Skip to main content
SpringerLink
Log in

Tools in polypharmacy

Current evidence from observational and controlled studies

Werkzeuge im Umgang mit Polypharmazie

Aktuelle Evidenz aus kontrollierten- und Beobachtungsstudien

  • Beiträge zum Themenschwerpunkt
  • Published:
Zeitschrift für Gerontologie und Geriatrie Aims and scope Submit manuscript

Abstract

Increasing evidence in managing polypharmacy in the growing elderly population with a higher prevalence of multiple chronic disease is the basis for this paper. Poor adherence, drug–drug interactions, drug–disease interactions, and inappropriate medication challenge the prescriptions of health care providers in this group of patients. Risk factors, the prevalence of polypharmacy, and the impact on health issues will be shown by analyzing the recent literature. Based on intervention trials, several tools in polypharmacy have emerged as practical guides for clinical practice or for the geriatric ward to solve this problem. The Medication Appropriateness Index (MAI) and national lists of potentially inappropriate medication used in clinical practice are presented, including Screening Tool to Alert Doctors to the Right Treatment (START), Screening Tool of Older Persons’ Potentially Inappropriate Prescriptions (STOPP), and Assess, Comprehensive Geriatric Assessment, Adherence, Development, Emergence, Minimization, Interdisciplinarity, Alertness (ACADEMIA).

Zusammenfassung

Basis dieses Artikel ist die zunehmende Evidenz im Umgang mit Polypharmazie in der wachsenden multimorbiden geriatrischen Bevölkerung. Bestehende lange Medikamentenlisten und dadurch bedingte Medikamenteninteraktionen, unerwünschte Nebenwirkungen, geringe Patientenadhärenz und unpassende Verschreibungen stellen eine Herausforderung für den aktuell behandelnden Arzt dar. Anhand der neueren Literatur werden Risikofaktoren, die Prävalenz der Polypharmazie und deren Auswirkungen auf die Gesundheit aufgezeigt. Einige klinische Vorgehensweisen haben sich als brauchbare Werkzeuge bewährt, um dieses Problem zu lösen. Vorgestellt werden der Medication Appropriateness Index (MAI) sowie Listen von potenziell inadäquaten Medikamenten und von Verfahren, die in der klinischen Praxis eingesetzt werden. Dazu gehören: Tool to Alert Doctors to the Right Treatment (START), Screening Tool of Older Persons‘ Potentially Inappropriate Prescriptions (STOPP) und Assess, Comprehensive Geriatric Assessment, Adherence, Development, Emergence, Minimization, Interdisciplinarity, Alertness (ACADEMIA).

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Bain KT, Holmes HM, Beers MH et al (2008) Discontinuing medications: a novel approach for revising the prescribing stage of the medication-use process. J Am Geriatr Soc 56:1946–1952

    Article  PubMed  Google Scholar 

  2. Barry PJ, Gallagher P, Ryan C et al (2007) START (screening tool to alert doctors to the right treatment)an evidence-based screening tool to detect prescribing omissions in elderly patients. Age Ageing 36:632–638

    Article  PubMed  CAS  Google Scholar 

  3. Campanielli CM (2012) The American Geriatrics Society. American Geriatrics Society updated Beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc 60:616–631

    Article  Google Scholar 

  4. Carey EC, Covinsky KE, Lui LY et al (2008) Prediction of mortality in community-living frail elderly people with long-term care needs. J Am Geriatr Soc 56:68–75

    Article  PubMed  Google Scholar 

  5. Chumney EC, Robinson LC (2006) The effect of pharmacist interventions on patients with polyphamacy. Pharm Pract 4:103–109

    Google Scholar 

  6. Dovjak P, Sommeregger U, Otto R et al (2010) Polypharmazie in der Kardiologie—ein beachtliches Problem bei Synkopen, QT-Zeit-Verlangerung, Bradykardie und Tachykardie. Wien Med Wochenzeitschr 160:264–69

    Article  Google Scholar 

  7. Elsawy B, Higgins KE (2011) The geriatric assessment. Am Fam Physician 83:48–56

    PubMed  Google Scholar 

  8. Gallagher P, O’Mahony D (2008) STOPP (Screening Tool of Older Persons’ potentially inappropriate Prescriptions): application to acutely ill elderly patients and comparison with Beer’s criteria. Age Ageing 37:673–679

    Article  PubMed  Google Scholar 

  9. Gandhi TK, Weingart SN, Borus J et al (2003) Adverse drug events in ambulatory care. N Engl J Med 16:1556–1564

    Article  Google Scholar 

  10. Gosch M, Böhmdorfer B, Benvenuti Falger U et al (2010) Polypharmazie und Schmerztherapie. Wien Med Wochenzeitschr 160:286–292

