Is it possible to reduce polypharmacy in the elderly? A randomised, controlled trial

Objective: The present trial was originally designed to investigate the eff ectiveness of comprehensive day hospital care in chronically ill elderly pa tients. Another aim, reported here, was to investigate to what extent it is possible to reduce polypharmacy and simplify drug regimens during the shor t term tight control conditions of day hospital care. Patients: All home care patients (n = 174, mean age 77 years) in a rural ar ea, Kirkkonummi-Siuntio, in Finland, Design and setting: Patients were randomised into 2 groups, one of which wa s offered a 2-month period of day hospital care. Patients assumed to be non compliant (because they did not want day hospital care) were also included in order to see the effect of intervention in 'real-life'. The medications of all participants were reviewed and counted during an in-home assessment by a home nurse. In the intervention group, necessary revisions (dose reduc tion, discontinuation, possible additions) were performed through the tight monitoring of day hospital care and in co-operation with the patient. The patients were followed up for 10 months after completion of the interventio n programme. Outcome measures: Number of prescribed medications, number of over-the-coun ter (OTC) drugs, number of doses taken daily by the patients. Assessments w ere performed at baseline, and after 2, 5 and 12 months. Results: There were no significant changes in the number of prescribed medi cations. In patients in day hospital care, the number of doses was reduced significantly (p = 0.02) during the 2-month day hospital period compared wi th the control group. However, the patients compensated for the reductions by increasing the use of OTC drugs during the day hospital period (p = 0.05 ). In addition, only 3 months after the trial, the number of drugs had alre ady returned to the baseline level. Conclusions: In real life it seems to be difficult to reduce polypharmacy i n the elderly. Some drug reductions may be achieved with tight control unde r trial conditions, but when the intervention ceases the number of drugs us ed soon returns to its earlier level.