Abstract
BackgroundPolypharmacy, the concurrent use of multiple medications, consistently evokes a negative connotation, notably because it is associated with a plethora of adverse events. Nonetheless, the number of individuals exposed to polypharmacy is increasing steeply, especially for older people with multiple diseases. There is a need to carefully study the phenomenon at the population scale to full assess the associated health outcomes. Yet, this reveals a complex task because there exists no consensus indicator of polypharmacy. In fact, the definitions of polypharmacy are heterogeneous and its predisposing factors and associated outcomes are not well defined. The goal of this systematic review is to summarize the literature on polypharmacy in multimorbid individuals aged 65 years and over, targeting three objectives: (1) to identify the definitions of polypharmacy that are used in the context of multimorbidity among older individuals (≥65 years); (2) to ascertain predisposing and concurrent factors associated with polypharmacy; and (3) to describe positive and negative outcomes of polypharmacy among older individuals, including hospitalizations, mortality and costs.MethodsWe will include publications from 2004 to 2016 that target four concepts: polypharmacy, older individuals, multimorbidity and positive/negative outcomes. The search will be performed using EBM Reviews, Embase, Global Health, MEDLINE, AgeLine, CINAHL, Health Policy Reference Center, Public Affairs Index, SocINDEX and Google Scholar. Two independent reviewers will screen the articles, extract the information and evaluate the methodological quality of included studies. The results will be presented in tables and narrative summaries will be performed. We will perform meta-analyses (objective 3) if the heterogeneity is not important.DiscussionThis review will help describe the various ways of conceptualizing polypharmacy and how it is associated with health outcomes. We have selected outcomes most relevant for public surveillance performed with administrative databases. Other positive and negative outcomes have been associated with polypharmacy but may not be included in the review.Systematic review registrationPROSPERO CRD42014014989
Highlights
Polypharmacy, the concurrent use of multiple medications, consistently evokes a negative connotation, notably because it is associated with a plethora of adverse events
The first objective will help us gather the different definitions of polypharmacy used in the context of multimorbidity among older individuals
This collation will notably help evaluate if conceptualization of polypharmacy diverges between different settings and populations, and whether visions of polypharmacy in clinical practice, research and population surveillance are aligned
Summary
Participants/population The review will consider studies that include people aged 65 years and older with at least two concurrent chronic diseases. We will include studies if at least one of the following applies: At least 80% of participants are aged 65 years and older. The data from people aged 65 years and older can be extracted. We will include all settings (community, hospital, nursing homes) and types of health care (public, private). We will perform subgroup analyses according to those settings. Exposure and comparators Older individuals with chronic diseases exposed to polypharmacy will be considered. Older individuals with chronic disease not exposed to polypharmacy will be the comparators when applicable (objectives 2 and 3)
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