OBJECTIVES

: Older populations are considered a high-risk population to receive multiple medications and are vulnerable to potentially inappropriate medication (PIM) use. A systematic review and meta-analysis were conducted to investigate the regional variations in prevalence of polypharmacy (concomitant use of 5-9 medicines), hyperpolypharmacy (concomitant use of ≥10 medicines), and PIM use in older people in India.

METHODS

: Medline/PubMed, Embase, Scopus, and Google Scholar databases were searched from inception to 31 September 2020 for the prevalence of polypharmacy, hyperpolypharmacy, PIM use among older people (60+ years) in India. Of the total 2000 articles, 27 were included.

RESULTS

: Overall prevalence of polypharmacy (49%, 95% confidence interval: 42 – 56), hyperpolypharmacy (31%, 21 – 40), and PIM use in older population in India was 28% (24 – 32). Polypharmacy was more prevalence in North India (72%, 64 – 79) and hyperpolypharmacy is frequent used in inpatient care (37%, 26 – 47). Regional estimates for the prevalence of PIM use were as follows: 23% (21 – 25) for East, West (33%, 24 – 42), North (17.8%, 11 – 23), and 32% (26 – 38) in South India; and 31% (24 – 38) in older inpatients, and 27% (18 – 35%) in private hospitals, respectively. Overall estimates of the prevalence of PIM use in older population aged ≥70 was 35% (28 – 42), females (34%, 22 – 46), and higher number of PIM (≥3) 29% (22 – 36) in India.

CONCLUSIONS

: Polypharmacy and hyperpolypharmacy are widely prevalent, and 28% of the older people in India are affected by PIM. Significant regional differences exist in concomitant medication use and PIM prevalence. In view of these findings, urgent steps to promote rational geriatric prescribing, and prioritizing pharmacist-led comprehensive medication reviews to reduce medication-related problems among older people in India.