Pitfalls of solving polypharmacy problems
Authors:
Štefan Alušík 1; Zoltán Paluch 2
Authors‘ workplace:
Katedra vnitřního lékařství IPVZ, Praha
1; Ústav farmakologie 2. LF UK, Praha
2
Published in:
Vnitř Lék 2021; 67(1): 22-25
Category:
Overview
Polymedication is associated with a higher incidence of negative health indicators including falls, morbidity and mortality. Despite efforts, the solution to this problem is still unsatisfactory. The two main causes of polymedication are population aging and polymorbidity and, on the other hand, the development of the pharmaceutical industry and the availability of a wide range of medicines. The authors discuss the main shortcomings in the investigation of this issue, such as inconsistent terminology used, methodological shortcomings in data acquisition, lack of recommended guidelines for the polymorbid patients treatment, etc. They discuss whether polymedication is the cause or marker of increased falls, frailty and mortality. In the end they critically evaluate possible solution of polymedication in future – personalised medicine.
Keywords:
polypharmacy – polymorbidity – guidelines – personalised medicine
Sources
1. Eurostat Statistics Explained.File: Population age structure by major age groups, 2008 and 2018 (% of the total population).png. Dostupné z WWW: https://ec.europa.eu/eurostat/statisticsexplained/index.php?title=File:Population_age_structure_by_major_ age_groups,_2008_and_2018_(%25_of_the_total_population).png
2. Mair A, Wilson M, Dreischulte T. Addressing the Challenge of Polypharmacy. Annu Rev Pharmacol Toxicol. 2020; 60: 661–681. Dostupné z DOI:https://doi.org/10.1146/annurev- -pharmtox-010919-023508
3. Newnham W. Remarks on the Present Aspect of Medicine. Provincial Medical and Surgical Journal 1848; 12(11): 281–285. Dostupné z www: https://www.jstor.org/stable/25500348?- seq=1#metadata_info_tab_contents
4. Masnoon N, Shakib S, Kalisch -Ellett L, Caughey GE. What is polypharmacy? A systematic review of definitions. BMC Geriatr. 2017; 17(1): 230. Dostupné z DOI: https://doi. org/10.1186/s12877-017-0621-2
5. Lee EA, Brettler JW, Kanter MH et al. Refining the Definition of Polypharmacy and Its Link to Disability in Older Adults: Conceptualizing Necessary Polypharmacy, Unnecessary Polypharmacy, and Polypharmacy of Unclear Benefit. Perm J. 2020; 24: 18.212. Dostupné z DOI: https://doi.org/10.7812/TPP/18.212
6. Duerden M, Avery T, Payne R. Polypharmacy and medicines optimisation. Making it safe and sound.The King’s Fund, London 2013,56 s. Dostupné z WWW: https://www.kingsfund. org.uk/sites/default/files/field/field_publication_file/polypharmacy -and -medicines-optimisation -kingsfund -nov13.pdf
7. Medication Safety in Polypharmacy. Geneva: World Health Organization; 2019 (WHO/ UHC/SDS/2019.11). Licence: CC BY -NC -SA 3.0 IG. Dostupné z WWW:https://apps.who.int/ iris/bitstream/handle/10665/325454/WHO -UHC -SDS-2019.11-eng.pdf?ua=1
8. Bursztyn M. Hypertension, Its Treatment, Frailty, Falls, and Mortality. Hypertension. 2017; 70(2): 253–254. Dostupné z DOI: https://doi.org/10.1161/HYPERTENSIONAHA.117.09689.
9.Sabaté E, et al. Adherence to Long -Term Therapies: Evidence for Action. WHO, Geneva, 2003,199 p. Dostupné z WWW: https://www.who.int/chp/knowledge/publications/ adherence_report/en/
10. Thrall G, Lip G, Lane D. Compliance with pharmacological therapy in hypertension: can we do better, and how?. J Hum Hypertens 2004; 18: 595–597. https://doi.org/10.1038/sj.jhh.1001722.
