Table4_Polypharmacy Management in the Older Adults: A Scoping Review of Available Interventions.docx

Background: Polypharmacy paves the way for non-adherence, adverse drug reactions, negative health outcomes, increased use of healthcare services and rising costs. Since it is most prevalent in the older adults, there is an urgent need for introducing effective strategies to prevent and manage the problem in this age group.
Purpose: To perform a scoping review critically analysing the available literature referring to the issue of polypharmacy management in the older adults and provide narrative summary.
Data sources: Articles published between January 2010–March 2018 indexed in CINHAL, EMBASE and PubMed addressing polypharmacy management in the older adults.
Results: Our search identified 49 papers. Among the identified interventions, the most often recommended ones involved various types of drug reviews based on either implicit or explicit criteria. Implicit criteria-based approaches are used infrequently due to their subjectivity, and limited implementability. Most of the publications advocate the use of explicit criteria, such as e.g. STOPP/START, Beers and Medication Appropriateness Index (MAI). However, their applicability is also limited due to long lists of potentially inappropriate medications covered. To overcome this obstacle, such instruments are often embedded in computerised clinical decision support systems.
Conclusion: Multiple approaches towards polypharmacy management are advised in current literature. They vary in terms of their complexity, applicability and usability, and no “gold standard” is identifiable. For practical reasons, explicit criteria-based drug reviews seem to be advisable. Having in mind that in general, polypharmacy management in the older adults is underused, both individual stakeholders, as well as policymakers should strengthen their efforts to promote these activities more strongly.

研究背景：多重用药（polypharmacy）会引发药物治疗不依从、药物不良反应、不良健康结局、医疗服务使用增加以及医疗成本上升。由于该问题在老年人群中最为普遍，因此亟需引入有效策略，以预防和管理这一群体中的此类问题。
研究目的：开展一次范围综述（scoping review），批判性分析现有关于老年人群多重用药管理问题的相关文献，并提供叙述性总结。
数据来源：2010年1月至2018年3月期间发表，且收录于CINHAL、EMBASE及PubMed数据库中，针对老年人群多重用药管理的相关学术文章。
研究结果：本次文献检索共筛选出49篇论文。在已识别的干预措施中，最常被推荐的方案为基于隐式或显式标准的各类药物审查。基于隐式标准的方法因主观性较强且可实施性有限，应用频率较低。多数研究主张采用显式标准工具，例如STOPP/START标准、Beers标准及药物适宜性指数（Medication Appropriateness Index, MAI）。然而，由于这类工具涵盖的潜在不适当药物清单过长，其适用性也受到限制。为克服这一局限，此类工具常被嵌入计算机化临床决策支持系统中。
研究结论：现有文献建议采用多种策略开展老年人群多重用药管理。这些策略在复杂性、适用性及可用性方面各有差异，目前尚无公认的"金标准"方案。出于实践考量，基于显式标准的药物审查似乎更为可取。考虑到老年人群的多重用药管理总体上仍未得到充分应用，相关利益相关者及政策制定者均应加大力度，进一步推广此类管理活动。