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Polypharmacy Definitions for Multimorbid Older Adults Need Stronger Foundations to Guide Research, Clinical Practice and Public Health

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Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, Québec, QC G1V 0A6, Canada
2
Centre of Excellence on Aging of Quebec, CIUSSS-CN, Québec, QC G1S 4L8, Canada
3
Centre de Recherche sur les Soins et les Services de Première Ligne de L’Université Laval, Québec, QC G1J 0A4, Canada
4
Institut National de Santé Publique du Québec, Québec, QC G1V 5B3, Canada
5
Service de Pharmacologie, Toxicologie et Pharmacovigilance, Centre Régional de Pharmacovigilance, de Pharmacoépidémiologie et D’information sur les Médicaments, Centre Hospitalier Universitaire de Limoges, 87042 Limoges, France
6
INSEM 1248, Faculté de Médecine, Université de Limoges, 87032 Limoges, France
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Faculty of Pharmacy, Université Laval, Québec, QC G1V 0A6, Canada
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Santé des Populations et Pratiques Optimales en Santé, Centre de Recherche du CHU de Québec, Québec, QC G1S 4L8, Canada
9
Department of Nursing, University of Quebec at Rimouski, Lévis, QC G6V 0A6, Canada
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Centre de recherche du CISSS de Chaudière-Appalaches, Lévis, QC G6V 3Z1, Canada
*
Author to whom correspondence should be addressed.
Pharmacy 2019, 7(3), 126; https://doi.org/10.3390/pharmacy7030126
Received: 1 August 2019 / Revised: 8 August 2019 / Accepted: 23 August 2019 / Published: 29 August 2019
(This article belongs to the Special Issue Deprescribing of Problematic Polypharmacy)
There are numerous definitions of polypharmacy to describe the use of many medications among older adults, but there is a need to clarify if they are purposive and meaningful. By means of a systematic review, we identified definitions of polypharmacy used in multimorbid older adults (≥65 years). We evaluated if the definitions align among the domains of research, clinical practice, and public health and appraised whether concepts of polypharmacy are based on strong foundations. More than 46 definitions of polypharmacy were retrieved from 348 publications (research: n = 243; clinical practice: n = 88; public health: n = 17). Several thresholds based on the number of medications were mentioned. The majority of the publications (n = 202, 58%) used a minimal threshold of five medications. Heterogeneous qualitative definitions were identified, mostly stating that polypharmacy is “more drugs than needed”. There was no significant divergence between domains as to the type of definitions used, although qualitative definitions were more common in clinical practice. Nearly half (n = 156, 47%) of the publications provided no justification for the polypharmacy definition used. The wide variety of definitions for polypharmacy precludes comparisons, appropriate identification and management of polypharmacy in multimorbid older adults. Standardized definitions would allow more coherent judgments regarding the individual and collective stakes of polypharmacy. View Full-Text
Keywords: polypharmacy; older adults; multimorbidity; population health; research; clinical practice; medications; scoping review polypharmacy; older adults; multimorbidity; population health; research; clinical practice; medications; scoping review
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Sirois, C.; Domingues, N.S.; Laroche, M.-L.; Zongo, A.; Lunghi, C.; Guénette, L.; Kröger, E.; Émond, V. Polypharmacy Definitions for Multimorbid Older Adults Need Stronger Foundations to Guide Research, Clinical Practice and Public Health. Pharmacy 2019, 7, 126.

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