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Polypharmacy in the Hospitalized Older Adult

Considerations for Safe and Effective Treatment

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      References

        • Safran D.G.
        • Neuman P.
        • Schoen C.
        • et al.
        Prescription drug coverage and seniors: findings from a 2003 national survey.
        Health Aff (Millwood). 2005; 24 (Suppl Web Exclusives:W5-W166)
        • Albert M.
        • McCaig L.F.
        • Ashman J.J.
        Emergency department visits by Persons aged 65 and over: United States, 2009–2010. NCHS data Brief.
        (Available at:) (Accessed June 21, 2022)
        • Shehab N.
        • Lovegrove M.C.
        • Geller A.I.
        • et al.
        US emergency department visits for outpatient Adverse drug events, 2013-2014.
        JAMA. 2016; 316: 2115-2125
        • Oscanoa T.J.
        • Lizaraso F.
        • Carvajal A.
        Hospital admissions due to adverse drug reactions in the elderly. A meta-analysis.
        Eur J Clin Pharmacol. 2017; 73: 759-770
        • Trumic E.
        • Pranjic N.
        • Begic L.
        • et al.
        Idiosyncratic adverse reactions of most frequent drug combinations longterm use among hospitalized patients with polypharmacy.
        Med Arch. 2012; 66: 243-248
        • O'Mahony D.
        • Gudmundsson A.
        • Soiza R.L.
        • et al.
        Prevention of adverse drug reactions in hospitalized older patients with multi-morbidity and polypharmacy: the SENATOR∗ randomized controlled clinical trial.
        Age Ageing. 2020; 49 (published correction appears in Age Ageing. 2021 Nov 10;50(6):e10-e11): 605-614
        • Beuscart J.B.
        • Pelayo S.
        • Robert L.
        • et al.
        Medication review and reconciliation in older adults.
        Eur Geriatr Med. 2021; 12: 499-507
        • Chiarelli M.T.
        • Antoniazzi S.
        • Cortesi L.
        • et al.
        Pharmacist-driven medication recognition/reconciliation in older medical patients.
        Eur J Intern Med. 2021; 83: 39-44
        • US Preventive Services Task Force
        Vitamin, Mineral, and multivitamin Supplementation to prevent cardiovascular disease and cancer: US preventive services Task force recommendation Statement.
        JAMA. 2022; 327: 2326-2333
        • Hughes C.M.
        • McElnay J.C.
        • Fleming G.F.
        Benefits and risks of self medication.
        Drug Saf. 2001; 24: 1027-1037
        • Geller A.I.
        • Shehab N.
        • Weidle N.J.
        • et al.
        Emergency department visits for adverse events related to dietary supplements.
        N Engl J Med. 2015; 373: 1531-1540
        • Pitkälä K.H.
        • Suominen M.H.
        • Bell J.S.
        • et al.
        Herbal medications and other dietary supplements. A clinical review for physicians caring for older people.
        Ann Med. 2016; 48: 586-602
        • Awortwe C.
        • Makiwane M.
        • Reuter H.
        • et al.
        Critical evaluation of causality assessment of herb-drug interactions in patients.
        Br J Clin Pharmacol. 2018; 84: 679-693
      1. Agency for Healthcare research and Quality. HCUPnet. Healthcare Cost and Utilization Project (HCUP).
        (Available at:) (Accessed June 13, 2022)
        • Hajjar E.R.
        • Hanlon J.T.
        • Sloane R.J.
        • et al.
        Unnecessary drug use in frail older people at hospital discharge.
        J Am Geriatr Soc. 2005; 53: 1518-1523
      2. Centers for Medicare & Medicaid services. Chronic conditions among Medicare beneficiaries.
        (Available at:) (Accessed June 8. 2022)
        • Bauersachs R.M.
        • Herold J.
        Oral anticoagulation in the elderly and frail.
        Hamostaseologie. 2020; 40: 74-83
        • Parks A.L.
        • Fang M.C.
        Anticoagulation in older adults with multimorbidity.
        Clin Geriatr Med. 2016; 32: 331-346
        • Budnitz D.S.
        • Lovegrove M.L.
        • Shehab N.
