HEA93002: Critical Literature Review - Search Method Report

This report details the search method employed for a critical literature review on the effects of polypharmacy on older adults residing in aged care facilities. The research question, framed using the PICO format, investigates how polypharmacy impacts the health of nursing home residents. The search strategy involved electronic database searches (ProQuest, Cinahl, Academic Search Premier, PubMed, Medline, and Expanded Academic ASAP) using keywords such as 'polypharmacy,' 'older adults,' and 'nursing homes,' combined with Boolean operators and limiters (2015-2019, English). The inclusion criteria focused on peer-reviewed articles examining health issues related to polypharmacy in aged care settings. The initial search yielded 349 articles, with duplicates removed and abstracts screened, resulting in 22 full-text articles assessed for eligibility, and 12 articles included in the review. The report includes a database search template, a modified PRISMA flow diagram, and references to relevant literature.

HEA93002 Discovery and Enquiryin Health: The Critical Literature Review
ASSIGNMENT 2: REPORT ON SEARCH METHOD
Name of the Student:
Name of the University:
Author note:
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HEA93002 Discovery and Enquiryin Health: The Critical Literature Review
Method Template
Problem statement: The increasing issue of polypharmacy in residential care facilities in Australia.
Research question: The primary goal of this critical review is to identify the effects of polypharmacy
on the older adults living in the aged care facilities and secondary aim is to identify how it increases
risks of morbidity and mortality. Taking insights from the above, the following is the research question
for the study:
How polypharmacy effects the health of older adults living in nursing homes?
The PICO format was used to structure the question and guide the search, in the following way:
P (Population) – Older people living in aged care homes.
I (Intervention) – Polypharmacy
C (Comparison) – Strategies to minimize effects of polypharmacy
O (Outcome) – Patient outcomes, reduced health complications and risks associated with
polypharmacy.
Search strategy:
For the literature search of the provided research question, an electronic search strategy was
conducted using databases which can be accessed from the Southern Cross University, such as
ProQuest, Cinahl and Academic Search Premier, and additional databases such as PubMed,
Medline and Expanded Academic ASAP. Such databases were selected since they provide wide
range of peer-reviewed, scholarly journal articles which are dealing with subjects of relevance to
the research question, that is, health and life sciences and possibility of adding appropriate
search terms without the interference of excessive pre-set filters. The search strategy was
conducted using keywords such as ‘polypharmacy’, ‘older adults’, ‘health effects’ and ‘nursing
homes’, using Boolean operators. To further improve the literature search, limiters were used
such as ‘2015-2019’, ‘English’ and ‘nursing homes’.
Table 1 as mentioned in the succeeding sections highlights the details considered in conducting
this search strategy, such as the names of the databases, the key words used and the total
number of studies uncovered by this method. The literature search for relevant studies was
undertaken during the month of March, 2019, and was applied to scholarly, peer-reviewed
articles which were published within the years 2015 to 2019. For the purpose of appropriate
selection of articles, an inclusion criteria was used which included the following:
- Study designs and aim/s: Studies using qualitative as well as quantitative research designs
were included, which performed the research with the common aim of evaluating health
issues concerning with polypharmacy among aged patients in nursing homes.
- Interventions concerned with polypharmacy and outcomes associated with reduced age-
associated complications and positive health were considered during article selection.
- Participants and settings considered included elderly patients and primary care settings
such as nursing homes and elderly care settings
- Publication type and language: Scholarly, peer-reviewed articles, using English language
and published within the years 2015 to 2019 were considered.
The above literature search resulted in obtaining a total of 349 articles. After removing 226
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HEA93002 Discovery and Enquiryin Health: The Critical Literature Review
duplicate articles, the abstract of 127 articles were screened for inclusion in this review.
The abstracts of the selected articles were further evaluated for inclusion in the study resulting in
exclusion of over 52 articles. These articles were excluded due to the following reasons:
- The aim of the article was irrelevant to the research question, for example, evaluating the
definitions of polypharmacy, as mentioned in Masnoon et al., (2017).
- The study settings of the articles were irrelevant to the PICO format, for example, instead
of primary care, dealing with home care, as researched in Fjell et al., (2018).
