Prevalence and Factors Associated With Polypharmacy in Long-Term Care Facilities: A Systematic Review

doi:10.1016/j.jamda.2015.03.003

Journal of the American Medical Directors Association

Volume 16, Issue 6, 1 June 2015, Pages 535.e1-535.e12

https://doi.org/10.1016/j.jamda.2015.03.003 Get rights and content

Abstract

Objective

The objective of the study was to investigate the prevalence of, and factors associated with, polypharmacy in long-term care facilities (LTCFs).

Methods

MEDLINE, EMBASE, International Pharmaceutical Abstracts, Cumulative Index to Nursing and Allied Health Literature, and the Cochrane Library were searched from January 2000 to September 2014. Primary research studies in English were eligible for inclusion if they fulfilled the following criteria: (1) polypharmacy was quantitatively defined, (2) the prevalence of polypharmacy was reported or could be extracted from tables or figures, and (3) the study was conducted in a LTCF. Methodological quality was assessed using an adapted version of the Joanna Briggs Institute Critical Appraisal Checklist.

Results

Forty-four studies met the inclusion criteria and were included. Polypharmacy was most often defined as 5 or more (n = 11 studies), 9 (n = 13), or 10 (n = 11) medications. Prevalence varied widely between studies, with up to 91%, 74%, and 65% of residents taking more than 5, 9, and 10 medications, respectively. Seven studies performed multivariate analyses for factors associated with polypharmacy. Positive associations were found for recent hospital discharge (n = 2 studies), number of prescribers (n = 2), and comorbidity including circulatory diseases (n = 3), endocrine and metabolic disorders (n = 3), and neurological motor dysfunctioning (n = 3). Older age (n = 5), cognitive impairment (n = 3), disability in activities of daily living (n = 3), and length of stay in the LTCF (n = 3) were inversely associated with polypharmacy.

Conclusions

The prevalence of polypharmacy in LTCFs is high, varying widely between facilities, geographical locations and the definitions used. Greater use of multivariate analysis to investigate factors associated with polypharmacy across a range of settings is required. Longitudinal research is needed to explore how polypharmacy has evolved over time.

Section snippets

Search Strategy

MEDLINE, EMBASE, International Pharmaceutical Abstracts (IPA), Cumulative Index to Nursing and Allied Health Literature (CINAHL), and the Cochrane Library were searched to locate relevant studies in the English language published between January 2000 and September 2014. Subject headings and truncated search terms related to polypharmacy (polypharmacy, multiple medications, multiple medicines) and aged care facilities (nursing home, homes for the aged, assisted living facilities, long-term care,

Results

Forty-four studies satisfied our criteria for inclusion in the review (Figure 1). The study characteristics are summarized in Table 1. Studies were conducted in the United States (n = 15),19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33 Australia (n = 5),34, 35, 36, 37, 38 Italy (n = 2),17, 39 Netherlands (n = 2),40, 41 Sweden (n = 2),42, 43 United Kingdom (n = 3),44, 45, 46 Brazil (n = 1),⁴⁷ Canada (n = 1),⁴⁸ Finland (n = 1),⁴⁹ Hong Kong (n = 1),⁵⁰ Ireland (n = 1),⁵¹ Israel (n = 1),⁵²

Discussion

This was the first systematic review to investigate the prevalence of, and factors associated with, polypharmacy in LTCFs. This systematic review revealed a high prevalence of polypharmacy in LTCFs, with up to 91%, 74%, and 65% of residents taking more than 5, 9, and 10 medications, respectively. The prevalence of polypharmacy varied widely between LTCFs and according to the definitions of polypharmacy used. Comorbidity, recent hospital discharge, and number of prescribers were significantly

Conclusion

The prevalence of polypharmacy in LTCFs is high, varying widely between facilities, geographical locations, and definitions used. Associations with polypharmacy were reported for comorbidity, recent hospital discharge, and number of prescribers. Older age, cognitive impairment, ADL disability, and length of stay in the LTCF were inversely associated with polypharmacy. It is difficult to draw conclusions about polypharmacy and its associated factors because of the large degree of variability in

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Review ArticlePrevalence and Factors Associated With Polypharmacy in Long-Term Care Facilities: A Systematic Review

Abstract

Objective

Methods

Results

Conclusions

Section snippets

Search Strategy

Results

Discussion

Conclusion

Clin Geriatr Med

J Am Med Dir Assoc

Clin Geriatr Med

J Am Med Dir Assoc

Health Policy

J Am Med Dir Assoc

Am J Geriatr Pharmacother

J Am Med Dir Assoc

Geriatr Nurs

Am J Geriatr Pharmacother

J Am Med Dir Assoc

J Am Med Dir Assoc

J Am Med Dir Assoc

Arch Gerontol Geriatr

J Am Med Dir Assoc

Eur Geriatr Med

J Am Med Dir Assoc

Alzheimers Dement

J Nutr Health Aging

J Am Coll Cardiol

Alzheimers Dement

J Am Med Dir Assoc

J Am Med Dir Assoc

Multimorbidity and comorbidity of chronic diseases among the senior Australians: Prevalence and patterns

PLoS One

Recent trends in chronic disease, impairment and disability among older adults in the United States

BMC Geriatr

Polypharmacy in the elderly: A literature review

J Am Acad Nurse Pract

Assisted living expansion and the market for nursing home care

Health Serv Res

Escalating polypharmacy

QJM

Geriatric workforce capacity: A pending crisis for nursing home residents

Front Public Health

Clinical consequences of polypharmacy in elderly

Expert Opin Drug Saf

Hospital admissions associated with adverse drug reactions: A systematic review of prospective observational studies

Ann Pharmacother

Adverse drug events in the outpatient setting: An 11-year national analysis

Pharmacoepidemiol Drug Saf

Factors associated with falls among older adults living in institutions

BMC Geriatr

Reviewers' manual

An analysis of chronic kidney disease risk factors in a Louisiana nursing home population: A cross-sectional study

J La State Med Soc

Potentially inappropriate medications in nursing homes: Sources and correlates

The Internet Journal of Geriatrics and Gerontology

Risk factors for adverse drug events among nursing home residents

Arch Intern Med

Use of antipsychotics among older residents in VA nursing homes

Med Care

Racial differences in medication use among older, long-stay Veterans Affairs nursing home care unit patients

Consult Pharm

Review Article
Prevalence and Factors Associated With Polypharmacy in Long-Term Care Facilities: A Systematic Review