    Article  Google Scholar 

  11. Hanlon JT, Schmader KE, Koronkowski MJ et al (1997) Adverse drug events in high risk older outpatients. J Am Geriatr Soc 370:185–191

    Google Scholar 

  12. Hanlon JT, Schmader KE, Samsa GP et al (1992) A method for assessing drug therapy appropriateness. J Clin Epidem 45:1045–1051

    Article  CAS  Google Scholar 

  13. Hauptverband der österreichischen Sozialversicherungsträger (2012) Die österreichische Sozialversicherung in Zahlen. Available at: http://www.sozialversicherung.at. Accessed 20 June 2012

  14. Holt S, Schmiedl S, Thürmann PA (2010) Potentiell inadäquate Medikation für ältere Menschen: Die PRISCUS Liste. Dtsch Ärztebl 107:543–551

    Google Scholar 

  15. Hovstadius B, Astrand B, Petersson G (2010) Assessment of regional variation in polypharmacy. Pharmocoepidemiol Drug Saf 19:375–383

    Google Scholar 

  16. Iglseder B, Dovjak P, Benvenuti-Falger U et al (2010) Medikamenten-induzierte Delirien älterer Menschen, Wien Med Wochenzeitschr 160:281–285

    Google Scholar 

  17. LaMantia MA, Scheunemann LP, Viera AJ et al (2010) Interventions to improve transitional care between nursing homes and hospitals: a systematic review. J Am Geriatr Soc 58:777–782

    Article  PubMed  Google Scholar 

  18. Mann E, Böhmdorfer B, Frühwald T et al (2012) Potentially inappropriate medication in geriatric patients: the Austrian consensus panel list. Wien Klin Wochenschr 124:160–169

    Article  PubMed  Google Scholar 

  19. Naranjo CA, Busto U, Sellers EM et al (1981) A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther 30:239–245

    Article  PubMed  CAS  Google Scholar 

  20. Onder G, Petrovic M, Tangiisuran B et al (2010) Development and validation of a score to assess risk of adverse drug reactions among in-hospital patients 65 years of older. Arch Intern Med 170:1142–1148

    Article  PubMed  Google Scholar 

  21. Osterberg L, Blaschke T (2005) Adherence to Medication. N Engl J Med 353:487–497

    Article  PubMed  CAS  Google Scholar 

  22. Scott IA, Gray LC, Martin JH et al (2012) Minimizing inappropriate medication in older populations: a ten-step conceptual framework. Am J Med 125:529–537

    Article  PubMed  Google Scholar 

  23. Sommeregger U et al (2011) Österreichisches Geriatrisches Basisassessment. Österreichische Gesellschaft für Geriatrie und Geronotologie, Apollogasse 19,1070 Wien

  24. Sommeregger U, Iglseder B, Böhmdorfer B et al (2010) Polypharmazie und Stürze im Alter. Wien Med Wochenzeitschr 160:293–296

    Article  Google Scholar 

  25. Spinewine A, Schmader KE, Barber N et al (2007) Appropriate prescribing in elderly people: how well can it be measured and optimised? Lancet 370:173–84

    Article  PubMed  Google Scholar 

  26. Steinman MA, Handler SM, Gurwitz JH et al (2011) Beyond the prescription: medication monitoring and adverse drug events in older adults. J Am Geriatr Soc 59:1513–1520

    Article  PubMed  Google Scholar 

  27. Steinman MA, Hanlon JT (2010) Managing medication in clinically complex elders. JAMA 304:1592–1601

    Article  PubMed  CAS  Google Scholar 

  28. Studenski S, Perera S, Patel K et al (2011) Gait speed and survival in older adults. JAMA 305:50–58

    Article  PubMed  CAS  Google Scholar 

  29. Vass M, Hendriksen C (2005) Polypharmacy and older people. Z Gerontol Geriatr 38(Suppl 1):I/14–I/17

    Article  Google Scholar 

  30. Williams A, Manias E, Walker R (2008) Interventions to improve medication adherence in people with multiple chronic conditions: a systematic review. J Adv Nurs 63:132–143

    Article  PubMed  Google Scholar 

  31. Woodard LD, Landrum CR, Urech TH et al (2012) Treating chronically ill people with diabetes mellitus with limited life expectancy; implications for performance measurement. J Am Geriatr Soc 60:193–201

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

The corresponding author states that there are no conflicts of interest.

Author information

Authors and Affiliations

  1. Landeskrankenhaus Gmunden, Miller von Aichholzstr. 49, 4810, Gmunden, Austria

    P. Dovjak

Authors
  1. P. Dovjak
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to P. Dovjak.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Dovjak, P. Tools in polypharmacy. Z Gerontol Geriat 45, 468–472 (2012). https://doi.org/10.1007/s00391-012-0362-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00391-012-0362-y

Keywords

Schlüsselwörter

Search

Navigation