Italian guidelines on management of persons with multimorbidity and polypharmacy

doi:10.1007/s40520-022-02094-z

Review

. 2022 May;34(5):989-996.

doi: 10.1007/s40520-022-02094-z. Epub 2022 Mar 6.

Italian guidelines on management of persons with multimorbidity and polypharmacy

Graziano Onder¹, Davide Liborio Vetrano^{2

3}, Katie Palmer^{4

5}, Caterina Trevisan^{2

6}, Laura Amato⁷, Franco Berti⁸, Annalisa Campomori⁹, Lucio Catalano¹⁰, Andrea Corsonello^{11

12}, Paola Kruger¹³, Gerardo Medea¹⁴, Alessandro Nobili¹⁵, Gianluca Trifirò¹⁶, Simona Vecchi⁷, Nicola Veronese¹⁷, Alessandra Marengoni¹⁸

Affiliations

¹ Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, Via Giano della Bella 34, 00161, Rome, Italy. graziano.onder@iss.it.
² Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Solna, Sweden.
³ Stockholm Gerontology Research Center, Stockholm, Sweden.
⁴ Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden.
⁵ FINGERS Brain Health Institute, Stockholm, Sweden.
⁶ Department of Medical Sciences, University of Ferrara, Ferrara, Italy.
⁷ Department of Epidemiology, Lazio Regional Health Service, Rome, Italy.
⁸ Internal Medicine, San Camillo Forlanini Hospital, Rome, Italy.
⁹ Hospital Pharmacy Unit, Trento General Hospital, Autonomous Province of Trento, Trento, Italy.
¹⁰ Fondazione Policlinico Universitario "Agostino Gemelli"IRCCS, Rome, Italy.
¹¹ Geriatric Medicine, IRCCS INRCA, 87100, Cosenza, Italy.
¹² Unit of Geriatric Pharmacoepidemiology and Biostatistics, IRCCS INRCA, 87100, Cosenza, Italy.
¹³ European Patient's Academy on Therapeutic Innovation (EUPATI), Rome, Italy.
¹⁴ Italian College of General Practice (SIMG), 50142, Florence, Italy.
¹⁵ Department of Health Policy, Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, 20156, Milan, Italy.
¹⁶ Section of Pharmacology, Department of Diagnostics and Public Health, University of Verona, Verona, Italy.
¹⁷ Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, 90133, Palermo, Italy.
¹⁸ Department of Clinical and Experimental Science, University of Brescia, Brescia, Italy.

PMID: 35249211
PMCID: PMC9135855
DOI: 10.1007/s40520-022-02094-z

Review

Italian guidelines on management of persons with multimorbidity and polypharmacy

Graziano Onder et al. Aging Clin Exp Res. 2022 May.

. 2022 May;34(5):989-996.

doi: 10.1007/s40520-022-02094-z. Epub 2022 Mar 6.

Authors

Affiliations

¹ Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, Via Giano della Bella 34, 00161, Rome, Italy. graziano.onder@iss.it.
² Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Solna, Sweden.
³ Stockholm Gerontology Research Center, Stockholm, Sweden.
⁴ Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden.
⁵ FINGERS Brain Health Institute, Stockholm, Sweden.
⁶ Department of Medical Sciences, University of Ferrara, Ferrara, Italy.
⁷ Department of Epidemiology, Lazio Regional Health Service, Rome, Italy.
⁸ Internal Medicine, San Camillo Forlanini Hospital, Rome, Italy.
⁹ Hospital Pharmacy Unit, Trento General Hospital, Autonomous Province of Trento, Trento, Italy.
¹⁰ Fondazione Policlinico Universitario "Agostino Gemelli"IRCCS, Rome, Italy.
¹¹ Geriatric Medicine, IRCCS INRCA, 87100, Cosenza, Italy.
¹² Unit of Geriatric Pharmacoepidemiology and Biostatistics, IRCCS INRCA, 87100, Cosenza, Italy.
¹³ European Patient's Academy on Therapeutic Innovation (EUPATI), Rome, Italy.
¹⁴ Italian College of General Practice (SIMG), 50142, Florence, Italy.
¹⁵ Department of Health Policy, Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, 20156, Milan, Italy.
¹⁶ Section of Pharmacology, Department of Diagnostics and Public Health, University of Verona, Verona, Italy.
¹⁷ Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, 90133, Palermo, Italy.
¹⁸ Department of Clinical and Experimental Science, University of Brescia, Brescia, Italy.

