Quality of life and medicines optimisation interventions in older adults receiving polypharmacy: a systematic review

Abstract Introduction Many older adults experience declining health and multimorbidity requiring polypharmacy. Medication use may impact quality of life (QoL) through adverse drug reactions, complex medication regimes and impact on everyday life.1 QoL is frequently included in medicines optimisation intervention trials as a patient-reported outcome. Previous systematic reviews have investigated specific interventions, such as deprescribing, or included QoL as a secondary outcome of the review. Therefore, a systematic review generating a comprehensive picture of how medicines optimisation interventions impact QoL in an ageing population is justified. Aim To determine how QoL is measured and the impact of medicines optimisation interventions on QoL in older adults receiving polypharmacy. Methods This review was registered on PROSPERO (CRD420251023185). Five databases (MEDLINE, Embase, CENTRAL, International Pharmaceutical Abstracts and Web of Science Core Collection) were searched in April 2025. Search terms included ‘older adult,’ ‘polypharmacy,’ ‘med* optimisation intervention*’ and ‘quality of life.’ Citation searching was conducted. Eligible studies were randomised controlled trials (RCT) or cluster-RCTs of a medicines optimisation intervention in older adults aged ≥50 years receiving polypharmacy (≥5 regular medicines) with QoL as an outcome. Two reviewers conducted title/abstract and full-text screening. Data were extracted using Covidence and risk of bias (RoB) assessed using the Cochrane RoB 2 tool and independently checked by a second reviewer. Data extracted included the author, year of publication, the country in which the study was conducted, intervention details, QoL instrument used and associated details, rationale for the selected instrument and relevant results. Data were synthesised narratively, with further meta-synthesis planned. Results In total, 678 studies were identified. After duplicate removal and title/abstract screening, 142 full-text papers were assessed for eligibility. Reasons for exclusion were study protocol/trial registrations (n = 46), QoL not assessed (n = 12), incorrect study design (n = 12), commentary/preliminary/preprint article or conference abstract (n = 11), ineligible population (n = 6) and wrong intervention (n = 2), leaving 52 studies for inclusion. Studies were published between 1996 and 2024, and conducted across Europe (n = 39), Australia (n = 7), North America (n = 4), and Asia (n = 2). Whilst a range of medicines optimisation interventions were identified, interventions involving medication review were most common (n = 41). Studies were conducted in primary care (n = 26), hospital (n = 17) and aged-care facilities (n = 9), and often involved a multidisciplinary team (n = 34). The EuroQol (EQ-5D) was the most commonly used QoL instrument (n = 36). No study utilised a medication-related measure of QoL. There was poor reporting of key elements of the QoL instrument, for example, a lack of information on the minimal clinically important difference. Although most studies reported that medicines optimisation interventions did not impact the QoL of participants (n = 41), several had conflicting results (n = 9). Conclusion The findings suggest that these interventions may not significantly impact a patient’s QoL. Further qualitative research with patients is needed to explore their expectations of such interventions on QoL. This review used an extensive search strategy and searched databases from inception, gathering a comprehensive evidence-base to judge the effect of medicines optimisation interventions on QoL. Study findings should be interpreted with caution due to the high RoB of many of the included studies.