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Abstract
Background: The increasing number of elderly people in the population is leading to an increase in the amount of treatment prescribed for chronic diseases. As these diseases require treatment with an increasing number of medicines, the problems of polypharmacy are becoming more important. Objectives: By means of an extensive literature review:- to define polypharmacy; to determine the extent and nature of polypharmacy in the elderly; and to discover the problems which may result from polypharmacy in general practice.
Method: A Medline search from 1985 to 1998 yielded 1751 references from which we selected 143 articles for review.
Results: Qualitative definitions of polypharmacy vary greatly. We recommend defining it simply and quantitatively as the simultaneous use of two or more drugs. In almost every study the use of cardiovascular drugs is high, and in particular diuretics are often used in combination with other drugs. Giving more than one drug to a patient becomes more common over time; this applies especially to ACE inhibitors, calcium channel blockers and analgesics. The extent of the harm done by polypharmacy is not clear, because information is lacking on the clinical relevance of some recognised interactions.
Conclusion: The quality of the papers we studied was too poor to allow a systematic review. Pooling of the studies was impossible, because in only nine of the 62 studies standard deviations around averages were mentioned. Many studies could not be compared with each other because different methods were used to measure prevalence. Papers sometimes failed to clarify whether they were referring to prescription drugs only or prescription and non-prescriptions medicines. Some of the populations interviewed were not representative. Therefore, we can draw very few conclusions about the degree of polypharmacy in the different studies or the extent to which it is associated with health problems. There is a need for more standardisation of definitions and improved quality of research in this area. EurJ Gen Pract 2000;6:98–106.
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