Impact of a Multidisciplinary Approach to Polypharmacy Management in Community-Dwelling Older Adults: Insights From a Specialized Outpatient Clinic

Objectives

The increase in polypharmacy among older adults increases the risk of drug-related problems, making multidisciplinary interventions essential. This study evaluated the impact of a multidisciplinary polypharmacy consultation on medication management and outcomes in older outpatients.

Methods

This prospective observational study at a Spanish teaching hospital involved geriatricians, clinical pharmacists, and nurses. Older adults (≥ 75 years) with polypharmacy underwent medication review at baseline and at 3 and 6 months. Data on medication use, adherence to Screening Tool of Older Person's Prescriptions (STOOP) criteria, and anticholinergic burden were analyzed.

Results

The study included 104 older adults (mean age 86.2 years; 66% female). An average of 3.6 recommendations per participant was made (63.8% acceptance rate). Common drug-related problems were adverse effects (20%), non-adherence (18.1%), and incorrect dose/regimen (14.4%). Interventions led to an average reduction of 1.7 medications per patient, with 1.3 dosage or regimen changes and 1.1 new prescriptions. The mean number of medications decreased from 9.6 at baseline to 8.9 at 3 months (p < 0.001) and remained below baseline at 6 months. STOPP criteria violations per patient dropped from 1.2 to 1.0 (p = 0.036). Of the 126 medications flagged by STOPP criteria, 68.3% were addressed, 24.6% discontinued, mainly psychotropics, and 89.3% of these discontinuations were maintained. The anticholinergic burden decreased from 1.3 to 1.1 at 3 months (p = 0.036) and remained below baseline at 6 months.

Conclusions

A multidisciplinary clinic effectively managed polypharmacy in older adults by reducing medication load and improving appropriateness per STOPP criteria, highlighting the importance of proactive medication management.

Trial Registration

ClinicalTrials.gov: NCT05408598 (March 1, 2022)