Nashwa Masnoon
University of South Australia, Australia
Title: What is polypharmacy and how do we assess it?
Biography
Biography: Nashwa Masnoon
Abstract
Multimorbidity and the use of multiple medicines, commonly referred to as polypharmacy, is common in the older population. However there is no universal definition of polypharmacy. Three systematic reviews of polypharmacy definition, assessment tools and their associations with clinical outcomes were conducted using Medline/Embase databases of articles in English between 2000-2016 which i) defined polypharmacy ii) explored tools that assess polypharmacy and iii) examined clinical outcomes. A total of 112 articles were identified for polypharmacy definitions. While definitions ranged from two or more, to 11 or more medications daily, the most commonly reported definition was five or more medications daily (n=51, 45.5%). Few studies (6.3%) distinguished between appropriate and inappropriate polypharmacy but this distinction was not based on the pharmacology of medications. A total of 26 polypharmacy tools were identified and divided into two broad categories; tools with a scoring system (n=8) such as the Drug Burden Index and tools that do not provide a score (n=18) but criteria for appropriate or inappropriate prescribing such as the Beers Criteria. Out of the 26 tools identified, 50% were associated with at least one clinical outcome. Three of the tools were associated with mortality, hospitalisation and functional decline. Studies have used the number of medicines to define polypharmacy which may not be clinically relevant without considering the pharmacology of medications involved. There is a need for tools which consider polypharmacy at an individualised-patient level to provide tailored guidance around optimising appropriate therapy and deprescribing inappropriate therapy to improve health outcomes.