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Polypharmacy in older adults: a narrative review of definitions, epidemiology and consequences

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Pazan, Farhad, Wehling, Martin·2021·European Geriatric Medicine
DOI 10.1007/s41999-021-00479-3PMC PMC8149355
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Abstract

Background: The number of older adults has been constantly growing around the globe. Consequently, multimorbidity and related polypharmacy have become an increasing problem. In the absence of an accepted agreement on the definition of polypharmacy, data on its prevalence in various studies are not easily comparable. Besides, the evidence on the potential adverse clinical outcomes related to polypharmacy is limited though polypharmacy has been linked to numerous adverse clinical outcomes. This narrative review aims to find and summarize recent publications on definitions, epidemiology and clinical consequences of polypharmacy. Methods: The MEDLINE database was used to identify recent publications on the definition, prevalence and clinical consequences of polypharmacy using their respective common terms and their variations. Systematic reviews and original studies published between 2015 and 2020 were included. Results: One hundred and forty-three definitions of polypharmacy and associated terms were found. Most of them are numerical definitions. Its prevalence ranges from 4% among community-dwelling older people to over 96.5% in hospitalized patients. In addition, numerous adverse clinical outcomes were associated with polypharmacy. Conclusion: The term polypharmacy is imprecise, and its definition is yet subject to an ongoing debate. The clinically oriented definitions of polypharmacy found in this review such as appropriate or necessary polypharmacy are more useful and relevant. Regardless of the definition, polypharmacy is highly prevalent in older adults, particularly in nursing home residents and hospitalized patients. Approaches to increase the appropriateness of polypharmacy can improve clinical outcomes in older adults.

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  • Polypharmacy significantly affects nitrate metabolism in older adults.

    “Polypharmacy significantly affects nitrate metabolism in older adults [267].”

    From Dietary Nitrate-Rich Vegetables as Natural Modulators of Health: Mechanisms and Benefits in Ageing Populations (2026) · cites this paper as [267]

    The Introduction discusses age-related changes in drug pharmacokinetics, and the Clinical consequences section discusses outcomes associated with polypharmacy, but neither addresses nitrate metabolism. Searches for nitrate metabolism and nitric oxide metabolism found no relevant passage in our copy. (LLM, conf=0.75)

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Authors
Pazan, F., & Wehling, M.
Affiliations
Heidelberg University (DE)
Corresponding author
Wehling, Martin
ORCID
Venue
European Geriatric Medicine
Publisher
Springer Science and Business Media LLC
Published
2021-03-10
Volume
12
Issue
3
Pages
443-452
ISSN
  • 1878-7649 (ISSN-L)
  • 1878-7657
DOI
10.1007/s41999-021-00479-3
PMC
PMC8149355
OpenAlex
W3135197215
Cited by
542
References
1
Citations by year
2026: 150 · 2025: 114 · 2024: 128 · 2023: 97 · 2022: 43 · 2021: 10
FWCI
10.43
Type
journal article
Language
en
Open access
Licence
Locations
  • European Geriatric Medicine (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Informationszentrum Lebenswissenschaften (ZB MED) (submittedVersion, cc-by)
Funders
Medizinische Fakultät Mannheim der Universität Heidelberg
Topics
  • Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
  • Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
  • Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Pharmacy and Medical Practices
Keywords
polypharmacy, older adults, multimorbidity, polypharmacy prevalence, adverse clinical outcomes, nursing home residents, hospitalized patients, medication appropriateness
MeSH terms
Multimorbidity, Aged, Humans, Prevalence, Polypharmacy, Independent Living

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