Evidence map›Paper›PMID 30021528›Full record

ArticleBMC family practice2018

Polypharmacy in older patients with chronic diseases: a cross-sectional analysis of factors associated with excessive polypharmacy.

Anja Rieckert, Ulrike S Trampisch, Renate Klaaßen-Mielke, Eva Drewelow, Aneez Esmail, Tim Johansson, Sophie Keller, Ilkka Kunnamo, Christin Löffler, Joonas Mäkinen and 3 more

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMC family practice, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 69 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
69citing papers in PubMed, 2 pooled it
6.6field-weighted citation impact, top 2% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

69 citing papers in PubMed, 2 syntheses or guidelines pooled it, 133 citations in OpenAlex.

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  14. Supporting Older People Living With Frailty to Self-Manage Multiple Medicines: An Experience-Based Co-Design of a Complex Intervention Developed in UK Primary Care.Health expectations : an international journal of public participation in health care and health policy · 2025
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9 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors at 6 institutions in 4 countries.

Anja RieckertInstitute of General Practice and Family Medicine, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Str. 50, 58448, Witten, Germany. Anja.Rieckert@uni-wh.de.ORCID 0000-0002-9735-378X
Ulrike S TrampischDepartment of Medical Informatics, Biometry and Epidemiology, Ruhr University, Universitätsstr. 105, 44789, Bochum, Germany.
Renate Klaaßen-MielkeDepartment of Medical Informatics, Biometry and Epidemiology, Ruhr University, Universitätsstr. 105, 44789, Bochum, Germany.
Eva DrewelowInstitute of General Practice, Rostock University Medical Center, Doberaner Str. 142, 18057, Rostock, Germany.
Aneez EsmailNIHR School of Primary Care Research, University of Manchester, Oxford Road 176, M13 9PL, Manchester, UK.
Tim JohanssonCentre for Primary Care, NIHR School of Primary Care Research, University of Manchester, Oxford Road M13 9PL, Manchester, UK.
Sophie KellerCentre for Primary Care, NIHR School of Primary Care Research, University of Manchester, Oxford Road M13 9PL, Manchester, UK.
Ilkka KunnamoDuodecim Medical Publications Ltd., Kaivokatu 10 A, 00100, Helsinki, Finland.
Christin LöfflerInstitute of General Practice, Rostock University Medical Center, Doberaner Str. 142, 18057, Rostock, Germany.
Joonas MäkinenDuodecim Medical Publications Ltd., Kaivokatu 10 A, 00100, Helsinki, Finland.
Giuliano PiccolioriSouth Tyrolean Academy of General Practice, Wangergasse 18, 39100, Bolzano, Italy.
Anna VögeleSouth Tyrolean Academy of General Practice, Wangergasse 18, 39100, Bolzano, Italy.
Andreas SönnichsenInstitute of General Practice and Family Medicine, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Str. 50, 58448, Witten, Germany.
University of Manchester · GBEurac Research · ITFinnish Medical Society Duodecim · FIRuhr University Bochum · DEUniversity of Rostock · DEWitten/Herdecke University · DE

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundPolypharmacy is common in older people and associated with potential harms. The aim of this study was to analyse the characteristics of an older multimorbid population with polypharmacy and to identify factors contributing to excessive polypharmacy in these patients.

methodsThis cross-sectional analysis is based on the PRIMA-eDS trial, a large randomised controlled multicentre study of polypharmacy in primary care. Patients' baseline data were used for analysis. A number of socioeconomic and medical data as well as SF-12-scores were entered into a generalized linear mixed model to identify variables associated with excessive polypharmacy (taking ≥10 substances daily).

resultsThree thousand nine hundred four participants were recruited. Risk factors significantly associated with excessive polypharmacy were frailty (OR 1.45; 95% CI 1.22-1.71), > 8 diagnoses (OR 2.64; 95% CI 2.24-3.11), BMI ≥30 (OR 1.18; 95% CI 1.02-1.38), a lower SF-12 physical health composite score (OR 1.47; 95% CI 1.26-1.72), and a lower SF-12 mental health composite score (OR 1.33; 95% CI 1.17-1.59) than the median of the study population (≤36.6 and ≤ 48.7, respectively). Age ≥ 85 years (OR 0.83; 95% CI 0.70-0.99) led to a significantly lower risk for excessive polypharmacy. No association with excessive polypharmacy could be found for female sex, low educational level, and smoking. Regarding the study centres, being recruited in the UK led to a significantly higher risk for excessive polypharmacy compared to being recruited in Germany 1/Rostock (OR 1.71; 95% CI 1.27-2.30). Being recruited in Germany 2/Witten led to a slightly significant lower risk for excessive polypharmacy compared to Germany 1/Rostock (OR 0.74; 95% CI 0.56-0.97).

conclusionsFrailty, multimorbidity, obesity, and decreased physical as well as mental health status are risk factors for excessive polypharmacy. Sex, educational level, and smoking apparently do not seem to be related to excessive polypharmacy. Physicians should especially pay attention to their frail, obese patients who have multiple diagnoses and a decreased health-related quality of life, to check carefully whether all the drugs prescribed are evidence-based, safe, and do not interact in an unfavourable way.

trial registrationThis trial has been registered with Current Controlled Trials Ltd. on 31 July 2014 (ISRCTN10137559).

Indexed as

PolypharmacyAgedAged, 80 and overAge FactorsCross-Sectional StudiesFrailtyGermanyHealth StatusHumansLinear ModelsMental HealthMultiple Chronic ConditionsRisk FactorsAgedCross-sectional studyEuropePolypharmacyPRIMA-eDSProtective factorsRisk factors

Identifiers

PMID30021528
PMCPMC6052592
OpenAlexW2883869784

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.