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Polypharmacy and Deprescribing

Guest Editors:
Kinda IbrahimUniversity of Southampton, UK
Lisa Kouladjian O’DonnellUniversity of Syndey, Australia

This collection is no longer accepting submissions.

BMC Geriatrics is calling for submissions to our Collection on Polypharmacy and Deprescribing. We are interested in attracting a wide range of submissions relating to polypharmacy and deprescribing to address the current gaps and challenges in research and implementation in clinical practice.

Meet the Guest Editors

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Kinda IbrahimUniversity of Southampton, UK

Dr Kinda Ibrahim is a Pharmacist and Senior Lecturer, working in Academic Geriatric Medicine at the University of Southampton. She is also the deputy lead for the NIHR Wessex Applied Research Collaboration (ARC) Ageing and Dementia Theme and the ARC Wessex Associate Lead for Career Development. Kinda’s research is focused on Medicine Optimisation and Deprescribing among older patients, with a specific focus on those living with frailty who are taking multiple medications. She co-chairs the Network for European Researchers in Deprescribing (NERD) steering committee and is a key member of the joint AHSN/ARC Wessex Medicine Optimisation network and the European Geriatric Medicine Society (EUGMS) Polypharmacy Special Interest Group which bring together national and international researchers interested in deprescribing.

Lisa Kouladjian O’DonnellUniversity of Syndey, Australia
Dr Lisa Kouladjian O’Donnell is a Research Fellow in Geriatric Pharmacotherapy, Faculty of Medicine and Health, The University of Sydney, and Kolling Institute, Royal North Shore Hospital, New South Wales, Australia. Her research focuses on optimising quality use of medicines in older adults with particular interests in developing and translating digital health tools into clinical practice. Her work on The Drug Burden Index Calculator © and The Goal-directed Medication review Electronic Decision Support System (G-MEDSS) © are clear examples of developing medication management tools for clinicians and translational into practice.

About the collection

BMC Geriatrics is calling for submissions to our Collection on Polypharmacy and Deprescribing.

The consequences of ageing can often result in the diagnosis of multiple chronic conditions, also known as multimorbidity leading to prescribing multiple medications (polypharmacy). Recently, it has been distinguished that sometimes polypharmacy is appropriate but most often, especially in older age, a medication that was at one point needed may become less needed or unsafe. It is estimated that more than 50% of older people are prescribed at least one medication with more harm than benefit. Inappropriate polypharmacy is associated with significant poor health outcomes such as injurious falls, cognitive impairment, hospitalization, and death, and can lead to wasteful healthcare expenditure.

Optimisation of medication prescribing has become a major public-health issue worldwide, particularly in older people, and the reduction and prevention of medication-induced harm is now classified as one of global health priorities of the World Health Organisation (WHO). Deprescribing, the process of withdrawing medications, under the supervision of a healthcare practitioner, which may no longer be of benefit or may be causing harm, may be a solution to polypharmacy, but is often hard to initiate and maintain. There has been an increasing body of research around deprescribing of medications in older people over the last 15 years. Yet, there is still a lack of a common understanding of what are the best practices or approaches for implementing deprescribing in different cultures, healthcare systems, and clinical settings. This is particularly important, as deprescribing requires complex changes to established patterns of behaviour at the individual, organisational, and systems levels. Effective deprescribing should be a patient-centred approach that involves participation by patients and/or relatives and carers, good prescriber/patient relationships and communication, and shared decision making.

Within this collection at BMC Geriatrics, we are interested in attracting a wide range of submissions relating to polypharmacy and deprescribing to address the current gaps and challenges in research and implementation in clinical practice. The span of articles may be preclinical and clinical studies, to epidemiological and implementation research and strategies.

Definition of Polypharmacy

  • What’s the new ‘norm’ in polypharmacy? ≥5 medications? ≥10 medications? 
  • Challenging the previously defined definitions.
  • How to define inappropriate polypharmacy?
  • Medication related problems in various settings e.g. hospital, community, residential aged care settings 
  • New harms of polypharmacy previously undefined?

