Polypharmacy prescribing guidance - draft: consultation

20. Appendix H: Additional scoping searches

We ran an additional scoping search in October 2023 to identify eligible articles published since our last search, i.e., from Nov 2022 to Oct 2023 and to consider how they might impact on the conclusions and recommendations from the Hot Topics. We retrieved 209 full texts and excluded 142. We considered the majority of the 67 articles provisionally meeting our eligibility criteria (see below) did not significantly change our conclusions or recommendations. Table 42 below captures the reasons for exclusion, and below that is the list of excluded articles.

1. Anticholinergic Burden

Braithwaite, E., Todd, O.M., Atkin, A., Hulatt, R., Tadrous, R., Alldred, D.P., Pirmohamed, M., Walker, L., Lawton, R. and Clegg, A., 2023. Interventions for reducing anticholinergic medication burden in older adults—a systematic review and meta-analysis. Age and Ageing, 52(9), 176.

Xu, X.J. and Tan, M.P., 2022. Anticholinergics and falls in older adults. Expert Review of Clinical Pharmacology, 15(3), pp.285-294.

3. Older Adult and Frailty subsections (incl hypertension, diabetes, mental health, etc.)

Abas, J., Capricho, Z.A., Golpeo, B., Idong, C.B., Macantan, J., Miranda, M.D. and Faller, E., 2022. Polypharmacy among geriatric patients in asean countries: a comparative review. Journal of Health Promotion and Service Management, 1(2), pp.94-113.

Bhagavathula, A.S., Tesfaye, W., Vidyasagar, K. and Fialova, D., 2022. Polypharmacy and Hyperpolypharmacy in Older Individuals with Parkinson’s Disease: A Systematic Review and Meta-Analysis. Gerontology, 68(10), pp.1081-1090.

Brokaar, E.J., van den Bos, F., Visser, L.E. and Portielje, J.E., 2022. Deprescribing in older adults with cancer and limited life expectancy: an integrative review. American Journal of Hospice and Palliative Medicine®, 39(1), pp.86-100.

Brunner, L., Rodondi, N. and Aubert, C.E., 2022. Barriers and facilitators to deprescribing of cardiovascular medications: a systematic review. BMJ open, 12(12).

Cheng, C., Yu, H. and Wang, Q., 2023, January. Nurses’ Experiences Concerning Older Adults with Polypharmacy: A Meta-Synthesis of Qualitative Findings. In Healthcare (Vol. 11, No. 3, p. 334). MDPI.

Clarkson, L., Hart, L., Lam, A.K. and Khoo, T.K., 2023. Reducing inappropriate polypharmacy for older patients at specialist outpatient clinics: a systematic review. Current Medical Research and Opinion, 39(4), pp.545-554.

De Luca, V., Femminella, G.D., Patalano, R., Formosa, V., Lorusso, G., Rivetta, C., Di Lullo, F., Mercurio, L., Rea, T., Salvatore, E. and Korkmaz Yaylagul, N., 2022. Assessment tools of biopsychosocial frailty dimensions in community-dwelling older adults: A narrative review. International Journal of Environmental Research and Public Health, 19(23), p.16050.

Fu, J.L. and Perloff, M.D., 2022. Pharmacotherapy for spine-related pain in older adults. Drugs & Aging, 39(7), pp.523-550.

Hu, K., Zhou, G., Jiang, M., Wei, X., Yu, J., Liu, L., Wang, Z., Feng, L., Wu, M., Li, T. and Ma, B., 2023. Hypertension treatment in frail older adults: a systematic review and appraisal of guidelines. Drugs & Aging, 40(10), pp.881-893.

Kumari, S., Jain, S. and Kumar, S., 2022. Effects of polypharmacy in elderly diabetic patients: a review. Cureus, 14(9).

Lam, J.Y.J., Barras, M., Scott, I.A., Long, D., Shafiee Hanjani, L. and Falconer, N., 2022. Scoping review of studies evaluating frailty and its association with medication harm. Drugs & Aging, 39(5), pp.333-353.

Lau, S.R., Waldorff, F., Holm, A., Frølich, A., Andersen, J.S., Sallerup, M., Christensen, S.E., Clausen, S.S., Due, T.D. and Hølmkjær, P., 2023. Disentangling concepts of inappropriate polypharmacy in old age: a scoping review. BMC Public Health, 23(1), pp.1-12.

