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Polypharmacy

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161. How Chronic Is Polypharmacy in Old Age? A Longitudinal Nationwide Cohort Study. (PubMed)

How Chronic Is Polypharmacy in Old Age? A Longitudinal Nationwide Cohort Study. To evaluate the chronicity of polypharmacy among older adults and to identify factors associated with chronic polypharmacy.Longitudinal cohort study using register data.Nationwide, Sweden.All 711,432 older adults (aged 65 years and older) living in Sweden with five or more prescription drugs in October 2010 were included and followed up until December 2013. Mean age at baseline was 77 (SD = 7.8) years, 59% were (...) women, and 7% lived in nursing homes.Monthly changes in the exposure to polypharmacy. Data regarding prescription drug use were extracted from the Swedish Prescribed Drugs Register.Overall, 82% were continuously exposed to polypharmacy for 6 months or longer, and 74% for 12 months or longer. The proportion of individuals who remained exposed until the end of the study was 55%. Among the 21,361 individuals who had not been exposed to polypharmacy during the 6-month period before baseline (ie

2018 Journal of the American Geriatrics Society

162. Predictors of polypharmacy among elderly Thais with depressive and anxiety disorders: findings from the DAS study. (PubMed)

Predictors of polypharmacy among elderly Thais with depressive and anxiety disorders: findings from the DAS study. Polypharmacy is a geriatric syndrome defined variously as the use of potentially inappropriate drugs and/or the concurrent use of multiple medications including prescription and over-the-counter drugs. An association has been shown between polypharmacy and physical health, increased morbidity and increased mortality. However, there is little information regarding the association (...) between polypharmacy and physical disease, personality trait and mental health problems in elderly. The aim of this study was to investigate potential predictive psychosocial factors related to polypharmacy in elderly Thai people.The study analysed the secondary data from the Depressive Disorders, Anxiety Disorders, Suicide Risk and Associated Factors Among Elderly Thai People Program (DAS Study) which was funded by National Research Council of Thailand and conducted between January 2012 and April

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2018 BMC Geriatrics

163. Influence of Polypharmacy on the Effectiveness and Safety of Rivaroxaban versus Warfarin in Patients with Nonvalvular Atrial Fibrillation. (PubMed)

Influence of Polypharmacy on the Effectiveness and Safety of Rivaroxaban versus Warfarin in Patients with Nonvalvular Atrial Fibrillation. Patients with nonvalvular atrial fibrillation (NVAF) often have multiple comorbidities requiring concomitant medications in addition to their oral anticoagulant (OAC). The objective of this study was to evaluate the impact of polypharmacy on the effectiveness and safety of rivaroxaban versus warfarin in patients with NVAF managed in routine clinical (...) experiencing polypharmacy (concomitant prescription claims for five or more unique chronic medication claims) were included. Patients who had concomitant prescription claims for ≥ 10 unique chronic medication claims constituted the substantial polypharmacy cohort used in the secondary analysis. Patients receiving rivaroxaban were propensity-score matched in a 1:1 ratio to patients receiving warfarin (13,981 patients in each polypharmacy OAC group, and 1765 patients in each substantial polypharmacy OAC

2018 Pharmacotherapy

164. Core Outcome Set for Trials Aimed at Improving the Appropriateness of Polypharmacy in Older People in Primary Care. (PubMed)

Core Outcome Set for Trials Aimed at Improving the Appropriateness of Polypharmacy in Older People in Primary Care. To develop a core outcome set (COS) for use in effectiveness trials of interventions aiming to improve the appropriateness of polypharmacy in older people in primary care.Standard COS development methodology was followed, comprising identification of outcomes of studies from an update of a Cochrane systematic review and previously collected qualitative data and an online Delphi (...) the outcome as critical and 15% or fewer scoring the outcome as not important.Twenty-nine outcomes identified from the Cochrane review and existing qualitative data were included in the Delphi exercise. The final COS comprised 16 outcomes. The 7 highest-ranked outcomes were serious adverse drug reactions, medication appropriateness, falls, medication regimen complexity, quality of life, mortality, and medication side effects.A COS for interventions aiming to improve the appropriateness of polypharmacy

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2018 Journal of the American Geriatrics Society