- The study researched on alternative interventions irrelevant to the PICO question, for
example, recommendations of complementary therapies among elderly patients, as
researched by Gunnarsdottir, Vilhjalmsson and Hjaltadottir (2018).
- The study researched on a population group, irrelevant to to the PICOT question, for
example, health professional’s perspectives on healthcare and medications among elderly
patients, as researched by Smith and Thompson (2017).
See Figure 1 for the modified PRISMA flow diagram
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HEA93002 Discovery and Enquiryin Health: The Critical Literature Review
Database search Template
Table 1. Databases and search terms used to identify literature for review
Databas
e
Search terms No.
articl
es
Expand
ed
Academ
ic ASAP
“Polypharmacy” OR “multiple medications” OR “multidrug
therapy” OR “multidrug regimen” OR “multidrug prescription” OR
“aged care medications” OR “elderly care medications”
72
AND “aged care facilities” [MesH] OR “nursing homes” [MesH] OR
“primary care settings” [MesH] OR “health effects in the elderly”
[MesH] OR “morbidity” OR “mortality” [MesH] OR “elderly care
homes” [MesH] OR “eldery patients” [MesH] OR “aged patients”
[MesH
OR “pharmacological therapy” OR “multidrug intervention” OR
“elderly patient medications”
Limiters: 2015-2019; English; nursing homes; age care facilities; primary
care
Scholarly, peer reviewed studies
PubMed “Polypharmacy” OR “multiple medications” OR “multidrug
therapy” OR “multidrug regimen” OR “multidrug prescription” OR
“aged care medications” OR “elderly care medications”
40
AND “aged care facilities” [MesH] OR “nursing homes” [MesH] OR
“primary care settings” [MesH] OR “health effects in the elderly”
[MesH] OR “morbidity” OR “mortality” [MesH] OR “elderly care
homes” [MesH] OR “eldery patients” [MesH] OR “aged patients”
[MesH
OR “pharmacological therapy” OR “multidrug intervention” OR
“elderly patient medications”
Limiters: 2015-2019; English; nursing homes; age care facilities; primary
care
Scholarly, peer reviewed studies
Academ
ic
Search
Premier
“Polypharmacy” OR “multiple medications” OR “multidrug
therapy” OR “multidrug regimen” OR “multidrug prescription” OR
“aged care medications” OR “elderly care medications”
82
AND “aged care facilities” [MesH] OR “nursing homes” [MesH] OR
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HEA93002 Discovery and Enquiryin Health: The Critical Literature Review
“primary care settings” [MesH] OR “health effects in the elderly”
[MesH] OR “morbidity” OR “mortality” [MesH] OR “elderly care
homes” [MesH] OR “eldery patients” [MesH] OR “aged patients”
[MesH
OR “pharmacological therapy” OR “multidrug intervention” OR
“elderly patient medications”
Limiters: 2015-2019; English; nursing homes; age care facilities; primary
care
Scholarly, peer reviewed studies
ProQues
t
“Polypharmacy” OR “multiple medications” OR “multidrug
therapy” OR “multidrug regimen” OR “multidrug prescription” OR
“aged care medications” OR “elderly care medications”
25
AND “aged care facilities” [MesH] OR “nursing homes” [MesH] OR
“primary care settings” [MesH] OR “health effects in the elderly”
[MesH] OR “morbidity” OR “mortality” [MesH] OR “elderly care
homes” [MesH] OR “eldery patients” [MesH] OR “aged patients”
[MesH
OR “pharmacological therapy” OR “multidrug intervention” OR
“elderly patient medications”
Limiters: 2015-2019; English; nursing homes; age care facilities; primary
care
Scholarly, peer reviewed studies
Cinahl “Polypharmacy” OR “multiple medications” OR “multidrug
therapy” OR “multidrug regimen” OR “multidrug prescription” OR
“aged care medications” OR “elderly care medications”
43
AND “aged care facilities” [MesH] OR “nursing homes” [MesH] OR
“primary care settings” [MesH] OR “health effects in the elderly”
[MesH] OR “morbidity” OR “mortality” [MesH] OR “elderly care