PMID: 35249211
PMCID: PMC9135855
DOI: 10.1007/s40520-022-02094-z

Abstract

Multimorbidity and polypharmacy are emerging health priorities and the care of persons with these conditions is complex and challenging. The aim of the present guidelines is to develop recommendations for the clinical management of persons with multimorbidity and/or polypharmacy and to provide evidence-based guidance to improve their quality of care. The recommendations have been produced in keeping with the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Overall, 14 recommendations were issued, focusing on 4 thematic areas: (1.) General Principles; (2.) target population for an individualized approach to care; (3.) individualized care of patients with multimorbidity and/or polypharmacy; (4.) models of care. These recommendations support the provision of individualized care to persons with multimorbidity and/or polypharmacy as well as the prioritization of care through the identification of persons at increased risk of negative health outcomes. Given the limited available evidence, recommendations could not be issued for all the questions defined and, therefore, some aspects related to the complex care of patients with multimorbidity and/or polypharmacy could not be covered in these guidelines. This points to the need for more research in this field and evidence to improve the care of this population.

Keywords: Deprescribing; Frailty; Models of care; Multimorbidity; Patient-centered care; Polypharmacy.

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Conflict of interest statement

None.

Figures

**Fig. 1**
Areas covered by the guidelines and related review questions

See this image and copyright information in PMC

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References

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1. Istituto Nazionale di Statistica. Il futuro demografico del Paese. Available: https://www.istat.it/it/archivio/214228 (Accessed on Feb 7, 2022)
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[1] Marengoni A, Onder G. Guidelines, polypharmacy, and drug-drug interactions in patients with multimorbidity. BMJ. 2015 doi: 10.1136/bmj.h1059. - DOI - PubMed

[2] Marengoni A, Onder G. Guidelines, polypharmacy, and drug-drug interactions in patients with multimorbidity. BMJ. 2015 doi: 10.1136/bmj.h1059. - DOI - PubMed

[3] Istituto Nazionale di Statistica. Il futuro demografico del Paese. Available: https://www.istat.it/it/archivio/214228 (Accessed on Feb 7, 2022)

[4] Istituto Nazionale di Statistica. Il futuro demografico del Paese. Available: https://www.istat.it/it/archivio/214228 (Accessed on Feb 7, 2022)

[5] Vetrano DL, Palmer K, Marengoni A, et al. Frailty and multimorbidity: a systematic review and meta-analysis. J Gerontol A Biol Sci Med Sci. 2019;74:659–666. doi: 10.1093/gerona/gly110. - DOI - PubMed

[6] Vetrano DL, Palmer K, Marengoni A, et al. Frailty and multimorbidity: a systematic review and meta-analysis. J Gerontol A Biol Sci Med Sci. 2019;74:659–666. doi: 10.1093/gerona/gly110. - DOI - PubMed

[7] Calderón-Larrañaga A, Vetrano DL, Onder G, et al. Assessing and measuring chronic multimorbidity in the older population: a proposal for its operationalization. J Gerontol Ser A Biol Sci Med Sci. 2016 doi: 10.1093/gerona/glw233. - DOI - PMC - PubMed

[8] Calderón-Larrañaga A, Vetrano DL, Onder G, et al. Assessing and measuring chronic multimorbidity in the older population: a proposal for its operationalization. J Gerontol Ser A Biol Sci Med Sci. 2016 doi: 10.1093/gerona/glw233. - DOI - PMC - PubMed

[9] Khezrian M, McNeil CJ, Murray AD, et al. An overview of prevalence, determinants and health outcomes of polypharmacy. Ther Adv Drug Saf. 2020 doi: 10.1177/2042098620933741. - DOI - PMC - PubMed

[10] Khezrian M, McNeil CJ, Murray AD, et al. An overview of prevalence, determinants and health outcomes of polypharmacy. Ther Adv Drug Saf. 2020 doi: 10.1177/2042098620933741. - DOI - PMC - PubMed

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Italian guidelines on management of persons with multimorbidity and polypharmacy

Affiliations

Italian guidelines on management of persons with multimorbidity and polypharmacy

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

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Cited by

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources