3205 Polypharmacy and quality of life in older people: where do we stand? A narrative review

Abstract

Introduction Health affects older people’s quality of life (QoL). Those experiencing health decline often require multiple medications (polypharmacy). This narrative review aims to explore the effect polypharmacy has on QoL and health-related QoL (HRQoL). We also wished to determine the QoL/HRQoL measurement tools employed and polypharmacy definitions used in included studies. Method Searches were carried out primarily in MEDLINE and EMBASE. Publication databases for The Irish Longitudinal Study on Ageing (TILDA) and the English Longitudinal Study of Ageing (ELSA) were also searched. Search terms such as ‘polypharmacy’, ‘older person’, ‘health-related quality of life’ and ‘quality of life’ were used. Primary or secondary research articles investigating the association between polypharmacy and QoL/HRQoL, including qualitative studies, QoL/HRQOL tool development studies, and randomised controlled trials investigating the number of medications and QoL/HRQoL as outcomes were included. Screening and data extraction were undertaken by one reviewer and a narrative synthesis conducted. Results In total, 55 articles were included. The key finding of this review was the heterogeneity of the effect of polypharmacy on QoL/HRQoL, ranging from no association to a significant negative clinical association. Considerable variation was seen in the number of QoL/HRQoL measurement tools and polypharmacy definitions used. Qualitative studies highlighted factors which were perceived to impact QoL/HRQoL, including the relationship between patients and healthcare providers, clear benefit of medication and commitment to everyday medication management. These findings highlight the difficulty in interpreting the true impact of polypharmacy on QoL/HRQoL. Conclusion(s) In qualitative research, patients highlight the negative impact of polypharmacy on QoL; however, this isn’t always reflected in quantitative research. The range of differing associations could be due to the responsiveness of the tools used, populations studied, or the nature of the relationship between polypharmacy and QoL, which is likely intertwined bidirectionally with many contributing and confounding factors.