Lee 2022. The patterns and implications of potentially suboptimal medicine regimens among older adults: a narrative review. Therapeutic advances in drug safety, 13, p.20420986221100117.

Lee, G.B., Etherton-Beer, C., Hosking, S.M., Pasco, J.A. and Page, A.T., 2022. The patterns and implications of potentially suboptimal medicine regimens among older adults: a narrative review. Therapeutic advances in drug safety, 13, p.20420986221100117.

Ma, W., Wang, H., Wen, Z., Liu, L. and Zhang, X., 2023. Potentially inappropriate medication and frailty in older adults: A systematic review and meta-analysis. Archives of Gerontology and Geriatrics, p.105087.

Maffoni, M., Traversoni, S., Costa, E., Midão, L., Kardas, P., Kurczewska-Michalak, M. and Giardini, A., 2020. Medication adherence in the older adults with chronic multimorbidity: a systematic review of qualitative studies on patient’s experience. European geriatric medicine, 11, pp.369-381.

Mondal, A., Li, A., Edusa, S., Gogineni, A., Karipineni, S., Abdelhafez, S., Nalluri, S.D., Meka, G.G., Bawa, J., Puli, S. and Venkata, V.S., 2023. Does statin use in frail patients provide survival benefits? insights from a meta-analysis. Current Problems in Cardiology, p.102038.

Mouazer, A., Tsopra, R., Sedki, K., Letord, C. and Lamy, J.B., 2022. Decision-support systems for managing polypharmacy in the elderly: A scoping review. Journal of Biomedical Informatics, 130, p.104074.

Omuya, H., Nickel, C., Wilson, P. and Chewning, B., 2023. A systematic review of randomised-controlled trials on deprescribing outcomes in older adults with polypharmacy. International Journal of Pharmacy Practice, p.riad025.

Onder. "Italian guidelines on management of persons with multimorbidity and polypharmacy." Aging Clinical and Experimental Research 34.5 (2022): 989-996.

Pazan, F., Petrovic, M., Cherubini, A., Cruz-Jentoft, A.J., Denkinger, M., van der Cammen, T.J., Stevenson, J.M., Ibrahim, K., Rajkumar, C., Bakken, M.S. and Crome, P., 2022. A systematic review of the current evidence from randomised controlled trials on the impact of medication optimisation or pharmacological interventions on quantitative measures of cognitive function in geriatric patients. Drugs & Aging, 39(11), pp.863-874.

Peat, G., Fylan, B., Marques, I., Raynor, D.K., Breen, L., Olaniyan, J. and Alldred, D.P., 2022. Barriers and facilitators of successful deprescribing as described by older patients living with frailty, their informal carers and clinicians: a qualitative interview study. BMJ open, 12(3).

Prasad, S., Katta, M.R. and Sarangi, A., 2023. Psychotropic Deprescribing in the Geriatric Population: A Review. Medical Research Archives, 11(4).

Radcliffe, E., Servin, R., Cox, N., Lim, S., Tan, Q.Y., Howard, C., Sheikh, C., Rutter, P., Latter, S., Lown, M. and Brad, L., 2023. What makes a multidisciplinary medication review and deprescribing intervention for older people work well in primary care? A realist review and synthesis. BMC geriatrics, 23(1), p.591.

Raza, A., Piekarz, H., Jawad, S., Langran, T. and Donyai, P., 2023. A systematic review of quantitative studies exploring staff views on antipsychotic use in residents with dementia in care homes. International Journal of Clinical Pharmacy, 45(5), pp.1050-1061.

Reeve, J., Maden, M., Hill, R., Turk, A., Mahtani, K., Wong, G., Lasserson, D., Krska, J., Mangin, D., Byng, R. and Wallace, E., 2022. Deprescribing medicines in older people living with multimorbidity and polypharmacy: the TAILOR evidence synthesis. Health Technology Assessment (Winchester, England), 26(32), p.1.

Remelli, F., Ceresini, M.G., Trevisan, C., Noale, M. and Volpato, S., 2022. Prevalence and impact of polypharmacy in older patients with type 2 diabetes. Aging clinical and experimental research, 34(9), pp.1969-1983.

Sadeq, A., Strugaru, M., Almutairi, M., Stewart, D., Ryan, C. and Grimes, T., 2022. Interprofessional interventions involving pharmacists and targeting the medicines management process provided to older people residing in nursing homes: a systematic review and meta-analysis of randomised controlled trials. Drugs & Aging, 39(10), pp.773-794.