Patient-focused interventions

  • Patient involvement in shared decision about deprescribing (tools, digital apps, barriers and facilitators, codesign strategies and interventions)
  • Patients and carers decision making aids for deprescribing 
  • The role of caregivers in the process of deprescribing/medicine optimisation 
  • Patient and caregiver-related outcomes relevant to deprescribing/medicine optimisationPatient/carers views vs. healthcare practitioner views 
  • How deprescribing is communicated to the most vulnerable people (i.e. patients with learning disability, limited health literacy, cognitive impairment, etc.)
  • Polypharmacy and deprescribing at end of life (prevalence, management, barriers/facilitators…etc)

Implementation research

  • What works or does not work in relation to implementing deprescribing/medicine optimisation in clinical practice
  • The role and value of multidisciplinary team involvement in deprescribing 
  • The use of technology to assist implementation (e,g. clinical decision support software/apps)
  • Innovative models of practices of implementation of deprescribing in different contexts and settings
  • What makes a sustainable implementation?
  • Policies and guidelines to support deprescribing.

Effectiveness and safety of deprescribing

  • Effectiveness and costeffectiveness of deprescribing/medicine optimisation interventions as a standalone intervention or part of multifactorial interventions
  • Safety of deprescribing/medicine optimisation interventions 
  • Ethical and legal implications around stopping medications 
  • The effectiveness, cost effectiveness and safety of deprescribing specific classes of drugs (e.g. fallincreasing drugs, opioids, antipsychotics, anticholinergics,…etc)
  • Tools, algorithms, guidelines and policies to facilitate deprescribing/medicine optimisation of specific classes of drugsEffect of deprescribing/medicine optimisation on geriatric syndromes (i.e. frailty, sarcopenia, falls, …etc)
  1. Evidence shows that potentially inappropriate medication (PIM) use in older adults significantly increases the utilization of healthcare resources. PIM is widely prescribed in older adults, however little is k...

    Authors: Behailu Terefe Tesfaye, Dula Dessalegn Bosho, Gashahun Mekonnen Dissassa, Mikiyas Gashaw Tesfaye and Mengist Awoke Yizengaw
    Citation: BMC Geriatrics 2024 24:65
  2. It is well known that polypharmacy is associated with adverse drug events. Accordingly, specialist geriatric units have to pay particular attention to the appropriateness of prescription and the withdrawal of ...

    Authors: Céline Rahuel, Maxime Pautrat, Amal Aïdoud, Bertrand Fougère and Camille Debacq
    Citation: BMC Geriatrics 2024 24:39
  3. As health reforms move Ireland from a mixed public-private system toward universal healthcare, it is important to understand variations in prescribing practice for patients with differing health cover and soci...

    Authors: Ciaran Prendergast, Michelle Flood, Logan T. Murry, Barbara Clyne, Tom Fahey and Frank Moriarty
    Citation: BMC Geriatrics 2023 23:755
  4. Older adults living with dementia may express challenging responsive behaviours. One management strategy is pharmacologic treatment though these options often have limited benefit, which may lead to multiple t...

    Authors: Shanna C Trenaman, Jack Quach, Susan K Bowles, Susan Kirkland and Melissa K Andrew
    Citation: BMC Geriatrics 2023 23:683
  5. Potentially inappropriate medication use is prevalent among older adults in primary care, leading to increased morbidity, adverse drug reactions, hospitalizations, and mortality. This study aimed to develop an...

    Authors: Roxana De las salas, Claudia Vaca-González, Javier Eslava-Schmalbach, Catalina Torres-Espinosa and Albert Figueras
    Citation: BMC Geriatrics 2023 23:682
  6. A third of older people take five or more regular medications (polypharmacy). Conducting medication reviews in primary care is key to identify and reduce/ stop inappropriate medications (deprescribing). Recent...