165. Polypharmacy in people with dementia: Associations with adverse health outcomes. (PubMed)

Polypharmacy in people with dementia: Associations with adverse health outcomes. Polypharmacy has been linked to higher risks of hospitalisation and death in community samples. It is commonly present in people with dementia but these risks have rarely been studied in this population. We aimed to investigate associations between polypharmacy and emergency department attendance, any and unplanned hospitalisation, and mortality in patients with dementia. Using a large mental health care database (...) of emergency department attendance (hazard ratio 1.20/1.35), hospitalisation (hazard ratio 1.12/1.32), unplanned hospital admission (hazard ratio 1.12/1.25), and death within two years (hazard ratio 1.29/1.39) after controlling for potential confounders. We found evidence of a dose response relationship with each additional drug at baseline increasing the risk of emergency department attendance and mortality by 5% and hospitalisation by 3%. In conclusion, polypharmacy at dementia diagnosis is associated

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2018 Experimental Gerontology

166. Opioid Prescribing and Polypharmacy in Children with Chronic Musculoskeletal Pain. (PubMed)

Opioid Prescribing and Polypharmacy in Children with Chronic Musculoskeletal Pain. Thirty percent of adults with fibromyalgia receive an opioid, but the prevalence of opioid prescribing in pediatric chronic musculoskeletal pain is unknown. The aims of this study were to determine the prevalence of and factors associated with opioid exposure and polypharmacy among children with chronic musculoskeletal pain.In this retrospective cohort study using health care claims data from 2000 to 2013 (...) , the index date was the first ICD-9 code 729.1. Included subjects were ≥ 2 and < 18 years old at the index date with two or more codes within 12 months and 18 months of continuous enrollment. Subjects with burns, sickle cell disease, or malignancy were excluded. Opioid exposure was defined as one or more prescriptions within six months before or any time after the index date. Polypharmacy was considered minor (2-4 medications) or major (≥5 medications).Of 25,321 included subjects, 20% received an opioid

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2018 Pain Medicine

167. Developing a measure of polypharmacy appropriateness in primary care: systematic review and expert consensus study. (PubMed)

Developing a measure of polypharmacy appropriateness in primary care: systematic review and expert consensus study. Polypharmacy is an increasing challenge for primary care. Although sometimes clinically justified, polypharmacy can be inappropriate, leading to undesirable outcomes. Optimising care for polypharmacy necessitates effective targeting and monitoring of interventions. This requires a valid, reliable measure of polypharmacy, relevant for all patients, that considers clinical (...) appropriateness and generic prescribing issues applicable across all medications. Whilst there are several existing measures of potentially inappropriate prescribing, these are not specifically designed with polypharmacy in mind, can require extensive clinical input to complete, and often cover a limited number of drugs. The aim of this study was to identify what experts consider to be the key elements of a measure of prescribing appropriateness in the context of polypharmacy.Firstly, we conducted

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2018 BMC Medicine

168. Variation of polypharmacy in older primary care attenders occurs at prescriber level. (PubMed)

Variation of polypharmacy in older primary care attenders occurs at prescriber level. Polypharmacy is particularly important in older persons as they are more likely to experience adverse events compared to the rest of the population. Despite the relevance, there is a lack of studies on the possible association of patient, prescriber and practice characteristics with polypharmacy. Thus, the aim of this study was to determine the rate of polypharmacy among older persons attending public (...) and private primary care clinics, and its association with patient, prescriber and practice characteristics.We used data from The National Medical Care Survey (NMCS), a national cross-sectional survey of patients' visits to primary care clinics in Malaysia. A weighted total of 22,832 encounters of patients aged ≥65 years were analysed. Polypharmacy was defined as concomitant use of five medications and above. Multilevel logistic regression was performed to examine the association of polypharmacy

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2018 BMC Geriatrics

169. Factors associated with polypharmacy in primary care: a cross-sectional analysis of data from The English Longitudinal Study of Ageing (ELSA). (PubMed)

Factors associated with polypharmacy in primary care: a cross-sectional analysis of data from The English Longitudinal Study of Ageing (ELSA). While older age and ill health are known to be associated with polypharmacy, this paper aims to identify whether wealth, body mass index (BMI), smoking and alcohol consumption are also associated with polypharmacy (5-9 prescribed medications) and hyperpolypharmacy prevalence (≥10 prescribed medications), among older people living in England.Cross (...) -sectional study.The English Longitudinal Study of Ageing Wave 6 (2012-2013).7730 participants aged over 50 years.Two multivariate models were created. HR with corresponding 95% CI, for polypharmacy and hyperpolypharmacy, were calculated after adjusting for gender, age, wealth, smoking, alcohol consumption, BMI, self-rated health and the presence of a chronic health condition.Lower wealth (lowest wealth quintile vs highest wealth quintile, adjusted HR 1.28; 95% CI 1.04 to 1.69, P=0.02) and obesity

