Consequences of polypharmacy among the people living with dementia: a systematic review and meta-analysis.

Abstract

Objectives: The aim of this systematic review and meta-analysis was to analyse and summarize studies on the effects of polypharmacy on people living with dementia (PwD). The study aimed to categorize these effects, evaluate the quality of the studies, and estimate the pooled effect sizes of these consequences using meta-analysis.

Method: A systematic literature review was conducted following the PRISMA guideline. Covidence software was used for screening, study selection, and data extraction. The quality assessment was conducted using the Newcastle-Ottawa Scale (NOS) scale. Random effect models were used to perform the meta-analyses and the heterogeneity was reported with I² statistics.

Results: This review of 19 studies found that polypharmacy is significantly associated with potentially inappropriate medication (PIM), hospitalisation, adverse drug reactions, and mortality. The quality of the studies was fair to good. Meta-analysis revealed that the odds of having PIM among the PwD exposed to polypharmacy was 2.93 times (95% CI: 2.24-3.82; I² = 95.6%). The studies showed heterogeneity in design, sample size, follow-up duration, confounder adjustment, polypharmacy definitions, and inconsistent tools for dementia diagnosis.

Conclusion: Polypharmacy in PwD is associated with increased potentially inappropriate medication, adverse drug reactions, and hospitalisation. Regular management of polypharmacy is recommended in clinical practice.