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Polypharmacy in Older Patients.

Henry J Woodford1

  • 1Northumbria Healthcare, North Tyneside General Hospital, North Shields, UK.

British Journal of Hospital Medicine (London, England : 2005)
|October 30, 2024
PubMed
Summary
This summary is machine-generated.

Polypharmacy in older adults requires individual assessment beyond pill counts. Medicines optimisation, including deprescribing, improves prescribing quality and patient outcomes.

Keywords:
deprescribinggeriatricsmedicines optimisationpolypharmacytherapeutics

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Area of Science:

  • Gerontology
  • Pharmacology
  • Clinical Medicine

Background:

  • Polypharmacy is prevalent in older adults, linked to adverse health outcomes.
  • Current prescribing guidelines often lack deprescribing criteria, contributing to medication accumulation.
  • Clinical trial data may not fully represent older populations, especially those with multi-morbidity or frailty.

Purpose of the Study:

  • To highlight the importance of assessing appropriate versus inappropriate polypharmacy in older individuals.
  • To discuss barriers to deprescribing and the risks associated with inappropriate prescribing.
  • To introduce medicines optimisation as a strategy to improve medication use, including deprescribing.

Main Methods:

  • Review of existing literature on polypharmacy, deprescribing, and medicines optimisation in older adults.
  • Analysis of factors contributing to inappropriate prescribing and therapeutic burden.
  • Discussion of the principles of medicines optimisation, emphasizing shared decision-making and follow-up.

Main Results:

  • Assessing appropriateness of polypharmacy is more informative than simple pill counts.
  • Inappropriate prescribing can result from lack of evidence-based practice, unfavorable benefit-harm balance, hazardous medications, therapeutic burden, reduced adherence, or prescribing cascades.
  • Older adults with multi-morbidity and frailty may have different risk-benefit profiles for medications.

Conclusions:

  • Medicines optimisation, incorporating deprescribing, is crucial for improving medication appropriateness in older people.
  • Individualized assessment and shared decision-making are key components of effective medicines optimisation.
  • Addressing barriers to deprescribing is essential to mitigate risks associated with polypharmacy.