Polypharmacy in the elderly: A bibliometric and visualization analysis

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Electronic Journal of General Medicine

2024, 21(1), em555

e-ISSN: 2516-3507

https://www.ejgm.co.uk/ Review Article OPEN ACCESS

Polypharmacy in the elderly: A bibliometric and visualization

analysis

Ghaith M Al-Taani

, Sayer I Al-Azzam

, Karem H Alzoubi

3,4

* , Waleed M Sweileh

, Suhaib Muflih

Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Yarmouk University, Irbid, JORDAN

Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, JORDAN

Department of Pharmacy Practice and Pharmacotherapeutics, College of Pharmacy, University of Sharjah, Sharjah, UAE

Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, JORDAN

Department of Physiology and Pharmacology/Toxicology, College of Medicine and Health Sciences, Nablus, PALESTINE

*Corresponding Author: khalzoubi@just.edu.jo

Citation: Al-Taani GM, Al-Azzam SI, Alzoubi KH, Sweileh WM, Muflih S. Polypharmacy in the elderly: A bibliometric and visualization analysis.

Electron J Gen Med. 2024;21(1):em555. https://doi.org/10.29333/ejgm/13901

ARTICLE INFO

ABSTRACT

Received: 24 Feb. 2023

Accepted: 24 Sep. 2023

Background: The incidence of polypharmacy is increasing owing to population aging and the associated presence

of multiple comorbidities. This study aimed to provide an extensive overview of the history and development of

the scientific literature on polypharmacy.

Methods: Data were gathered from the comprehensive Scopus database and assessed using various bibliometric

methods, including analyses of citations, growth patterns, and key contributors in the field.

Results: A notable upward trend in the publication rate of polypharmacy research was observed throughout the

study period (1976-2022). Journal of the American Geriatrics Society emerged as the predominant platform for

disseminating polypharmacy-related findings. Hughes CM from Queen’s University Belfast, the United Kingdom

(UK), emerged as the most prolific author in this field. Most articles were authored by researchers affiliated with

institutions in the United States (n=267), the UK (n=92), and Italy (n=72).

Conclusion: This study provides compelling evidence of the escalating interest in polypharmacy and momentum

in related research, highlighting the crucial publication-related aspects and indicators in this field. The findings

underline the value of bibliometric analyses as a tool for healthcare professionals. The wide dissemination,

influence, and visibility of polypharmacy research in reputable scientific journals emphasize the urgent clinical

need for addressing polypharmacy concerns and encourage further exploration in this area.

Keywords: polypharmacy, elderly individuals, bibliometric analysis, visualization analysis, research activity

INTRODUCTION

The term “polypharmacy” was coined to describe issues

related to excessive or increased drug use [1]. However, the

definition of polypharmacy varies across studies. Among 110

studies in which the term polypharmacy was used, 51 defined

it as the concurrent use of five or more medications. Some

researchers have used the term polypharmacy to refer to the

simultaneous administration of six or more medications [2, 3].

However, no consensus exists on how many drugs constitute

polypharmacy [4]. Potentially inappropriate medication use is

common in polypharmacy and is linked to adverse health

effects, including adverse drug reactions and preventable

hospital admissions [5-7]. World Health Organization (WHO)

predicted that approximately one-fifth of the global population

would be aged 60 years or above by 2020 [8]. Older adults are

more prone to experiencing polypharmacy, which presents a

significant public health challenge. It has been estimated that

39.0% of adults aged over 65 years in the United States (US)

take five or more medications daily [9]. A disproportionally high

rate of medication consumption is observed among elderly

individuals; for example, older adults account for less than

20.0% of the US population but over 30.0% of prescription drug

users. Evidence also suggests that elderly individuals in

European countries may exhibit a higher rate of drug

consumption than those in other nations [10]. Additionally,

approximately half of the elderly population has been

demonstrated to take one or more medications that could be

considered medically unnecessary [7].

Problems associated with polypharmacy can contribute to

increased hospitalizations and emergency department visits,

particularly when combined with multimorbidity. In the US, it

has been estimated that this issue costs two billion dollars

annually, primarily resulting from inadequate management of

patients taking multiple medications [11]. Thus, it is essential

to address polypharmacy to ensure that patients receive safe

and appropriate care. Owing to the risks associated with

polypharmacy, healthcare providers must minimize

inappropriate polypharmacy and its related adverse events.

Medical teams are suggested to screen for inappropriate

medications using tools on consensus of expert clinicians in

geriatrics like beer criteria and screening tools of older people’s

prescriptions, to address the challenge of polypharmacy. Also,

2 / 9 Al-Taani et al. / ELECTRON J GEN MED, 2024;21(1):em555

medical teams are suggested to use nonpharmacological

measures with established efficacy instead of medications to

address common symptoms in elderly patients [12].

Medication therapy management (MTM) services were

legislated in the US in 2004. This cognitive input from

pharmacists is intended to address medication adherence

issues and reduce inappropriate prescriptions [13].

Pharmacists conduct dictation reviews through MTM services

via face-to-face or telephone approaches to overcome

medicine-related problems (MRPs) that threaten the

achievement of therapeutic goals. These MRPs include

adherence issues, the use of ineffective drugs, adverse effects,

drug interactions, over- and under-prescriptions, and dosing

issues related to medications [14]. In addition, the association

between polypharmacy and MRPs has been confirmed [15].

