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Is It Possible to Reduce Polypharmacy in the Elderly?

A Randomised, Controlled Trial

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Abstract

Objective

The present trial was originally designed to investigate the effectiveness of comprehensive day hospital care in chronically ill elderly patients. Another aim, reported here, was to investigate to what extent it is possible to reduce polypharmacy and simplify drug regimens during the short term tight control conditions of day hospital care.

Patients

All home care patients (n = 174, mean age 77 years) in a rural area, Kirkkonummi-Siuntio, in Finland.

Design and setting

Patients were randomised into 2 groups, one of which was offered a 2-month period of day hospital care. Patients assumed to be noncompliant (because they did not want day hospital care) were also included in order to see the effect of intervention in ‘real-life’. The medications of all participants were reviewed and counted during an in-home assessment by a home nurse. In the intervention group, necessary revisions (dose reduction, discontinuation, possible additions) were performed through the tight monitoring of day hospital care and in co-operation with the patient. The patients were followed up for 10 months after completion of the intervention programme.

Outcome measures

Number of prescribed medications, number of over-the-counter (OTC) drugs, number of doses taken daily by the patients. Assessments were performed at baseline, and after 2, 5 and 12 months.

Results

There were no significant changes in the number of prescribed medications. In patients in day hospital care, the number of doses was reduced significantly (p = 0.02) during the 2-month day hospital period compared with the control group. However, the patients compensated for the reductions by increasing the use of OTC drugs during the day hospital period (p = 0.05). In addition, only 3 months after the trial, the number of drugs had already returned to the baseline level.

Conclusions

In real life it seems to be difficult to reduce polypharmacy in the elderly. Some drug reductions may be achieved with tight control under trial conditions, but when the intervention ceases the number of drugs used soon returns to its earlier level.

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Acknowledgements

We are grateful to physicians of Kirkkonummi-Siuntio primary healthcare centre for their help during this study. This study was supported by the Ragnar Ekberg Foundation, the Research Council of Medical Sciences (The Academy of Finland), the Finnish Medical Society Duodecim, the Orion Corporation Research Foundation and the Kirkkonummi-Siuntio primary healthcare centre.

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Authors and Affiliations

  1. Department of Medicine, Geriatric Clinic, Helsinki University Hospital, Helsinki, Finland

    Kaisu H. Pitkala, Timo E. Strandberg & Reijo S. Tilvis

Authors
  1. Kaisu H. Pitkala
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  2. Timo E. Strandberg
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  3. Reijo S. Tilvis
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Correspondence to Kaisu H. Pitkala.

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Pitkala, K.H., Strandberg, T.E. & Tilvis, R.S. Is It Possible to Reduce Polypharmacy in the Elderly?. Drugs & Aging 18, 143–149 (2001). https://doi.org/10.2165/00002512-200118020-00007

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