title: Health outcomes associated with polypharmacy in community-dwelling older adults: a systematic review.
abstract: OBJECTIVE
  To summarize evidence regarding the health outcomes associated with polypharmacy, defined as number of prescribed medications, in older community-dwelling persons.
  
  
  METHODS
  Systematic review of MEDLINE (OvidSP 1946 to May, Week 3, 2014).
  
  
  METHODS
  Community.
  
  
  METHODS
  Observational studies examining health outcomes according to number of prescription medications taken.
  
  
  METHODS
  Association between number of medications and health outcomes. Because of the importance of comorbidity as a potential confounder of the relationship between polypharmacy and health outcomes, articles were assessed regarding the quality of their adjustment for confounding.
  
  
  RESULTS
  Of the 50 studies identified, the majority that were rated good in terms of their adjustment for comorbidity demonstrated relationships between polypharmacy and a range of outcomes, including falls, fall outcomes, fall risk factors, adverse drug events, hospitalization, mortality, and measures of function and cognition. However, a number of these studies failed to demonstrate associations, as did a substantial proportion of studies rated fair or poor.
  
  
  CONCLUSIONS
  Data are mixed regarding the relationship between polypharmacy, considered in terms of number of medications, and adverse outcomes in community-dwelling older persons. Because of the challenge of confounding, randomized controlled trials of medication discontinuation may provide more-definitive evidence regarding this relationship than observational studies can provide.
authors.affiliation: Clinical Epidemiology Research Center, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut; Department of Medicine, Yale University.
authors.forename: Terri R
authors.initials: TR
authors.lastname: Fried
authors.forename: John
authors.initials: J
authors.lastname: O'Leary
authors.forename: Virginia
authors.initials: V
authors.lastname: Towle
authors.forename: Mary K
authors.initials: MK
authors.lastname: Goldstein
authors.forename: Mark
authors.initials: M
authors.lastname: Trentalange
authors.forename: Deanna K
authors.initials: DK
authors.lastname: Martin
mesh_terms: D000058:Accidental Falls; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000188:drug therapy*; D015897:Comorbidity; D064420:Drug-Related Side Effects and Adverse Reactions; D015577:Geriatric Assessment; D006801:Humans; D019338:Polypharmacy; D055553:Prescription Drugs / Q000008:administration & dosage* / Q000009:adverse effects*; D012307:Risk Factors
chemical_list: D055553:Prescription Drugs
keywords: observational studies; polypharmacy; systematic review