Loading
Life sciences · Journal article
Global Health Action · August 17, 2026
Early or partial results. Treat as a signal, not a conclusion.
This integrative synthesis combines direct evidence from two Indian observational studies on polypharmacy and medication safety patterns with indirect evidence from systematic reviews on deprescribing and informal-provider interventions. The work identifies common problems—polypharmacy in one-third, potentially inappropriate medications, prescribing omissions, and self-medication—but provides only low-to-very-low certainty evidence for deprescribing efficacy and acknowledges that direct prospective evaluation of proposed interventions is needed.
Integrative synthesis of two observational cross-sectional studies and two systematic reviews. Study I: record-based cohort from Kolkata. Study II: 600 older adults from six Indian cities. Study III: frail or end-of-life older adults (systematic review and meta-analysis). Study IV: low- and middle-income countries, informal healthcare providers (systematic review).. Intervention: Polypharmacy (observed exposure in Studies I–II); deprescribing of preventive medications (Study III); informal healthcare provider interventions (Study IV). India (Studies I–II); global low- and middle-income countries (Studies III–IV).
One-third of older adults in the six-city community study had polypharmacy; potentially inappropriate medications, prescribing omissions, and self-medication were common. Polypharmacy was associated with higher anticholinergic burden and numerically higher cardiac autonomic neuropathy, although residual confounding limits causal interpretation. Risks of unsafe medication practices were higher with multimorbidity, recent hospitalization, care transitions, or living alone.
Residual confounding limits causal interpretation in the polypharmacy–autonomic function association. One-third of older adults in the six-city community study had polypharmacy; potentially inappropriate medications, prescribing omissions, and self-medication were common.
Clinicians should recognize that medication safety problems are common among Indian older adults, particularly in vulnerable subgroups, and that deprescribing may be safe in frail or end-of-life populations, but prospective evaluation of structured interventions—including care-transition support, medication review, and informal-provider engagement—is needed before implementing system-level changes.
An integrative PhD synthesis combining two small observational studies in India with two systematic reviews on related topics, providing direct evidence of limited scope and indirect contextual evidence, but lacking a unified prospective design or definitive hard outcomes to guide practice change.
As stated by the source record.
Quoted from the source exactly as published.
Clinicians should recognize that medication safety problems are common among Indian older adults, particularly in vulnerable subgroups, and that deprescribing may be safe in frail or end-of-life populations, but prospective evaluation of structured interventions—including care-transition support, medication review, and informal-provider engagement—is needed before implementing system-level changes.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Background. Unsafe medication practices among older adults are an important global health concern, particularly in low- and middle-income countries where multimorbidity, fragmented care, self-medication, and informal healthcare provision intersect.Objective(s). To synthesize direct evidence on medication safety among older adults in India and contextual evidence on deprescribing and community-level provider interventions relevant to safer medication use.Methods. This PhD synthesis integrates four studies: a record-based cross-sectional study on polypharmacy and cardiovascular autonomic function in Kolkata; a six-city community study of 600 Indian older adults; a systematic review and meta-analysis on deprescribing preventive medications in frail or end-of-life older adults; and a systematic review of informal healthcare provider interventions in low- and middle-income countries. Studies I-II provided direct Indian older-adult evidence, while Studies III-IV provided indirect contextual evidence for their optimization and implementation.Results. Polypharmacy was associated with higher anticholinergic burden and numerically higher cardiac autonomic neuropathy although residual confounding limits causal interpretation. In the multicity study, one-third had polypharmacy, while potentially inappropriate medications, prescribing omissions, and self-medication were common. Risks were higher with multimorbidity, recent hospitalization, care transitions, or living alone. Deprescribing showed no statistically significant increase in mortality, hospitalization, or major cardiovascular events, but heterogeneity was high and certainty low to very low. Informal-provider interventions showed the potential to improve knowledge, referral, case management, and medication-related practices.Conclusions. Medication safety among older adults in India requires an integrated continuum approach, but direct evidence supports only some components and implementation strategies that need prospective evaluation.
Taken from the source record, never inferred. Follow any of these and new work involving them reaches your briefing.