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2018 BMJ open

170. Association of Polypharmacy with Survival, Complications, and Healthcare Resource Use after Elective Noncardiac Surgery: A Population-based Cohort Study. (PubMed)

Association of Polypharmacy with Survival, Complications, and Healthcare Resource Use after Elective Noncardiac Surgery: A Population-based Cohort Study. Polypharmacy is increasingly prevalent in older patients and is associated with adverse events among medical patients. The impact of polypharmacy on outcomes after elective surgery is poorly described. The authors' objective was to measure the association of polypharmacy with survival, complications, and resource use among older patients (...) undergoing elective surgery.After registration (NCT03133182), the authors identified all individuals older than 65 yr old having their first elective noncardiac surgery in Ontario, Canada, between 2002 and 2014. Using linked administrative data, the authors identified all prescriptions dispensed in the 90 days before surgery and classified people receiving five or more unique medications with polypharmacy. The associations of polypharmacy with 90-day survival (primary outcome), complications, length

2018 Anesthesiology

171. International core outcome set for clinical trials of medication review in multi-morbid older patients with polypharmacy. (PubMed)

International core outcome set for clinical trials of medication review in multi-morbid older patients with polypharmacy. Comparisons of clinical trial findings in systematic reviews can be hindered by the heterogeneity of the outcomes reported. Moreover, the outcomes that matter most to patients might be underreported. A core outcome set can address these issues, as it defines a minimum set of outcomes that should be reported in all clinical trials in a particular area of research (...) patients with polypharmacy.

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2018 BMC Medicine

172. [Antipsychotic polypharmacy in the treatment of schizophrenia]

[Antipsychotic polypharmacy in the treatment of schizophrenia] Antipsykotisk polyfarmaci i behandlingen af skizofreni [Antipsychotic polypharmacy in the treatment of schizophrenia] Antipsykotisk polyfarmaci i behandlingen af skizofreni [Antipsychotic polypharmacy in the treatment of schizophrenia] Baandrup L, Lublin H, Nordentoft M, Peacock L, Sorensen J, Andersen SE, Glenthoj B Record Status This is a bibliographic record of a published health technology assessment from a member of INAHTA (...) . No evaluation of the quality of this assessment has been made for the HTA database. Citation Baandrup L, Lublin H, Nordentoft M, Peacock L, Sorensen J, Andersen SE, Glenthoj B. Antipsykotisk polyfarmaci i behandlingen af skizofreni. [Antipsychotic polypharmacy in the treatment of schizophrenia] Copenhagen: Danish Centre for Evaluation and Health Technology Assessment (DACEHTA). Volume 11(1). 2011 Authors' objectives The aim of this health technology assessment is to explore how antipsychotic polypharmacy

2011 Health Technology Assessment (HTA) Database.

173. Polypharmacy associated with non-prescribed medicines use among older adults with multi-morbidity: a systematic review

Polypharmacy associated with non-prescribed medicines use among older adults with multi-morbidity: a systematic review Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. CRD bears no responsibility or liability for the content of this registration record, any associated files or external websites. Email salutation (e.g. "Dr Smith" or "Joanne") for correspondence

2017 PROSPERO

174. Polypharmacy and medicines optimisation

Polypharmacy and medicines optimisation Polypharmacy and medicines optimisation | The King's Fund Main navigation Health and care services Leadership, systems and organisations Patients, people and society Policy, finance and performance Search term Apply Polypharmacy and medicines optimisation: Making it safe and sound This content relates to the following topics: Share this content Related details Authors Martin Duerden Tony Avery Rupert Payne Publication details ISBN 978 1 909029 18 7 Pages (...) 68 Polypharmacy – the concurrent use of multiple medications by one individual – is an increasingly common phenomenon that demands attention at clinical policy and practice level. Driven by the growth of an ageing population and the rising prevalence of multi-morbidity, polypharmacy has previously been considered something to avoid. It is now recognised as having both positive and negative potential, depending on how medicines and care are managed. This report proposes a pragmatic approach

2013 The King's Fund

175. Understanding the association between antipsychotic polypharmacy and metabolic disorders in people with psychosis

Understanding the association between antipsychotic polypharmacy and metabolic disorders in people with psychosis Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. CRD bears no responsibility or liability for the content of this registration record, any associated files or external websites. Email salutation (e.g. "Dr Smith" or "Joanne") for correspondence

2017 PROSPERO

176. Systematic review of polypharmacy tools and association with clinical outcomes

Systematic review of polypharmacy tools and association with clinical outcomes Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. CRD bears no responsibility or liability for the content of this registration record, any associated files or external websites. Email salutation (e.g. "Dr Smith" or "Joanne") for correspondence: Organisation web address: Timing and effect

