Active implementation of patient-centered polypharmacy management for older adults with multimorbidity can help to identify and correct the medication errors that patients may have, avoid the occurrence of potential medication errors, reduce and control the development of drug-related diseases, improve the clinical treatment effect, and delay the disease progression, thereby facilitating the achievement of targets for disease control, and improvement of quality of life of patients. In the light of problems of polypharmacy in Chinese elderly patients with multimorbidity, we summarized relevant interventions including strengthening top-level design of management, building multidisciplinary teams, innovating medication management technologies, and meeting patients'needs of drug information, providing a reference for medication management of these patients. We found that problems of polypharmacy in Chinese elderly patients are serious, and actively exploring multiple approaches to polypharmacy management based on medication features of these patients may be a key breakthrough for addressing the problems.
Due to susceptibility to multiple chronic diseases, polypharmacy is often needed in older adults, which may easily lead to increased risk of potentially inappropriate medications (PIM) if polypharmacy is accompanied by various alterations in pharmacokinetics and pharmacodynamics of medications. PIM are highly prevalent in older adults, which may be asociated with higher risks of frailty, falls, cognitive decline, and other adverse drug events. In China, the research on PIM is relatively weak, and PIM are insufficiently focused and often managed with non-standardized and non-intelligent approaches in primary care. We systematically reviewed recent studies in the prevalence, screening and assessment tools and management strategies of PIM in older adults, providing theoretical support and practical reference for reducing the harm of PIM and standardizing drug management.
It is a great challenge to ensure medication safety in healthcare for older adults, since polypharmacy in this group may increase the risk of potentially inappropriate medications, leading to adverse drug reactions, drug-drug interactions, hospitalizations, increased medical costs, and even deaths. Deprescribing improves patient prognosis and reduces adverse drug events through patient participation, and shared decision-making. The prevalence of multimorbidity and polypharmacy in older adults is notably in community care, the frontline for the management of use of multiple drugs. As primary care physicians have a deep understanding of patients' past and current diagnoses and treatments, they play a vital role in reviewing and managing patients' medications. However, there are few reports on deprescribing in primary care in China. We described the definition of deprescribing, and reviewed its recent advances, with a focus on the implementation process of deprescribing in the community, and the impact of deprescribing on chronic disease management by primary care physicians. This review may provide a reference for further study and policy making regarding deprescribing in the community in China.