    Authors: Eloise Radcliffe, Renée Servin, Natalie Cox, Stephen Lim, Qian Yue Tan, Clare Howard, Claire Sheikh, Paul Rutter, Sue Latter, Mark Lown, Lawrence Brad, Simon D. S. Fraser, Katherine Bradbury, Helen C. Roberts, Alejandra Recio Saucedo and Kinda Ibrahim
    Citation: BMC Geriatrics 2023 23:591
  7. Nursing home (NH) residents with severe dementia use many medications, sometimes inappropriately within a comfort care approach. Medications should be regularly reviewed and eventually deprescribed. This pragm...

    Authors: Edeltraut Kröger, Machelle Wilchesky, Michèle Morin, Pierre-Hugues Carmichael, Martine Marcotte, Lucie Misson, Jonathan Plante, Philippe Voyer and Pierre Durand
    Citation: BMC Geriatrics 2023 23:520
  8. On average, older patients use five or more medications daily. A consequence is an increased risk of adverse drug reactions, interactions, or medication errors. Therefore, it is important to understand the cha...

    Authors: Thorbjørn Hougaard Mikkelsen, Jens Søndergaard, Niels Kristian Kjaer, Jesper Bo Nielsen, Jesper Ryg, Lene Juel Kjeldsen and Christian Backer Mogensen
    Citation: BMC Geriatrics 2023 23:477
  9. Medication reviews in primary care provide an opportunity to review and discuss the safety and appropriateness of a person’s medicines. However, there is limited evidence about access to and the impact of rout...

    Authors: Rebecca M. Joseph, Roger D. Knaggs, Carol A. C. Coupland, Amelia Taylor, Yana Vinogradova, Debbie Butler, Louisa Gerrard, David Waldram, Barbara Iyen, Ralph K. Akyea, Darren M. Ashcroft, Anthony J. Avery and Ruth H. Jack
    Citation: BMC Geriatrics 2023 23:435
  10. Use of anticholinergic (ACH) medications is associated with increased risk of cognitive decline in the elderly. However, little is known about this association from a health plan perspective.

    Authors: Insiya B. Poonawalla, Yihua Xu, Rainelle Gaddy, Alex James, Matt Ruble, Salina Burns, Suzanne W. Dixon and Brandon T. Suehs
    Citation: BMC Geriatrics 2023 23:401
  11. Clinical evidence demonstrating a longitudinal association between prescribed medications and sarcopenia onset is lacking. We investigated the association of polypharmacy (the use of five or more medications) ...

    Authors: Tomoki Tanaka, Masahiro Akishita, Taro Kojima, Bo-Kyung Son and Katsuya Iijima
    Citation: BMC Geriatrics 2023 23:390
  12. Shared decision-making(SDM) is recognized as an important means of managing polypharmacy among older people with chronic diseases. However, no studies have quantitatively measured the effect of SDM on polyphar...

    Authors: Qiao Zong, Zhanchun Feng, Jia Wang, Zehao Zheng, Chaoyi Chen and Da Feng
    Citation: BMC Geriatrics 2023 23:258
  13. Falls are dangerous to the health of older adults and can impact their functional status leading to frailty. The use of potentially inappropriate medications (PIMs) among older adults may lead to adverse healt...

    Authors: Khalid S. AlHarkan, Safaa Alsousi, Mujtaba AlMishqab, Majd Alawami, Jaffar Almearaj, Hassan Alhashim, Hassan Alamrad, Layla M. Alghamdi, Abdulelah Almansour and Reem S. AlOmar
    Citation: BMC Geriatrics 2023 23:222
  14. Polypharmacy is a growing public health problem occurring in all healthcare settings worldwide. Elderly patients with lumbar spinal canal stenosis (LSS) who manifest low back and neuropathic pain and have a hi...

