision-support systems for managing polypharmacy in the elderly: A scoping review.

Area of Science:

• Gerontology
• Health Informatics
• Pharmacology

Background:

• Polypharmacy, defined as the use of more than five medications, is a major public health concern, particularly among the elderly.
• It leads to adverse drug reactions, drug interactions, and increased healthcare costs.
• Existing therapeutic guidelines for managing polypharmacy are complex and difficult to implement.

Purpose of the Study:

• To conduct a scoping review of electronic decision-support systems (DSS) for managing polypharmacy in elderly patients.
• To analyze the technical design, knowledge sources, and evaluation methods of these systems.
• To identify gaps and propose future research directions for polypharmacy management DSS.

Main Methods:

• A systematic bibliographic search was conducted to identify relevant electronic systems.
• The review analyzed system design (rule-based, documentary, mixed), outputs (textual, alerts, visual), and evaluation criteria (clinical practice, patient outcomes, efficiency, user satisfaction).

Main Results:

• Nineteen polypharmacy management systems were identified, exhibiting considerable variation in technical design and output formats.
• Evaluations were minimal, with only one system assessed against all predefined criteria.
• No machine learning or conflict management systems were found among the reviewed DSS.

Conclusions:

• Current electronic decision-support systems for polypharmacy management in the elderly have limited evaluation data.
• There is a critical need for developing novel methodologies that integrate diverse approaches for more effective polypharmacy management.
• Future research should focus on creating robust, comprehensively evaluated DSS, potentially incorporating machine learning and advanced conflict resolution.