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Benefits, risks and impacts on quality of life of medications used in multimorbid older adults: a Delphi study

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Abstract

Background Multimorbidity and polypharmacy are common in older people. Despite the existence of quality criteria for medication use among this population, there is little guidance for managing the complex pharmacological arsenal in a multimorbidity context. Objective To establish consensus on benefits, risks and impacts on quality of life of medications used in an older adult with three chronic diseases that require complex pharmacotherapy. Setting International experts in pharmacology. Method A panel of experts responded to three rounds of a Delphi survey. They assessed the benefits, risks and positive impacts on quality of life of 50 different medications or medication classes that could be used by a hypothetical multimorbid older patient aged 65–75 years, with type 2 diabetes, heart failure and chronic obstructive pulmonary disease. Each aspect was evaluated on a 5-level Likert scale. Main outcome measure Percentage of agreement on each of the three aspects for all medication. Results Consensus was reached on 95% of items (166/174). Only two medication classes were associated with both the highest category of benefits and positive impacts on quality of life, and the lowest risk category: long-acting anticholinergics and long-acting beta-2-agonists. Nine other medications/classes of medications were categorized within the highest benefits level (metformin, DPP-4-inhibitors, short-acting beta-2-agonists, ACE inhibitors, beta-blockers, warfarin, non-vitamin K oral anticoagulants, nitrates and acetaminophen). Fifteen medications were included in the highest level of risks, among which warfarin and Non-vitamin K oral anticoagulants. Conclusions Medications recommended in clinical guidelines for individual diseases are generally considered positive for multimorbid older patients. Nevertheless, a non-negligible number of medications was deemed negative or very negative by our panelists. For multimorbid patients, individualizing treatment according to their preferences seems of utmost importance.

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Acknowledgements

We sincerely thank all the participants who generously responded to our lengthy Delphi survey and provided valuable comments. We also thank Myles Gaulin who edited our document.

Author information

Authors and Affiliations

  1. Department of Social and Preventive Medicine, Laval University, Quebec, Canada

    Caroline Sirois

  2. Centre d’excellence sur le vieillissement de Québec, CIUSSS-CN, Hôpital St-Sacrement, Local L2-28, 1050, Chemin Ste-Foy, Quebec, QC, G1S 4L8, Canada

    Caroline Sirois

  3. Centre de recherche sur les soins et les services de première ligne de l’Université Laval, Quebec, Canada

    Caroline Sirois

  4. Department of Nursing, UQAR, Lévis, Canada

    Carlotta Lunghi

  5. Faculty of Medicine, Laval University, Quebec, Canada

    William Berthelot

  6. Service de Pharmacologie, Toxicologie et Pharmacovigilance, Centre Régional de Pharmacovigilance, de Pharmacoépidémiologie et d’information sur les médicaments, Centre Hospitalier Universitaire de Limoges, Limoges, France

    Marie-Laure Laroche

  7. Faculty of Medicine, Limoges University, Limoges, France

    Marie-Laure Laroche

  8. INSERM 1248, Limoges University, Limoges, France

    Marie-Laure Laroche

  9. Department of Management, UQAR, Lévis, Canada

    Anissa Frini

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Correspondence to Caroline Sirois.

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The study was supported by a Grant from the Université du Québec à Rimouski and a grant by the Research Centre in Patient Care and Front Line Services at Laval University (Centre de recherche sur les soins et les services de première ligne de l’Université Laval). Caroline Sirois is a recipient of a Junior 1 Research Scholar from the Quebec Research Funds in Health (Fonds de recherche du Québec — Santé, FRQS).

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Sirois, C., Lunghi, C., Berthelot, W. et al. Benefits, risks and impacts on quality of life of medications used in multimorbid older adults: a Delphi study. Int J Clin Pharm 42, 40–50 (2020). https://doi.org/10.1007/s11096-019-00935-y

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