    Authors: Sota Nagai, Risa Inagaki, Takehiro Michikawa, Soya Kawabata, Kaori Ito, Kurenai Hachiya, Hiroki Takeda, Daiki Ikeda, Shinjiro Kaneko, Shigeki Yamada and Nobuyuki Fujita
    Citation: BMC Geriatrics 2023 23:169
  15. Socioeconomic status (SES) may influence prescribing, concordance and adherence to medication regimens. This review set out to investigate the association between polypharmacy and an individual’s socioeconomic...

    Authors: Anum Iqbal, Charlotte Richardson, Zain Iqbal, Hannah O’Keefe, Barbara Hanratty, Fiona E. Matthews and Adam Todd
    Citation: BMC Geriatrics 2023 23:149
  16. Deprescribing of preventive medication is recommended in older patients with polypharmacy, including people with type 2 diabetes (T2D). It seems that many patients in low-middle-income countries are not willin...

    Authors: Monika Pury Oktora, Cindra Tri Yuniar, Lia Amalia, Rizky Abdulah, Eelko Hak and Petra Denig
    Citation: BMC Geriatrics 2023 23:21
  17. Polypharmacy is commonly associated with adverse health outcomes. There are currently no meta-analyses of the prevalence of polypharmacy or factors associated with polypharmacy. We aimed to estimate the pooled...

    Authors: Mahin Delara, Lauren Murray, Behnaz Jafari, Anees Bahji, Zahra Goodarzi, Julia Kirkham, Mohammad Chowdhury and Dallas P. Seitz
    Citation: BMC Geriatrics 2022 22:601

    The Correction to this article has been published in BMC Geriatrics 2022 22:742

  18. Polypharmacy is a serious concern among older adults and is frequently related to adverse outcomes, including health problems, reduced quality of life, and increased medical expenses. Although personality trai...

    Authors: Yuko Yoshida, Tatsuro Ishizaki, Yukie Masui, Yasumichi Arai, Hiroki Inagaki, Madoka Ogawa, Saori Yasumoto, Hajime Iwasa, Kei Kamide, Hiromi Rakugi, Kazunori Ikebe and Yasuyuki Gondo
    Citation: BMC Geriatrics 2022 22:372
  19. In older patients with polypharmacy and multiple comorbidities, even low grades of statin-associated muscle symptoms may have clinical implications. The aim of this study was therefore to investigate the poten...

    Authors: Sigbjørn Veddeng, Håkon Madland, Espen Molden, Torgeir Bruun Wyller and Rita Romskaug
    Citation: BMC Geriatrics 2022 22:242
  20. Polypharmacy is common in people with dementia. The use of psychotropic drugs (PDs) and other, potentially inappropriate medications is high. The aims of this cross-sectional study were 1) to investigate the u...

    Authors: Lina Riedl, Esther Kiesel, Julia Hartmann, Julia Fischer, Carola Roßmeier, Bernhard Haller, Victoria Kehl, Josef Priller, Monika Trojan and Janine Diehl-Schmid
    Citation: BMC Geriatrics 2022 22:214
  21. Older adults receive treatment for fall injuries in both inpatient and outpatient settings. The effect of persistent polypharmacy (i.e. using multiple medications over a long period) on fall injuries is unders...

    Authors: Lingshu Xue, Robert M. Boudreau, Julie M. Donohue, Janice C. Zgibor, Zachary A. Marcum, Tina Costacou, Anne B. Newman, Teresa M. Waters and Elsa S. Strotmeyer
    Citation: BMC Geriatrics 2021 21:710
  22. Evidence regarding clinically relevant effects of interventions aiming at reducing polypharmacy is weak, especially for the primary care setting. This study was initiated with the objective to achieve clinical...

    Authors: Angelika Mahlknecht, Christian J. Wiedermann, Marco Sandri, Adolf Engl, Martina Valentini, Anna Vögele, Sara Schmid, Felix Deflorian, Carmelo Montalbano, Dara Koper, Romuald Bellmann, Andreas Sönnichsen and Giuliano Piccoliori
    Citation: BMC Geriatrics 2021 21:659