Association between polypharmacy and mortality in the older adults: A systematic review and meta-analysis

Yuan Li; Xianzhuo Zhang; Liu Yang; Yongjie Yang; Gaoxing Qiao; Chunyun Lu; Kefeng Liu

doi:10.1016/j.archger.2022.104630

Association between polypharmacy and mortality in the older adults: A systematic review and meta-analysis

Arch Gerontol Geriatr. 2022 May-Jun:100:104630. doi: 10.1016/j.archger.2022.104630. Epub 2022 Jan 28.

Authors

Yuan Li¹, Xianzhuo Zhang², Liu Yang³, Yongjie Yang⁴, Gaoxing Qiao⁵, Chunyun Lu⁵, Kefeng Liu⁶

Affiliations

¹ Department of Nuclear Medicine, Henan medical key laboratory of molecular imaging, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
² The First School of Clinical Medicine, Lanzhou University, Lanzhou, China.
³ Emergency Intensive Care Unit, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
⁴ Department of Pharmacy, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; Henan Key Laboratory of Precision Clinical Pharmacy, Zhengzhou University, Zhengzhou, China.
⁵ Department of Pharmacy, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
⁶ Department of Pharmacy, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; Henan Key Laboratory of Precision Clinical Pharmacy, Zhengzhou University, Zhengzhou, China. Electronic address: liukefeng-num.1@163.com.

PMID: 35101709
DOI: 10.1016/j.archger.2022.104630

Abstract

Background: Polypharmacy and related adverse consequences are common in the older adults, especially mortality, but the causality of this relationship remains unclear. This meta-analysis aimed to explore the relationship between polypharmacy and mortality in older adults.

Methods: We systematically searched Pubmed, Embase, and the Cochrane Library from inception until August 2021 to identify observational studies providing quantitative estimates on the association between polypharmacy(≥5drugs) and mortality in the elderly (≥65 years). Results from individual studies were pooled using a random-effects or fixed-effects model.

Results: A total of twenty-four cohort studies including 2,967,952 participants of 65 years or older in this meta-analysis. twenty-four studies found a significant increase in mortality associated with polypharmacy (≥5 drugs) [Relative Risk, RR=1.28, 95%CI (1.19,1.39), P<0.05] or excessive polypharmacy (≥10 drugs) [Relative Risk, RR=1.44, 95%CI (1.03,2.01), P<0.05] among older adults. Eight studies showed an 50% increased hospitalization rate for polypharmacy in the older adults [RR=1.50, 95%CI (1.18,1.89), P<0.05]. Subgroup analysis showed that the relationship between polypharmacy and mortality was different among older adults in community [RR=1.41, 95%CI (1.24,1.60), P<0.05], in hospital [RR=1.10, 95%CI (1.00,1.20), P<0.05], in institutions [RR=1.47, 95%CI (1.29,1.68), P<0.05]. The mortality rate of the elderly using 5 to 9 drugs was [RR=1.23, 95%CI (1.06,1.43), P<0.05] and using more than 10 drugs was [RR=1.44, 95%CI (1.03,2.01), P<0.05].

Conclusions: The results of this meta-analysis suggest that polypharmacy may be associated with increased mortality in older adults, but this association must be carefully considered and needed further validation.

Glossary: CI=confidence interval; MOOSE=Meta-analysis of Observational Studies in Epidemiology; NOS = Newcastle-Ottawa Scale; PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses; RR = relative risk; HR = hazard ratio; OR = odds ratio; GRADE = Grading of Recommendations Assessment Development and Evaluation.

Keywords: Hospitalization; Meta-analysis; Mortality; Older adults; Polypharmacy.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

Aged
Cohort Studies
Hospitalization*
Humans
Odds Ratio
Polypharmacy*