Polypharmacy management interventions in older adults: An umbrella review of meta-analyses of randomized controlled...

To synthesize evidence from meta-analyses of randomized controlled trials (RCTs) evaluating interventions aimed at improving polypharmacy management in older adults, with a focus on key clinical outcomes including mortality, hospitalizations, and falls.

Umbrella review.

We conducted an umbrella review of systematic reviews with meta-analyses of RCTs assessing interventions to optimize polypharmacy in elderly populations across healthcare settings. Eligible interventions included medication reviews, deprescribing strategies, and educational or behavioral approaches targeting medication appropriateness, reduction, or adherence. Searches were performed in Pubmed, Cochrane and Web of Science up to September 2024. Study selection, data extraction, and quality assessment, performed using AMSTAR2 and GRADE, were independently conducted by multiple reviewers. The protocol was prospectively registered on the Open Science Framework, and reporting followed the PRIOR checklist.

Six articles including 21 meta-analyses, encompassing 110 primary RCTs, were included. Medication reviews focused on deprescribing were associated with reduced mortality in community settings but not in hospitals. Behavioral and mixed educational-behavioral interventions appeared most effective in reducing hospitalizations, particularly in community populations. Medication reviews in hospital settings showed only modest effects, and no intervention significantly reduced fall risk. The overall certainty of evidence was low due to heterogeneity, small-study effects, and publication bias.

Evidence on interventions to manage polypharmacy in older adults remains limited and inconsistent. Tailored, patient-centered strategies may offer greater benefit, but higher-quality and standardized trials are needed to strengthen the evidence base and guide public health strategies in aging populations.