OBJECTIVE Polypharmacy is widespread among older people, but the adverse outcomes associated with it are unclear. We aim to synthesize current evidence on the adverse health, social, medicines management, and health care utilization outcomes of polypharmacy in older people. DESIGN A systematic review, of systematic reviews and meta-analyses of observational studies, was conducted. Eleven bibliographic databases were searched from 1990 to February 2018. Quality was assessed using AMSTAR (A Measurement Tool to Assess Systematic Reviews). SETTING AND PARTICIPANTS Older people in any health care setting, residential setting, or country. RESULTS Twenty-six reviews reporting on 230 unique studies were included. Almost all reviews operationalized polypharmacy as medication count, and few examined medication classes or disease states within this. Evidence for an association between polypharmacy and many adverse outcomes, including adverse drug events and disability, was conflicting. The most consistent evidence was found for hospitalization and inappropriate prescribing. No research had explored polypharmacy in the very old (aged ≥85 years), or examined the potential social consequences associated with medication use, such as loneliness and isolation. CONCLUSIONS AND IMPLICATIONS The literature examining the adverse outcomes of polypharmacy in older people is complex, extensive, and conflicting. Until polypharmacy is operationalized in a more clinically relevant manner, the adverse outcomes associated with it will not be fully understood. Future studies should work toward this approach in the face of rising multimorbidity and population aging.

中文翻译：

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老年人综合用药的不良结果：系统评价

目的 综合用药在老年人中很普遍，但与之相关的不良后果尚不清楚。我们的目标是综合目前关于老年人多药治疗不良健康、社会、药物管理和医疗保健利用结果的证据。设计 对观察性研究的系统评价和荟萃分析进行了系统评价。从 1990 年到 2018 年 2 月检索了 11 个书目数据库。使用 AMSTAR（评估系统评价的测量工具）评估质量。环境和参与者 任何医疗保健环境、住宅环境或国家的老年人。结果 纳入了 26 篇关于 230 项独特研究的综述。几乎所有评论都将多种药物作为药物计数操作，很少有人检查药物类别或疾病状态。多重用药与许多不良结果（包括不良药物事件和残疾）之间存在关联的证据是相互矛盾的。最一致的证据是住院和不适当的处方。没有研究在高龄（≥ 85 岁）中探索多药治疗，或检查与药物使用相关的潜在社会后果，例如孤独和孤立。结论和意义 研究老年人多重用药不良结局的文献复杂、广泛且相互矛盾。在以更具临床相关性的方式实施多药治疗之前，不会完全了解与之相关的不良后果。面对不断上升的多重发病率和人口老龄化，未来的研究应该朝着这种方法努力。