11. Midão L, Giardini A, Menditto E, Kardas P, Costa E. Polypharmacy prevalence among older adults based on the survey of health, ageing and retirement in Europe. Arch Gerontol Geriatr. 2018;78:213-220. Dostupné z DOI: https://doi.org/10.1016/j.archger.2018. 06. 018.
12. Wastesson JW, Canudas -Romo V, Lindahl -Jacobsen R, Johnell K. Remaining Life Expectancy With and Without Polypharmacy: A Register -Based Study of Swedes Aged 65 Years and Older. J Am Med Dir Assoc. 2016; 17(1): 31–35.Dostupné z DOI: https://doi.org/10.1016/j.jamda.2015. 07. 015.
13. Kojima T. The Need for Actions Against Polypharmacy in Older People With Frailty. Ann Geriatr Med Res. 2018;22(3):111-116. Dostupné z DOI: https://doi.org/10.4235/ agmr.2018. 22. 3.111.
14. Saum KU, Schöttker B, Meid AD, Holleczek B, Haefeli WE, Hauer K et al. Is Polypharmacy associated with frailty in older people? Results from the ESTHER cohort study. J Am Geriatr Soc 2017; 65: e27–32. Dostupné z DOI: https://doi.org/10.1111/jgs.1471.
15. Leelakanok N, Holcombe AL, Lund BC, Gu X, Schweizer ML. Association between polypharmacy and death: A systematic review and meta -analysis. J Am Pharm Assoc (2003). 2017; 57(6): 729–738.e10. Dostupné z DOI: https://doi.org/10.1016/j. japh.2017. 06. 002.
16. Mair A, Fernandez -Llimos F, Alonso A et al. Polypharmacy Management by 2030:a patient safety challenge,2nd edition.The Simpathy Consorcium 2017; 56p. Dostupné z WWW:http:// www.simpathy.eu/sites/default/files/Managing_polypharmacy2030-web.pdf.
17. Mangin D, Bahat G, Golomb BA et al. International Group for Reducing Inappropriate Medication Use&Polypharmacy (IGRIMUP): Position Statement and 10 Recommendations for Action. Drugs Aging. 2018; 35(7): 575–587. Dostupné z DOI: https://doi.org/10.1007/s40266-018-0554-2.
18. Johnell K. The controversies surrounding polypharmacy in old age -where are we? Expert Rev Clin Pharmacol. 2018; 11(9): 825–827. Dostupné z DOI: https://doi.org/10.108 0/17512433.2018.1510313.
19. Huizer -Pajkos A, Kane AE, Howlett SE et al. Adverse Geriatric Outcomes Secondary to Polypharmacy in a Mouse Model: The Influence of Aging. J Gerontol A Biol Sci Med Sci. 2016; 71(5): 571–577. Dostupné z DOI: https://doi.org/10.1093/gerona/glv046.
20. Iriart JAB. Precision medicine/personalized medicine: a critical analysis of movements in the transformation of biomedicine in the early 21st century. Cad. Saúde Pública 2019; 35(3): e00153118. Dostupné z DOI:https://doi.org/10.1590/0102-311x00153118.
21. Nimmesgern E, Benediktsson I, Norstedt I. Personalized Medicine in Europe. Clin Transl Sci 2017; 10(2): 61–63. Dostupné z DOI: https://doi.org/10.1111/cts.12446.
22. Molokhia M, Majeed A. Current and future perspectives on the management of polypharmacy. BMC Fam Pract. 2017; 18: 70.Dostupné z DOI: http://doi.org/10.1186/s12875- 017-0642-0https://www.ncbi.nlm.nih.gov/pubmed/28587644.
Labels
Diabetology Endocrinology Internal medicineArticle was published in
Internal Medicine
2021 Issue 1
Most read in this issue
- Fever of unknown origin
- Long-term ECG monitoring
- Follow‑up care after COVID-19 and its related concerns
- EMPEROR reduced – empagliflozin in patients with heart failure and reduced ejection fraction