        • et al.
        Emergency hospitalizations for adverse drug events in older Americans.
        N Engl J Med. 2011; 365: 2002-2012
        • Ruff C.
        • Giugliano R.P.
        • Braunwald E.
        • et al.
        Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials.
        Lancet. 2014; 383: 955-962
        • Yancy C.W.
        • Jessup M.
        • Bozkurt B.
        • et al.
        2013 ACCF/AHA guideline for the management of heart failure: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines.
        Circulation. 2013; 128: 1810-1852
        • Unlu O.
        • Levitan E.B.
        • Reshetnyak E.
        • et al.
        Polypharmacy in older adults hospitalized for heart failure.
        Circ Heart Fail. 2020; 13: e006977
        • Sztramko R.
        • Chau V.
        • Wong R.
        Adverse drug events and associated factors in heart failure therapy among the very elderly.
        Can Geriatr J. 2011; 14: 79-92
        • Mets T.
        • De Bock V.
        • Praet J.P.
        First-dose hypotension, ACE inhibitors, and heart failure in the elderly.
        Lancet. 1992; 339: 1487
        • Haffner C.A.
        • Kendall M.J.
        • Struthers A.D.
        • et al.
        Effects of captopril and enalapril on renal function in elderly patients with chronic heart failure.
        Postgrad Med J. 1995; 71: 287-292
        • Rao V.N.
        • Fudim M.
        • Savarese G.
        • et al.
        Polypharmacy in heart failure with reduced Ejection fraction: Progress, not problem.
        Am J Med. 2021; 134: 1068-1070
        • Goyal P.
        • Mangal S.
        • Krishnaswami A.
        • et al.
        Polypharmacy in heart failure: Progress but also problem.
        Am J Med. 2021; 134: 1071-1073
        • Singh D.
        • Agusti A.
        • Anzueto A.
        • et al.
        Global strategy for the diagnosis, management, and prevention of chronic obstructive Lung disease: the GOLD science committee report 2019.
        Eur Respir J. 2019; 53: 1900164
        • Putcha N.
        • Wise R.A.
        Medication regimens for managing COPD exacerbations.
        Respir Care. 2018; 63: 773-782
        • Polański J.
        • Chabowski M.
        • Świątoniowska-Lonc N.
        • et al.
        Medication compliance in COPD patients.
        Adv Exp Med Biol. 2020; 1279: 81-91
        • McCarthy B.
        • Casey D.
        • Devane D.
        • et al.
        Pulmonary rehabilitation for chronic obstructive pulmonary disease.
        Cochrane Database Syst Rev. 2015; 23: CD003793
        • Safka K.A.
        • McIvor R.A.
        Non-pharmacological management of chronic obstructive pulmonary disease.
        Ulster Med J. 2015; 84: 13-21
        • Noor S.
        • Ismail M.
        • Ali Z.
        Potential drug-drug interactions among pneumonia patients: do these matter in clinical perspectives?.
        BMC Pharmacol Toxicol. 2019; 20: 45
        • Kennedy K.E.
        • Teng C.
        • Patek T.M.
        • et al.
        Hypoglycemia associated with antibiotics Alone and in combination with Sulfonylureas and Meglitinides: an Epidemiologic Surveillance study of the FDA adverse event reporting system (FAERS).
        Drug Saf. 2020; 43: 363-369
        • Akhtar A.
        • Ahmad Hassali M.A.
        • Zainal H.
        • et al.
        A cross-Sectional assessment of urinary Tract infections among geriatric patients: prevalence, medication regimen complexity, and factors associated with treatment outcomes.
        Front Public Health. 2021; 9: 657199
        • Iloanusi S.
        • Mgbere O.
        • Essien E.J.
        Polypharmacy among COVID-19 patients: a systematic review.
        J Am Pharm Assoc (2003). 2021; 61: e14-e25
        • Kimura H.
        • Tanaka K.
        • Saito H.
        • et al.
        Association of polypharmacy with kidney disease progression in adults with CKD.
        Clin J Am Soc Nephrol. 2021; 16: 1797-1804
        • Cashion W.
        • McClellan W.
        • Judd S.
        • et al.
