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oai:figshare.com:article/32640696 2026-10-01T16:28:57Z portal_1172 item_type_8 month_year_10_2026

Appropriate polypharmacy in older people: an assessment of evidence and methodological approaches Mubarak Nasser Alqahtani (24169449) PUREID: 628058691 Polypharmacy older people interventions outcome measurement instruments fidelity Objective: To examine various aspects of polypharmacy including the evaluation of effective interventions, the methodologies used in measuring outcomes, and the assessment of intervention fidelity and complexity.<br><br>Method: A systematic review, following Cochrane Collaboration methodology, assessed interventions improving polypharmacy appropriateness in older adults. The COSMIN guideline was applied to select OMIs for a polypharmacy COS. OMIs were identified from systematic reviews and evaluated for quality, with consensus on OMIs reached through a two -round Delphi study involving diverse stakeholders. Intervention fidelity was assessed using the NIH-BCC framework, and intervention complexity was evaluated<br>using the iCAT_SR tool.<br><br>Results: A total of 18 RCTs were included in the systematic review. Interventions showed uncertain effectiveness in improving medication appropriateness, reducing potentially inappropriate medications (PIMs) or prescribing omissions (PPOs), or lowering the proportion of patients with PIMs or PPOs. The certainty of evidence was very low due to heterogeneity in outcome reporting and measurement. Following COSMIN guidelines, seven OMIs demonstrated good quality, These OMIs were presented to 50 participants from various countries and professional backgrounds. Consensus was reached on three OMIs: ‘number of serious<br>ADRs’, ‘number of deaths’, and ‘number of patients who fell’. No consensus was reached for the remaining four OMIs. Fidelity assessment revealed overall poor fidelity, with none of the trials addressing all NIH-BCC domains. High intervention complexity was noted in one core dimension (behavior of intervention recipients), while optional dimensions lacked sufficient detail for<br>consistent evaluation.<br><br>Conclusion: Evidence on the effectiveness of interventions for appropriate polypharmacy in older adults remains uncertain. The identification of OMIs may support the use of the polypharmacy COS in future studies to measure and compare intervention effects, and facilitate the synthesis of trial findings, generating stronger evidence in systematic reviews . Poor fidelity and high complexity underscore the need for standardised approaches in future studies. 2026-10-01T16:28:57Z Text Thesis 10.17034/32640696.v1 https://figshare.com/articles/thesis/Appropriate_polypharmacy_in_older_people_an_assessment_of_evidence_and_methodological_approaches/32640696 All Rights Reserved