2017 PROSPERO

177. Factors associated with polypharmacy and excessive polypharmacy in older people with intellectual disability differ from the general population: a cross-sectional observational nationwide study. (PubMed)

Factors associated with polypharmacy and excessive polypharmacy in older people with intellectual disability differ from the general population: a cross-sectional observational nationwide study. (1) To evaluate the prevalence of polypharmacy (5-9 medicines) and excessive polypharmacy (10+ medicines) and (2) to determine associated demographic and clinical characteristics in an ageing population with intellectual disabilities (IDs).Observational cross-sectional study.Wave One (2009/2010 (...) ) of the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA).A nationally representative sample of 753 persons with ID, aged between 41 and 90 years. Participants/proxy reported medicines (prescription and over the counter) taken on a regular basis; medication data was available for 736 participants (98%).Participants were divided into those with no polypharmacy (0-4 medicines), polypharmacy (5-9 medicines) and excessive polypharmacy (10+ medicines). Medication use patterns were

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2016 BMJ open

178. The impact of a medication review with follow-up service on hospital admissions in aged polypharmacy patients. (PubMed)

The impact of a medication review with follow-up service on hospital admissions in aged polypharmacy patients. The aims were to assess the impact of a medication review with follow-up (MRF) service provided in community pharmacy to aged polypharmacy patients on the number of medication-related hospital admissions and to estimate the effect on hospital costs.This was a sub-analysis of a cluster randomized controlled trials carried out in 178 community pharmacies in Spain. Pharmacies (...) -related hospitalization were €6672. Medication-related hospitalization costs were lower for patients receiving MRF [IG: €94 (SD 917); CG: €301 (SD 2102); 95% CI 35.9, 378.0, P = 0.018].MRF provided by community pharmacists might be an effective strategy to balance the assurance of the benefit from medications and the avoidance of medication-related hospitalizations in aged patients using polypharmacy.© 2016 The British Pharmacological Society.

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2017 British journal of clinical pharmacology Controlled trial quality: uncertain

179. Polypharmacy in heart failure - Is reducing medication safe? (PubMed)

Polypharmacy in heart failure - Is reducing medication safe? 26837864 2017 06 30 2017 08 17 1874-1754 214 2016 Jul 01 International journal of cardiology Int. J. Cardiol. Polypharmacy in heart failure - Is reducing medication safe? 529-30 10.1016/j.ijcard.2015.09.093 S0167-5273(15)30533-7 Hopper Ingrid I Centre of Cardiovascular Research and Education in Therapeutics, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Clinical Pharmacology Department (...) Hydroxymethylglutaryl-CoA Reductase Inhibitors R16CO5Y76E Aspirin IM Aged Aspirin administration & dosage therapeutic use Cross-Over Studies Evidence-Based Medicine Female Heart Failure drug therapy Humans Hydroxymethylglutaryl-CoA Reductase Inhibitors administration & dosage therapeutic use Male Middle Aged Pilot Projects Polypharmacy Practice Guidelines as Topic Prospective Studies Quality of Life 2015 06 28 2015 09 24 2016 2 4 6 0 2016 2 4 6 0 2017 7 1 6 0 ppublish 26837864 S0167-5273(15)30533-7 10.1016/j.ijcard

2017 International journal of cardiology Controlled trial quality: uncertain

180. Polypharmacy and major adverse events in atrial fibrillation: observations from the AFFIRM trial. (PubMed)

Polypharmacy and major adverse events in atrial fibrillation: observations from the AFFIRM trial. Polypharmacy, as the use of five or more drugs, has commonly been associated with the elderly and multiple co-morbidities and related to impairment of clinical state and adverse outcomes, in general population. Limited data are available on the relationship between polypharmacy and adverse outcomes in atrial fibrillation (AF). We describe the prevalence of polypharmacy and AF, and its association (...) with major adverse events, such as stroke and cardiovascular (CV) death.For this study, we analysed all AFFIRM Trial patients with complete pharmacological data. Polypharmacy was recorded in 40 % of 4056 AF patients. The crude incidence of CV death was 3.45 % patient-years among patients with polypharmacy, vs 1.65 % patient-years without polypharmacy. Kaplan-Meier analysis showed that patients with polypharmacy had a higher cumulative incidence of CV death (p < 0.001). Cox regression analysis

2017 Clinical research in cardiology : official journal of the German Cardiac Society Controlled trial quality: uncertain

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