A systematic review of case-series studies on the effectiveness of interventions to reduce polypharmacy and its adverse consequences in the elderly

Abstract

Background: Aging is frequently accompanied by chronic diseases; consequently, older people are exposed to polypharmacy, often with negative health-consequences. The aim of this study is to conduct a systematic review of the literature reporting on the effectiveness of different approaches to reduce polypharmacy in the elderly. Methods: We conducted a comprehensive literature search of MEDLINE, Scopus and ISI Web of Knowledge databases. Eligible studies were case-series reporting outcomes of interventions aimed at reducing polypharmacy and its consequences in the elderly. A quality appraisal of the studies included was performed. Results: Nineteen studies were included, of which seven conducted in hospital setting, six in community setting, six in nursing homes. Seventeen were judged as moderate quality, and two as poor quality. Majority of the interventions were carried out by pharmacists, alone (35%) or with other professionals (40%). Interventions consisted in pharmacotherapy reviews based on various tools and software; in some cases educational interventions were performed for review-performers and patients. Studies conducted in community-setting provided also a feedback to primary care physician. The outcomes included five categories: therapy’s characteristics, quality of life, health-related outcomes, costs, healthcare services’ utilization. Therapy-related outcomes were positively affected by all types of interventions, while results were contrasting for quality of life and services’ use. Costs and health outcomes were reported by only few studies. Conclusion: Interventions aimed at reducing polypharmacy are effective in optimizing the use of drugs. More research is needed regarding the effectiveness on quality of life, healthcare costs, services’ utilization, and health-related outcomes.