        Polypharmacy and mortality association by chronic kidney disease status: the reasons for Geographic and Racial differences in stroke study.
        Pharmacol Res Perspect. 2021; 9: e00823
        • Laville S.M.
        • Gras-Champel V.
        • Moragny J.
        • et al.
        Adverse drug reactions in patients with CKD.
        Clin J Am Soc Nephrol. 2020; 15: 1090-1102
        • Mason N.A.
        Polypharmacy and medication-related complications in the chronic kidney disease patient.
        Curr Opin Nephrol Hypertens. 2011; 20: 492-497
        • Peron E.P.
        • Ogbonna K.C.
        • Donohoe K.L.
        Antidiabetic medications and polypharmacy.
        Clin Geriatr Med. 2015; 31: 17-vii
        • Finfer S.
        • Chittock D.R.
        • et al.
        • NICE-SUGAR Study Investigators
        Intensive versus conventional glucose control in critically ill patients.
        N Engl J Med. 2009; 360: 1283-1297
        • Vasilevskis E.E.
        • Shah A.S.
        • Hollingsworth E.K.
        • et al.
        A patient-centered deprescribing intervention for hospitalized older patients with polypharmacy: rationale and design of the Shed-MEDS randomized controlled trial.
        BMC Health Serv Res. 2019; 19: 165
        • Petersen A.W.
        • Shah A.S.
        • Simmons S.F.
        • et al.
        Shed-MEDS: pilot of a patient-centered deprescribing framework reduces medications in hospitalized older adults being transferred to inpatient postacute care.
        Ther Adv Drug Saf. 2018; 9: 523-533
        • Thillainadesan J.
        • Gnjidic D.
        • Green S.
        • et al.
        Impact of deprescribing interventions in older hospitalised patients on prescribing and clinical outcomes: a systematic review of randomised trials.
        Drugs Aging. 2018; 35: 303-319
        • Elbeddini A.
        • Sawhney M.
        • Tayefehchamani Y.
        • et al.
        Deprescribing for all: a narrative review identifying inappropriate polypharmacy for all ages in hospital settings.
        BMJ Open Qual. 2021; 10: e001509
        • Kaminaga M.
        • Komagamine J.
        • Tatsumi S.
        The effects of in-hospital deprescribing on potential prescribing omission in hospitalized elderly patients with polypharmacy.
        Sci Rep. 2021; 11: 8898
        • Counter D.
        • Millar J.W.T.
        • McLay J.S.
        Hospital readmissions, mortality and potentially inappropriate prescribing: a retrospective study of older adults discharged from hospital.
        Br J Clin Pharmacol. 2018; 84: 1757-1763
        • Barnett S.R.
        Polypharmacy and perioperative medications in the elderly.
        Anesthesiol Clin. 2009; 27
        • Sampson E.L.
        • Blanchard M.R.
        • Jones L.
        • et al.
        Dementia in the acute hospital: prospective cohort study of prevalence and mortality.
        Br J Psychiatry. 2009; 195 (published correction appears in Br J Psychiatry. 2013 Feb;202:156): 61-66
        • Mohanty S.
        • Rosenthal R.A.
        • Russell M.M.
        • et al.
        Optimal perioperative management of the geriatric patient: a best practices guideline from the American College of surgeons NSQIP and the American geriatrics Society.
        J Am Coll Surg. 2016; 222: 930-947
        • Chow W.B.
        • Rosenthal R.A.
        • Merkow R.P.
        • et al.
        Optimal preoperative assessment of the geriatric surgical patient: a best practices guideline from the American College of surgeons national surgical Quality Improvement Program and the American geriatrics Society.
        J Am Coll Surg. 2012; 215: 453-466
        • Park H.Y.
        • Kim S.
        • Sohn H.S.
        • et al.
        The association between polypharmacy and hip fracture in Osteoporotic women: a Nested case-control study in South Korea.
        Clin Drug Investig. 2019; 39: 63-71
        • Härstedt M.
        • Rogmark C.
        • Sutton R.
        • et al.
        Polypharmacy and adverse outcomes after hip fracture surgery.