Saeed, D., Carter, G. and Parsons, C., 2022. Interventions to improve medicines optimisation in frail older patients in secondary and acute care settings: a systematic review of randomised controlled trials and non-randomised studies. International journal of clinical pharmacy, 44(1), pp.15-26.

Seewoodharry, M., Khunti, K., Davies, M.J., Gillies, C. and Seidu, S., 2022. Attitudes of older adults and their carers towards de‐prescribing: a systematic review. Diabetic Medicine, 39(7), p.e14801.

Shantsila, E., Lip, G., Shantsila, A., Maden, M., Hill, R., Williams, N. and Beevers, G., 2023. Pharmacotherapy for hypertension in very old people with frailty: A systematic review.

Toh, J.J.Y., Zhang, H., Soh, Y.Y., Zhang, Z. and Wu, X.V., 2023. Prevalence and health outcomes of polypharmacy and hyperpolypharmacy in older adults with frailty: A systematic review and meta-analysis. Ageing Research Reviews, 83, p.101811.

Verma, A., Saha, S., Jarl, J., Conlon, E., McGuinness, B. and Trépel, D., 2023. An Overview of Systematic Reviews and Meta-Analyses on the Effect of Medication Interventions Targeting Polypharmacy for Frail Older Adults. Journal of Clinical Medicine, 12(4), p.1379.

Wang, J., Shen, J.Y., Conwell, Y., Podsiadly, E.J., Caprio, T.V., Nathan, K., Yu, F., Ramsdale, E.E., Fick, D.M., Mixon, A.S. and Simmons, S.F., 2023. How “age‐friendly” are deprescribing interventions? A scoping review of deprescribing trials. Health Services Research, 58, pp.123-138.

Zhao, M., Chen, Z., Xu, T., Fan, P. and Tian, F., 2023. Global prevalence of polypharmacy and potentially inappropriate medication in older patients with dementia: a systematic review and meta-analysis. Frontiers in Pharmacology, 14, p.1221069.

4. Care homes / Care at home

Batten, M., Kosari, S., Koerner, J., Naunton, M. and Cargo, M., 2022. Evaluation approaches, tools and aspects of implementation used in pharmacist interventions in residential aged care facilities: A scoping review. Research in Social and Administrative Pharmacy, 18(10), pp.3714-3723.

Stötzner, P., Abate, R.E.F., Henssler, J., Seethaler, M., Just, S.A. and Brandl, E.J., 2022. Structured interventions to optimize polypharmacy in psychiatric treatment and nursing homes: A systematic review. Journal of Clinical Psychopharmacology, 42(2), pp.169-187.

Wiggin, D.A., Timmons, S., Rukundo, A. and Walsh, K.A., 2022. Improving the appropriateness of psychotropic prescribing for nursing home residents with dementia: an overview of reviews. Aging & Mental Health, 26(6), pp.1087-1094.

5. Chronic Pain

Dowd, L.A., Cross, A.J., Veal, F., Ooi, C.E. and Bell, J.S., 2022. A systematic review of interventions to improve analgesic use and appropriateness in long-term care facilities. Journal of the American Medical Directors Association, 23(1), pp.33-43.

Levy, R., 2022. Monotherapy vs. Polypharmacy: SNRIs for the Management of Mood Disorders and Chronic Pain. Physician Assistant Scholarly Project Papers. 128.

Pakniyat-Jahromi, S., Amazan, R., Garrels, E., Zamiri, A., Galo, A.R. and Gunturu, S., 2022. Treatment Modalities for Chronic Pain in Elderly Patients With Depression: A Systematic Review. The Primary Care Companion for CNS Disorders, 24(3), p.41182.

Sohi, G., Lao, N., Caraceni, A., Moulin, D.E., Zimmermann, C., Herx, L. and Gilron, I., 2022. Nonopioid drug combinations for cancer pain: A systematic review. Pain Reports, 7(2).

6. Osteoporosis

Jepsen, D.B., Bergen, E.S., Pan, J., van Poelgeest, E., Osman, A., Burghle, A., Ryg, J., Thompson, W. and Lundby, C., 2023. Recommendations on deprescribing of bisphosphonates in osteoporosis guidelines: a systematic review. European Geriatric Medicine, 14(4), pp.747-760.

