Consequences of polypharmacy among the people living with dementia: a systematic review and meta-analysis
Bibliographic record
Abstract
Abstract Background The objective of this systematic review and meta-analysis was to synthesise and summarise studies on the consequences of polypharmacy on people living with dementia (PwD), categorize the consequences, analyse the quality of the studies, and estimate pooled effect sizes of these consequences. Methods A systematic literature review was conducted following the PRISMA guideline. Covidence software was used for screening, study selection and data extraction. The quality of the selected studies was assessed using an adapted version of Newcastle-Ottawa Scale (NOS) scale. Random effect models were used to perform the meta-analyses and the heterogeneity among the studies was assessed by i2 statistics. Results Nineteen studies were selected for this review. The four most frequent consequences were: potentially inappropriate medication (PIM) (n = 6, 31.6%), hospitalisation (n = 4, 21%), adverse drug reaction (ADR) (n = 3, 15.8%), and mortality (n = 3, 15.8%), all of which were significantly associated with polypharmacy. The quality of the reviewed studies was fair to good quality (good, n = 13 and fair, n = 6). Meta-analysis was performed with five studies related to PIM and revealed that the odds of having PIM among the PwD exposed to polypharmacy was 2.93 times (95% CI: 2.24–3.82; I2 = 95.6%). Heterogeneity was observed in the selected studies with regards to study design, sample size, follow-up duration, adjustment of confounders, as well as definitions of polypharmacy and inconsistent tools for dementia diagnosis. Conclusions Polypharmacy is associated with PIM use, ADR, mortality and hospitalisation for PwD despite high heterogeneity among the studies in terms of polypharmacy definition and dementia diagnosis. Prospero Registration Number: CRD42023404749
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.025 | 0.057 |
| Meta-epidemiology (narrow) | 0.004 | 0.002 |
| Meta-epidemiology (broad) | 0.023 | 0.045 |
| Bibliometrics | 0.010 | 0.008 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".