        J Orthop Surg Res. 2016; 11: 151
        • By the 2019 American Geriatrics Society Beers Criteria® Update Expert Panel
        American Geriatrics Society 2019 updated AGS Beers criteria® for potentially inappropriate medication use in older adults.
        J Am Geriatr Soc. 2019; 67: 674-694
        • Subramaniam B.
        • Shankar P.
        • Shaefi S.
        • et al.
        Effect of Intravenous Acetaminophen vs Placebo combined with Propofol or Dexmedetomidine on postoperative delirium among older patients following cardiac surgery: the DEXACET randomized clinical trial.
        JAMA. 2019; 321 (published correction appears in JAMA. 2019 Jul 16;322(3):276): 686-696
        • Connolly K.P.
        • Kleinman R.S.
        • Stevenson K.L.
        • et al.
        Delirium reduced with Intravenous Acetaminophen in geriatric hip fracture patients.
        J Am Acad Orthop Surg. 2020; 28: 325-331
        • Johnson A.G.
        • Quinn D.I.
        • Day R.O.
        Non-steroidal anti-inflammatory drugs.
        Med J Aust. 1995; 163: 155-158
        • Derry S.
        • Wiffen P.J.
        • Kalso E.A.
        • et al.
        Topical analgesics for acute and chronic pain in adults - an overview of Cochrane Reviews.
        Cochrane Database Syst Rev. 2017; 5: CD008609
        • McGeeney B.E.
        Pharmacological management of neuropathic pain in older adults: an update on peripherally and centrally acting agents.
        J Pain Symptom Manage. 2009; 38: S15-S27https://doi.org/10.1016/j.jpainsymman.2009.05.003
        • Brouquet A.
        • Cudennec T.
        • Benoist S.
        • et al.
        Impaired mobility, ASA status and administration of tramadol are risk factors for postoperative delirium in patients aged 75 years or more after major abdominal surgery.
        Ann Surg. 2010; 251: 759-765
        • Fowler R.A.
        • Adhikari N.K.
        • Bhagwanjee S.
        Clinical review: critical care in the global context--disparities in burden of illness, access, and economics.
        Crit Care. 2008; 12: 225
        • Bell C.M.
        • Brener S.S.
        • Gunraj N.
        • et al.
        Association of ICU or hospital admission with unintentional discontinuation of medications for chronic diseases.
        JAMA. 2011; 306: 840-847
        • Cullen D.J.
        • Sweitzer B.J.
        • Bates D.W.
        • et al.
        Preventable adverse drug events in hospitalized patients: a comparative study of intensive care and general care units.
        Crit Care Med. 1997; 25: 1289-1297
        • By the 2019 American Geriatrics Society Beers Criteria® Update Expert Panel
        American geriatrics Society 2019 updated AGS Beers Criteria® for potentially inappropriate medication Use in older adults.
        J Am Geriatr Soc. 2019; 67: 674-694
        • Floroff C.K.
        • Slattum P.W.
        • Harpe S.E.
        • et al.
        Potentially inappropriate medication use is associated with clinical outcomes in critically ill elderly patients with neurological injury.
        Neurocrit Care. 2014; 21: 526-533
        • Garpestad E.
        • Devlin J.W.
        Polypharmacy and delirium in critically ill older adults: recognition and prevention.
        Clin Geriatr Med. 2017; 33: 189-203
        • Devlin J.W.
        • Fraser G.L.
        • Riker R.R.
        Drug-induced coma and delirium.
        in: Papadopoulos J. Cooper B. Kane-Gill S. Drug-induced complications in the critically ill patient: a guide for recognition and treatment. Society of Critical Care Medicine, Chicago2011: 107-116
        • Pandharipande P.
        • Shintani A.
        • Peterson J.
        • et al.
        Lorazepam is an independent risk factor for transitioning to delirium in intensive care unit patients.
        Anesthesiology. 2006; 104: 21-26
        • Zaal I.J.
        • Devlin J.W.
        • Hazelbag M.
        • et al.
        Benzodiazepine-associated delirium in critically ill adults.
        Intensive Care Med. 2015; 41: 2130-2137
        • Wolters A.E.
        • Zaal I.J.
        • Veldhuijzen D.S.
        • et al.