7. Risk of falls

Giovannini, S., Brau, F., Galluzzo, V., Santagada, D.A., Loreti, C., Biscotti, L., Laudisio, A., Zuccalà, G. and Bernabei, R., 2022. Falls among older adults: Screening, identification, rehabilitation, and management. Applied Sciences, 12(15), p.7934.

Shao, L., Shi, Y., Xie, X., Wang, Z., Wang, Z.A. and Zhang, J.E., 2023. Incidence and risk factors of falls among older people in nursing homes: systematic review and meta-analysis. Journal of the American Medical Directors Association.

Wedmann, F.M., Conca, A., Di Gregorio, P., Florio, V., Toscano, M. and Giupponi, G., 2023. Falls at the interface between geriatric and psychiatric patients: a critical review from a psychopharmacological perspective. Rivista di psichiatria, 58(5), pp.195-204.

Xu, Q., Ou, X. and Li, J., 2022. The risk of falls among the aging population: A systematic review and meta-analysis. Frontiers in public health, 10, p.902599.

8. Pharmacist Services

Al Bulushi, S., McIntosh, T., Grant, A., Stewart, D. and Cunningham, S., 2023. Implementation frameworks for polypharmacy management within healthcare organisations: a scoping review. International journal of clinical pharmacy, 45(2), pp.342-354.

Chan 2023 Categorization of deprescribing communication tools A scoping review

Croke, A., Cardwell, K., Clyne, B., Moriarty, F., McCullagh, L. and Smith, S.M., 2023. The effectiveness and cost of integrating pharmacists within general practice to optimize prescribing and health outcomes in primary care patients with polypharmacy: a systematic review. BMC Primary Care, 24(1), p.41.

de Andrade, F.K., Nunes, R.P.I., Zanetti, M.O.B., Zanetti, A.C.B., Dos Santos, M., de Oliveira, A.M., Carson-Stevens, A., Pereira, L.R.L. and Varallo, F.R., 2023. Validated medication deprescribing instruments for patients with palliative care needs a systematic review. Farmacia Hospitalaria.

Doherty, A.J., Boland, P., Reed, J., Clegg, A.J., Stephani, A.M., Williams, N.H., Shaw, B., Hedgecoe, L., Hill, R. and Walker, L., 2020. Barriers and facilitators to deprescribing in primary care: a systematic review. BJGP open, 4(3).

Faulkner, L., Hughes, C.M. and Barry, H.E., 2022. Interventions to improve medicines optimisation in older people with frailty in primary care: a systematic review. International Journal of Pharmacy Practice, 30(4), pp.297-304.

Gorman, A., Rankin, A., Hughes, C., O'Dwyer, M. and Ryan, C., 2022. Theoretically derived interventions aimed at improving appropriate polypharmacy in primary care: A systematic review. Exploratory research in clinical and social pharmacy, p.100166.

Hasan Ibrahim, A.S., Barry, H.E. and Hughes, C.M., 2021. A systematic review of general practice-based pharmacists’ services to optimize medicines management in older people with multimorbidity and polypharmacy. Family practice, 38(4), pp.509-523.

Laird, C., Benson, H. and Williams, K.A., 2023. Pharmacist interventions in osteoporosis management: a systematic review. Osteoporosis International, 34(2), pp.239-254.

Lampe, D., Grosser, J., Gensorowsky, D., Witte, J., Muth, C., van den Akker, M., Dinh, T.S. and Greiner, W., 2023. The Relationship of Continuity of Care, Polypharmacy and Medication Appropriateness: A Systematic Review of Observational Studies. Drugs & Aging, 40(6), pp.473-497.

O’Shea, J., Ledwidge, M., Gallagher, J., Keenan, C. and Ryan, C., 2022. Pharmacogenetic interventions to improve outcomes in patients with multimorbidity or prescribed polypharmacy: a systematic review. The Pharmacogenomics Journal, 22(2), pp.89-99.

Okeowo, D.A., Zaidi, S.T.R., Fylan, B. and Alldred, D.P., 2023. Barriers and facilitators of implementing proactive deprescribing within primary care: a systematic review. International Journal of Pharmacy Practice, 31(2), pp.126-152.

Rendrayani, F., Alfian, S.D., Wahyudin, W. and Puspitasari, I.M., 2022, December. Pharmacists’ Knowledge, Attitude, and Practice of Medication Therapy Management: A Systematic Review. In Healthcare (Vol. 10, No. 12, p. 2513). MDPI.

