Abstract
BackgroundThere has been a global increase in the use of herbal medicinal products (HMPs). About a quarter of UK adults use HMPs, bought over the counter by self-prescription and often not disclosed to healthcare professionals. Potential herb-drug interaction is a clinical concern, with older people at greater risk because of co-morbidities and slower clearance of pharmacologically active compounds. While there is a good understanding of general herbal medicine use by older people, less is known about the extent and implications of concurrent use with prescription medicines. The aim of this systematic review is to assess the prevalence, patterns, safety issues and other factors associated with concurrent prescription and herbal medicines use among older adults.Methods/designSystematic electronic searches of MEDLINE, PsychINFO, Excerpta Medica dataBASE (EMBASE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Allied and Complementary Medicine Database (AMED), Web of Science and Cochrane from inception till present for studies reporting the concurrent use of prescription medicines with HMPs in older adults (≥65 years). Lateral searching via related citation (PubMed) and checking reference lists of identified studies will be performed. Two reviewers will independently screen studies, extract data and appraise methodological quality using the Joanna Briggs Institute checklist for prevalence data and the Critical Appraisal Skills Programme (CASP) checklist. Qualitative and quantitative studies from all settings will be included. Non-empirical papers, in vitro experiments and animal studies will be excluded. Primary outcomes are prevalence and patterns of concurrent use, number and types of prescription and HMPs and adverse reactions reported. Secondary outcomes are disclosure of HMP use to healthcare professionals and cost of HMPs. A narrative synthesis of included studies will be performed to summarise the evidence.DiscussionThis review will synthesise and critically appraise current knowledge on the concurrent use of drugs and HMPs by older adults and thus provide a better understanding of the issue. It will also identify any gaps in knowledge. By establishing safety issues associated with concurrent use, it will also inform strategies that can help practitioners to identify and manage older people at potential risk of herb-drug interactions.Systematic review registrationPROSPERO CRD42014009091Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-016-0244-2) contains supplementary material, which is available to authorized users.
Highlights
There has been a global increase in the use of herbal medicinal products (HMPs)
By establishing safety issues associated with concurrent use, it will inform strategies that can help practitioners to identify and manage older people at potential risk of herb-drug interactions
Excessive and inappropriate medicine use is common among older adults [32, 33], and concurrent use with HMPs further complicates the problem
Summary
Failure to review and manage the concurrent use of prescription and herbal medicines in older adults is a considerable patient safety risk. This review is a significant addition to knowledge due to the paucity of evidence on the concurrent use of prescription drugs and HMPs in older adults. There is no up-to-date review on concurrent prescription and herbal medicine use among UK older adults; the only previous related study [34] is over a decade old. The review will provide healthcare professionals with up-to-date knowledge on the prevalence and factors associated with concurrent medication use among this population It will provide important baseline information for future intervention research. Additional file 2: Search strategy used for Medline detailing keywords, subject headings, search terms, search techniques and combination of search terms Competing interests This systematic literature review is part of TA’s research for a Doctorate in Health Research at the University of Hertfordshire.
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