        Anticholinergic medication use and transition to delirium in critically ill patients: a prospective cohort study.
        Crit Care Med. 2015; 43: 1846-1852
        • Barr J.
        • Fraser G.L.
        • Puntillo K.
        • et al.
        Clinical practice guidelines for the management of pain, agitation and delirium in adult ICU patients.
        Crit Care Med. 2013; 41: 263-306
        • Devlin J.W.
        • Fong J.J.
        • Fraser G.L.
        • et al.
        Delirium assessment in the critically ill.
        Intensive Care Med. 2007; 33: 929-940
        • Johnson A.
        • Guirguis E.
        • Grace Y.
        Preventing medication errors in transitions of care: a patient case approach.
        J Am Pharm Assoc (2003). 2015; 55: e264-e276
        • Allison G.M.
        • Weigel B.
        • Holcroft C.
        Does electronic medication reconciliation at hospital discharge decrease prescription medication errors?.
        Int J Health Care Qual Assur. 2015; 28: 564-573
        • Freyer J.
        • Greißing C.
        • Buchal P.
        • et al.
        Entlassungsmedikation – was weiß der Patient bei Entlassung über seine Arzneimittel? [Discharge medication - what do patients know about their medication on discharge?].
        Dtsch Med Wochenschr. 2016; 141 (German): e150-e156
        • Tobiano G.
        • Chaboyer W.
        • Teasdale T.
        • et al.
        Older patient and family discharge medication communication: a mixed-methods study.
        J Eval Clin Pract. 2021; 27: 898-906
        • Uitvlugt E.B.
        • Siegert C.E.
        • Janssen M.J.
        • et al.
        Completeness of medication-related information in discharge letters and post-discharge general practitioner overviews.
        Int J Clin Pharmacol. 2015; 37: 1206-1212
        • Kadoyama K.L.
        • Noble B.N.
        • Izumi S.
        • et al.
        Frequency and Documentation of medication decisions on discharge from the hospital to Hospice care.
        J Am Geriatr Soc. 2019; 67: 1258-1262
        • Perry T.D.
        • Nye A.M.
        • Johnson S.W.
        Medication discrepancy rates among Medicaid recipients at hospital discharge.
        J Am Pharm Assoc (2003). 2017; 57: 488-492
        • Van Hollebeke M.
        • Talavera-Pons S.
        • Mulliez A.
        • et al.
        Impact of medication reconciliation at discharge on continuity of patient care in France.
        Int J Clin Pharm. 2016; 38: 1149-1156
        • Welk B.
        • Killin L.
        • Reid J.N.
        • et al.
        Effect of electronic medication reconciliation at the time of hospital discharge on inappropriate medication use in the community: an interrupted time-series analysis.
        CMAJ Open. 2021; 9: E1105-E1113
        • O’Mahony D.
        • O’Sullivan D.
        • Byrne S.
        • et al.
        STOPP/START criteria for potentially inappropriate prescribing in older people: version 2.
        Age Ageing. 2015; 44: 213-218
        • Holt S.
        • Schmiedl S.
        • Thürmann P.A.
        Potentially inappropriate medications in the elderly: the PRISCUS list.
        Dtsch Arztebl Int. 2010; 107: 543-551
        • Gallagher P.F.
        • O'Connor M.N.
        • O'Mahony D.
        Prevention of potentially inappropriate prescribing for elderly patients: a randomized controlled trial using STOPP/START criteria.
        Clin Pharmacol Ther. 2011; 89: 845-854
        • de Agustín Sierra L.
        • Rodríguez Salazar J.
        • Jiménez-Muñoz A.B.
        • et al.
        Potentially inappropriate medication in acute hospitalized elderly patients with polypharmacy: an observational study comparing PRISCUS, STOPP, and Beers criteria.
        Eur J Clin Pharmacol. 2021; 77 (published correction appears in Eur J Clin Pharmacol. 2021 Feb 4): 757-766
        • Nauta K.J.
        • Groenhof F.
        • Schuling J.
        • et al.
        Application of the STOPP/START criteria to a medical record database.
        Pharmacoepidemiol Drug Saf. 2017; 26: 1242-1247