Turk, A., Wong, G., Mahtani, K.R., Maden, M., Hill, R., Ranson, E., Wallace, E., Krska, J., Mangin, D., Byng, R. and Lasserson, D., 2022. Optimising a person-centred approach to stopping medicines in older people with multimorbidity and polypharmacy using the DExTruS framework: a realist review. BMC medicine, 20(1), p.297.

Vaffis, S., Dhatt, H., Anderson, E.J., Nelson, M., Campbell, P., Black, H., Kolobova, I. and Warholak, T., 2022. Trends in telephonic comprehensive medication review in the United States from 2000 to present: a scoping literature review. Journal of the American Pharmacists Association, 62(2), pp.406-412.

Wang, J., Shen, J.Y., Conwell, Y., Podsiadly, E.J., Caprio, T.V., Nathan, K., Yu, F., Ramsdale, E.E., Fick, D.M., Mixon, A.S. and Simmons, S.F., 2022. Implementation considerations of deprescribing interventions: A scoping review. Journal of internal medicine.

9. Other

Eriksen, C.U., Kyriakidis, S., Christensen, L.D., Jacobsen, R., Laursen, J., Christensen, M.B. and Frølich, A., 2020. Medication-related experiences of patients with polypharmacy: a systematic review of qualitative studies. BMJ open, 10(9).

Laberge, M., Sirois, C., Lunghi, C., Gaudreault, M., Nakamura, Y., Bolduc, C. and Laroche, M.L., 2021. Economic evaluations of interventions to optimize medication use in older adults with polypharmacy and multimorbidity: a systematic review. Clinical interventions in aging, pp.767-779.

Table 42: Reason for exclusion

Reason

Protocol

Number excluded

1

Reason

Abstract only

Number excluded

5

Reason

Could not determine polypharmacy effect

Number excluded

1

Reason

Neither benefit nor harm

Number excluded

15

Reason

Not English language

Number excluded

2

Reason

Not polypharmacy

Number excluded

16

Reason

Neither SR nor GL

Number excluded

93

Reason

Not yet published

Number excluded

1

Reason

Out of scope

Number excluded

7

Reason

Exclude: no practical applications

Number excluded

1

Excluded references

1. Abd Ghafar, 2022. Frailty and diabetes in older adults: Overview of current controversies and challenges in clinical practice.

2. Abdelhafiz 2023. Effects of hypoglycaemic therapy on frailty: a multi-dimensional perspective

3. Aggarwal. "Multi-morbidity and polypharmacy in older people: challenges and opportunities for clinical practice." Geriatrics 5.4 (2020): 85.

4. Ali. "Interventions to address polypharmacy in older adults living with multimorbidity: Review of reviews." Canadian Family Physician 68.7 (2022): e215-e226.

5. Aljuhani 2023. The Role of Critical Care Pharmacists Beyond Intensive Care Units: A Narrative Review on Medication Management for ICU Survivors. Brazilian Journal of Pharmaceutical Sciences, 58.

6. Alruthea 2022. Interventions to Enhance Medication Safety in Residential Aged-care Settings

7. Angley 2022. Hospital‐initiated post‐discharge medication reviews in Australia: expert opinion on the barriers and enablers to implementation.

8. Arakelyan 2023. Effectiveness of holistic assessment–based interventions in improving outcomes in adults with multiple long-term conditions and/or frailty: an umbrella review protocol. JBI evidence synthesis, 21(9), pp.1863-1878.

9. Ashkanai 2023. The role of pharmacists in deprescribing benzodiazepines

10. Bai 2022. Using the behavior change wheel to link published deprescribing strategies to identified local primary healthcare needs

11. Bain 2023 A realist review of inpatient insulin self-administration policy interventions for people with diabetes in hospital

12. Baker 2022. Risk factors for osteoporosis and fractures in rheumatoid arthritis. Best Practice & Research Clinical Rheumatology, 36(3), p.101773.

13. Bayliss 2022. Recommendations for outcome measurement for deprescribing intervention studies. Journal of the American Geriatrics Society, 70(9), pp.2487-2497.

14. Beezer. "Polypharmacy definition and prevalence in heart failure: a systematic review." Heart failure reviews 27.2 (2022): 465-492.

