Drug-drug interactions and adverse drug reactions in polypharmacy among older adults: an integrative review
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ABSTRACT

Objective:

to identify and summarize studies examining both drug-drug interactions (DDI) and adverse drug reactions (ADR) in older adults polymedicated.

Methods:

an integrative review of studies published from January 2008 to December 2013, according to inclusion and exclusion criteria, in MEDLINE and EMBASE electronic databases were performed.

Results:

forty-seven full-text studies including 14,624,492 older adults (≥ 60 years) were analyzed: 24 (51.1%) concerning ADR, 14 (29.8%) DDI, and 9 studies (19.1%) investigating both DDI and ADR. We found a variety of methodological designs. The reviewed studies reinforced that polypharmacy is a multifactorial process, and predictors and inappropriate prescribing are associated with negative health outcomes, as increasing the frequency and types of ADRs and DDIs involving different drug classes, moreover, some studies show the most successful interventions to optimize prescribing.

Conclusions:

DDI and ADR among older adults continue to be a significant issue in the worldwide. The findings from the studies included in this integrative review, added to the previous reviews, can contribute to the improvement of advanced practices in geriatric nursing, to promote the safety of older patients in polypharmacy. However, more research is needed to elucidate gaps.

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Most cited references 167

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The integrative review: updated methodology.

Robin Whittemore, Kathleen Knafl (2005)

The aim of this paper is to distinguish the integrative review method from other review methods and to propose methodological strategies specific to the integrative review method to enhance the rigour of the process. Recent evidence-based practice initiatives have increased the need for and the production of all types of reviews of the literature (integrative reviews, systematic reviews, meta-analyses, and qualitative reviews). The integrative review method is the only approach that allows for the combination of diverse methodologies (for example, experimental and non-experimental research), and has the potential to play a greater role in evidence-based practice for nursing. With respect to the integrative review method, strategies to enhance data collection and extraction have been developed; however, methods of analysis, synthesis, and conclusion drawing remain poorly formulated. A modified framework for research reviews is presented to address issues specific to the integrative review method. Issues related to specifying the review purpose, searching the literature, evaluating data from primary sources, analysing data, and presenting the results are discussed. Data analysis methods of qualitative research are proposed as strategies that enhance the rigour of combining diverse methodologies as well as empirical and theoretical sources in an integrative review. An updated integrative review method has the potential to allow for diverse primary research methods to become a greater part of evidence-based practice initiatives.

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Polypharmacy in elderly patients.

Emily Hajjar, Angela Cafiero, Joseph Hanlon (2007)

Polypharmacy (ie, the use of multiple medications and/or the administration of more medications than are clinically indicated, representing unnecessary drug use) is common among the elderly. The goal of this research was to provide a description of observational studies examining the epidemiology of polypharmacy and to review randomized controlled studies that have been published in the past 2 decades designed to reduce polypharmacy in older adults. Materials for this review were gathered from a search of the MEDLINE database (1986-June 2007) and International Pharmaceutical Abstracts (1986-June 2007) to identify articles in people aged >65 years. We used a combination of the following search terms: polypharmacy, multiple medications, polymedicine, elderly, geriatric, and aged. A manual search of the reference lists from identified articles and the authors' article files, book chapters, and recent reviews was conducted to identify additional articles. From these, the authors identified those studies that measured polypharmacy. The literature review found that polypharmacy continues to increase and is a known risk factor for important morbidity and mortality. There are few rigorously designed intervention studies that have been shown to reduce unnecessary polypharmacy in older adults. The literature review identified 5 articles, which are included here. All studies showed an improvement in polypharmacy. Many studies have found that various numbers of medications are associated with negative health outcomes, but more research is needed to further delineate the consequences associated with unnecessary drug use in elderly patients. Health care professionals should be aware of the risks and fully evaluate all medications at each patient visit to prevent polypharmacy from occurring.

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Clinical consequences of polypharmacy in elderly.

Robert Maher, Joseph Hanlon, Emily Hajjar (2014)

Polypharmacy, defined as the use of multiple drugs or more than are medically necessary, is a growing concern for older adults. MEDLINE and EMBASE databases were searched from January 1, 1986 to June 30, 2013) to identify relevant articles in people aged > 65 years. We present information about: i) prevalence of polypharmacy and unnecessary medication use; ii) negative consequences of polypharmacy; and iii) interventions to improve polypharmacy. International research shows that polypharmacy is common in older adults with the highest number of drugs taken by those residing in nursing homes. Nearly 50% of older adults take one or more medications that are not medically necessary. Research has clearly established a strong relationship between polypharmacy and negative clinical consequences. Moreover, well-designed interprofessional (often including clinical pharmacist) intervention studies that focus on enrolling high-risk older patients with polypharmacy have shown that they can be effective in reducing aspects of unnecessary prescribing with mixed results on distal health outcomes.

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Author and article information

Journal

Journal ID (nlm-ta): Rev Lat Am Enfermagem

Journal ID (iso-abbrev): Rev Lat Am Enfermagem

Journal ID (publisher-id): rlae

Title: Revista Latino-Americana de Enfermagem

Publisher: Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo

ISSN (Print): 0104-1169

ISSN (Electronic): 1518-8345

Publication date (Electronic): 01 September 2016

Publication date Collection: 2016

Volume: 24

Electronic Location Identifier: e2800

Affiliations

[2 ]PhD, Associate Professor, Departamento de Enfermagem, Faculdade de Ciências da Saúde, Universidade de Brasília, Brasília, DF, Brazil. Scholarship holder from Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil.

[3 ]Researcher, Departament Epidemiology and Public Health, University College London, London, United Kingdom.

Author notes

Corresponding Author: Maria Cristina Soares Rodrigues Universidade de Brasília. Faculdade de Ciências da Saúde Departamento de Enfermagem Campus Universitário Darcy Ribeiro Asa Norte CEP: 70910-900, Brasília, DF, Brasil E-mail: mcsoares@ 123456unb.br

Article

DOI: 10.1590/1518-8345.1316.2800

PMC ID: 5016009

PubMed ID: 27598380

SO-VID: 8ef7c7d2-6292-4a99-a0bb-7e5cb38cd34f

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License

History

Date received : 15 November 2015

Date accepted : 13 April 2016

Page count

Figures: 9, Tables: 0, Equations: 0, References: 58, Pages: 1

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