homes” [MesH] OR “eldery patients” [MesH] OR “aged patients”
[MesH
OR “pharmacological therapy” OR “multidrug intervention” OR
“elderly patient medications”
Limiters: 2015-2019; English; nursing homes; age care facilities; primary
care
Scholarly, peer reviewed studies
Medline “Polypharmacy” OR “multiple medications” OR “multidrug 87
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HEA93002 Discovery and Enquiryin Health: The Critical Literature Review
therapy” OR “multidrug regimen” OR “multidrug prescription” OR
“aged care medications” OR “elderly care medications”
AND “aged care facilities” [MesH] OR “nursing homes” [MesH] OR
“primary care settings” [MesH] OR “health effects in the elderly”
[MesH] OR “morbidity” OR “mortality” [MesH] OR “elderly care
homes” [MesH] OR “eldery patients” [MesH] OR “aged patients”
[MesH
OR “pharmacological therapy” OR “multidrug intervention” OR
“elderly patient medications”
Limiters: 2015-2019; English; nursing homes; age care facilities; primary
care
Scholarly, peer reviewed studies
Total records identified after database searching 349
Total records after duplicates removed 123
REFERENCE:
Brownie, S., &Nancarrow, S. (2013). Effects of person-centered care on residents and staff in aged-care facilities: A
systematic review. Clinical Interventions in Aging, 8, 1-10
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HEA93002 Discovery and Enquiryin Health: The Critical Literature Review
Modified PRISMA flow diagram
ADOPT THIS Modified PRISMA flow diagram TEMPLATE to report the screening and
selection of articles to include in your Critical review.The diagram is modified from
Figure 1 in Brownie andNancarrow (2013, p.4). Please follow instruction in square
bracket and use your data to populate the modified PRISMA flow diagram.
Figure 1 Modified PRISMA flow diagram of article screening and selection
REFERENCE:
Brownie, S., &Nancarrow, S. (2013). Effects of person-centered care on residents and staff in aged-care facilities: A
systematic review. Clinical Interventions in Aging, 8, 1-10
7
Potentially relevant articles
identified through database
searching
(n = 349)
Articles excluded with reasons, after
full-text assessment (n= 10)
- Reason: Irrelevance to Primary
aims
- Reason: Irrelevance to Study
settings
- Reason: Irrelevance to
Interventions used
Cluster-randomized trial
(2 articles)
Quasi experimental
studies (10 articles based
on 7 studies)
Articles excluded after evaluation of
titles/abstract (n=110)
- Reason: Irrelevance to key
words
- Reason: Irrelevance to Study
Settings
- Reason: Irrelevance to Primary
Additional studies identified through
reference list search (n=0) [only state if
true and n>0]
Total articles included in review
(n =12, based on 8 studies)
Full-text articles assessed for eligibility
(n = 22)
Articles after duplicates removed
(n = 123)

HEA93002 Discovery and Enquiryin Health: The Critical Literature Review
References
Fjell, A., Cronfalk, B. S., Carstens, N., Rongve, A., Kvinge, L. M. R., Seiger, Å., ... &
Boström, A. M. (2018). Risk assessment during preventive home visits among
older people. Journal of multidisciplinary healthcare, 11, 609. doi:
https://dx.doi.org/10.2147%2FJMDH.S176646.
Gunnarsdottir, T. J., Vilhjalmsson, R., & Hjaltadottir, I. (2018). Use of complementary
therapies in nursing homes: Descriptive study. Complementary therapies in
clinical practice, 32, 65-69. doi: https://doi.org/10.1016/j.ctcp.2018.05.006.
Masnoon, N., Shakib, S., Kalisch-Ellett, L., & Caughey, G. E. (2017). What is
polypharmacy? A systematic review of definitions. BMC geriatrics, 17(1), 230. doi:
https://doi.org/10.1186/s12877-017-0621-2.
Smith, M. B., & Thomson, W. M. (2017). ‘Not on the radar’: dentists' perspectives on the
oral health care of dependent older people. Gerodontology, 34(1), 90-100. doi:
https://doi.org/10.1111/ger.12227.