15. Bennett 2023. Reconsidering ‘problematic’ polypharmacy: an opportunity for developing advanced generalist skills. InnovAiT, p.17557380231166737.

16. Berwick 2022. Medicines optimization in acute and chronic pain. Anaesthesia & Intensive Care Medicine

17. Black, J.E., 2022. Planned deprescribing to protect health systems in pandemics and other disasters: a scoping review. CNS spectrums, 27(2), pp.239-239.

18. Boreskie 2022. Frailty-aware care: giving value to frailty assessment across different healthcare settings. BMC geriatrics, 22, pp.1-12.

19. Bruneau 2022. Mechanism-based pharmacological treatment for chronic non-cancer pain in adolescents: current approaches and future directions. Pediatric Drugs, 24(6), pp.573-583.

20. Bui 2022. Polypharmacy in Hypertension: Should Hypertensive Therapy Be Re-evaluated Periodically?.

21. Cabrera 2023. Deprescription in Palliative Care. Cureus, 15(5).

22. Canio, 2022. Polypharmacy in older adults. Clinics in Geriatric Medicine, 38(4)

23. Carroll 2022. Chronic Pain: Prevalence and Management. Hematology/Oncology Clinics, 36(6), pp.1151-1165.

24. Cerreta 2023. Assessing medicines for use in the Geriatric Population. Clinical Pharmacology & Therapeutics, 113(3), pp.536-540.

25. Chatzis 2023. Current Management of Hypertension in Older Adults. Drugs & Aging

26. Cheng 2022. Interventions for depressive symptoms in people living with chronic pain: a systematic review of meta-analyses. Pain Medicine, 23(5), pp.934-954.

27. Cook 2022. Polypharmacy in the Homebound Population. Clinics in Geriatric Medicine, 38(4), pp.685-692.

28. Cook, E.A., Duenas, M. and Harris, P., 2022. Polypharmacy in the Homebound Population. Clinics in Geriatric Medicine, 38(4), pp.685-692.

29. Crabtree 2022 Intensive glycemic control and macrovascular, microvascular, hypoglycemia complications and mortality in older (age ≥60years) or frail adults with type 2 diabetes

30. Crisafulli 2022. Deprescribing as a strategy for improving safety of medicines in older people: Clinical and regulatory perspective. Frontiers in Drug Safety and Regulation, 2, p.1011701.

31. Crisafulli 2022. Deprescribing as a strategy for improving safety of medicines in older people: Clinical and regulatory perspective. Frontiers in Drug Safety and Regulation, 2, p.1011701.

32. Cucinotta. "Multimorbidity and polypharmacy: a risk factor for older patients." Acta Bio Medica: Atenei Parmensis 93.2 (2022).

33. Daunt, 2023. Polypharmacy stewardship: a novel approach to tackle a major public health crisis. The Lancet Healthy Longevity, 4(5), pp.e228-e235.

34. Davies, 2020. Adverse outcomes of polypharmacy in older people: systematic review of reviews. Journal of the American Medical Directors Association, 21(2), 181-187.

35. De Luca 2022. Assessment Tools of Biopsychosocial Frailty Dimensions in Community-Dwelling Older Adults: A Narrative Review

36. de Oliveira 2023. The prevalence of polypharmacy in the elderly with depressive symptoms: an integrative review. Seven Editora.

37. Delara 2022. Prevalence and factors associated with polypharmacy: a systematic review and meta-analysis. BMC geriatrics, 22(1), p.601.

38. DiConti-Gibbs 2022. Polypharmacy in the Hospitalized Older Adult: Considerations for Safe and Effective Treatment. Clinics in Geriatric Medicine, 38(4), pp.667-684.

39. Dovjak 2022. Polypharmacy in elderly people.

40. Edwina, 2023. Insights into the Pharmacokinetics and Pharmacodynamics of Direct Oral Anticoagulants in Older Adults with Atrial Fibrillation: A Structured Narrative Review. Clinical Pharmacokinetics, 62(3), pp.351-373.

41. Ekram 2022. Polypharmacy, frailty, and disability-free survival in community-dwelling healthy older individuals. Innovation in aging, 6(Supplement_1), pp.562-563.

42. Ermogenous. 2020. Treating age-related multimorbidity: the drug discovery challenge. Drug discovery today, 25(8), pp.1403-1415.

43. Esumi 2022. Polypharmacy in Older Adults with Alzheimer’s Disease. Medicina

44. Farinha, 2022. Optimizing adherence and persistence to non-vitamin K antagonist oral anticoagulant therapy in atrial fibrillation. European Heart Journal Supplements

45. Farooqui 2023. Challenges and Management Strategies in the Nutrition of Older People with Diabetes

46. Fatima 2022. A Comprehensive Review: Drug Interactions and Polypharmacy. FRONTIERS IN CHEMICAL SCIENCES, 3(2), pp.1-9.

47. Filippone 2022. Controversies in Hypertension II: The Optimal Target Blood Pressure.

48. Fujita 2023. Polypharmacy and precision medicine. Cambridge Prisms: Precision Medicine, 1, p.e22.

49. Gaitatzis. "Multimorbidity in people with epilepsy." Seizure (2023).

50. Galvain.2023, Efficacy and Safety of Anticoagulants in Patients with Atrial Fibrillation and History of Falls or Risk of Falls: A Systematic Review and Multilevel Meta-Analysis. Drug safety.

51. Ganga, 2022. Polypharmacy: An Overview. Journal of Pharmaceutical Care

52. Gilron 2022. Combined pharmacotherapy for chronic pain management. Clinical Pain Management: A Practical Guide, pp.218-228.

53. Glare 2022. Pharmacologic management of persistent pain in cancer survivors. Drugs, 82(3)

54. Gnjidic 2022. Achieving sustainable healthcare through deprescribing. Cochrane Database of Systematic Reviews, (10).

55. Goncuoglu 2023. Definition and prevalence over the years of polypharmacy in Turkey: A systematic review. Journal of research in pharmacy (online), 27(4).

56. Grymonprez, 2022. Impact of P‐glycoprotein and/or CYP3A4‐interacting drugs on effectiveness and safety of non‐vitamin K antagonist oral anticoagulants in patients with atrial fibrillation: A meta‐analysis. British Journal of Clinical Pharmacology

57. Hickman 2023. Deprescribing, Polypharmacy and Prescribing Cascades in Older People with Type 2 Diabetes: A Focused Review.

58. Hughes 2022. One size fits all? How to optimize the prescribing of appropriate polypharmacy in chronic diseases, using a behavioral approach–a United Kingdom perspective. Expert review of clinical pharmacology, 15(5), pp.497-499.

59. Hutchings 2023. How pharmacist-led health services are tailored to minoritized populations, their acceptability and effectiveness: A scoping literature review.

60. Ijaz 2022. Interventions for frailty among older adults with cardiovascular disease: JACC state-of-the-art review. Journal of the American College of Cardiology, 79(5), pp.482-503.

61. Iloanusi. "Polypharmacy among COVID-19 patients: A systematic review." Journal of the American Pharmacists Association 61.5 (2021): e14-e25.

62. Iqbal 2023. Are there socioeconomic inequalities in polypharmacy among older people? A systematic review and meta-analysis. BMC geriatrics, 23(1), pp.1-10.

63. Iqbal, 2022. How should a physician assess medication burden and polypharmacy?. Expert Opinion on Pharmacotherapy, 23(1), pp.1-4. 2022

64. Ismail 2022. Psychosis in Alzheimer disease—mechanisms, genetics and therapeutic opportunities. Nature Reviews Neurology, 18(3), pp.131-144.

65. Jalil 2022. Polypharmacy in Treatment of Behavioral Issues in Dementia—Use of Atypical Antipsychotics. Clinics in Geriatric Medicine, 38(4), pp.641-652.

66. Januário 2023. Worldwide Prevalence of Polypharmacy: A Systematic Review. Current Drug Metabolism.

67. Kojima, 2020. Geriatric management of older patients with multimorbidity. Geriatrics & gerontology international, 20(12), pp.1105-1111.

68. Kok 2022. The association between polypharmacy and malnutrition (risk) in older people: A systematic review. Clinical Nutrition ESPEN, 49, pp.163-171.

69. Komatsu 2023. Polypharmacy and sustainable developmental goals: linking evidence-based medicine, patient engagement, and shared decision-making. Renal Replacement Therapy

70. Koria 2022. The prevalence of frailty among older adults living with dementia: a systematic review. Journal of the American Medical Directors Association, 23(11), pp.1807-1814.

71. Kraut 2022. Antihypertensive medication in frail older adults: a narrative review through a deprescribing lens. American Heart Journal Plus: Cardiology Research and Practice

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