Besides using screening tools for inappropriate medication

use among elderly patients, pharmacists can de-prescribe

medications during MTM reviews using an evidence-based

approach that guarantees safety and efficacy, particularly for

elderly patients aiming to discontinue potentially

inappropriate medications. However, this process is complex

and challenging for clinicians [16, 17]. Pharmacists meet with

patients, conduct an individualized assessment of medications

relative to their expected benefit and risk, and propose

interventions to carefully discontinue a medication that

appears to be no longer required [18]. MTM services have been

shown to be beneficial for elderly patients in the US [19-21].

A bibliometric analysis is used to investigate the

characteristics of research studies and other published articles

on a particular topic over a specific period. Pritchard defined

bibliometrics as “the application of mathematics and

statistical methods to books and other media of

communication” [22]. A bibliometric analysis has been

employed extensively to examine the connections among

characteristics of published articles, such as subject areas,

author contributions, and citations, across diverse scientific

disciplines [23]. Bibliometric methods traditionally analyze

research outputs using different publication indicators, such as

document type, journal, country, and author, to identify

current and emerging research trends [24]. Since

polypharmacy negatively affects patient outcomes, is

associated with numerous risks, and has a pronounced effect

in different settings and disease statuses [25-29], a bibliometric

analysis of research articles about polypharmacy in elderly

individuals disseminated to the scientific community via

Scopus database was conducted.

METHODS

Database

SciVerse Scopus database was used to assess the evolution

and growth of the literature on polypharmacy in older adults.

Several reasons justify the use of this database [30, 31]. First,

Scopus contains over 23,000 indexed health, social, life, and

physical science journals. Second, SciVerse is 100% inclusive of

PubMed and has more indexed journals than Web of Science.

Third, Scopus has several functions that facilitate a

bibliometric analysis. This database is biased toward

publications from English-speaking countries and English

journals [32]; however, Web of Science has a similar bias

problem, and Scopus remains the most practical choice.

Search Strategy

Keywords and strategies used in this study were selected

on basis of previously published systematic reviews on

polypharmacy in geriatric patients [33-35]. Following keywords

were used to select papers concerning older adults: “old*

individuals,” “later life,” “old* person*,” “year* of age or older,”

“older adult*,” “older mig*,” “older work*,” “old* people,”

“elder*,” “geriatric,” “senior people,” “senior citiz*,” “aged

people,” “old* population*,” “nursing homes,” “older men,”

“older women,” “retiree,” “sixty-five year*,” “seventy year*,”

“seventy-year*,” “seventy-five year*,” “seventy-five year*,”

“eighty year*,” “eighty-year*,” “eighty-five year,” “eighty-five-

year*,” “ninety year*,” “ninety-year*,” “ninety-five year*,”

“ninety-five-year*,” and “hundred year*.” Keywords used to

identify papers using term polypharmacy were, as follows:

“polypharmacy” or “poly medication*” or “multiple

medications*”, or “multiple therapies*.” All keywords were

entered with quotation marks to retrieve the exact phrase, and

asterisks were used for wild cards. Keywords related to

polypharmacy were used in title search, while terms related to

elderly individuals were used in title/abstract search. Search

strategy was not limited by time. All documents published up

to 31 December 2022, were included in the study. No language

restriction was imposed on the retrieved documents. Only

documents published in peer-reviewed journals were included;

therefore, books and book chapters were excluded. A flowchart

depicting the number of retrieved documents at each stage of

the search strategy is shown in Figure 1.

Validation

The search strategy was validated for the absence of false-

positive results by reviewing top-20 cited documents.

Additionally, the number of publications of the top authors was

positively correlated with the number of publications of the

same authors in Scopus profile, indicating the absence of false-

negative results. These two methods have been implemented

in previously published bibliometric studies, e.g., [36].

Data Export & Analysis

The retrieved data were exported into Microsoft Excel as

comma-separated values (CSV) files. The exported information

included annual growth, core journals, core countries, core

institutions, and the most impactful documents. The exported

data were presented as bibliometric indicators in linear graphs

and tables. The linear graphs were created using statistical

package for the social sciences (version 21).

Visualization

All data were exported as CSV files into the free online

visualization program VOSviewer [37], which was used to

create maps to assess citations, author collaborations, and

cross-country collaborations.

RESULTS

General Description of Retrieved Documents

The search strategy yielded 1,072 documents from journals

indexed in Scopus. The retrieved documents were of different

types, including research articles (n=780, 72.8%), review

articles (n=168, 15.7%), and letters (n=49, 4.6%). The list of the

document types and their corresponding frequencies and

percentages is shown in Table 1.

Al-Taani et al. / ELECTRON J GEN MED, 2024;21(1):em555 3 / 9

All retrieved documents had English titles; but 37 (3.5%)

had Spanish/English titles, and 30 (2.8%) had German/English

titles. Other languages encountered included Chinese, Dutch,

and Portuguese. Of all the retrieved documents, 519 (48.4%)

were published in open-access journals. The remaining were

published in non-open-access (subscription) journals. In total,

4,420 authors (mean=4.1 authors per document) participated

in publishing retrieved documents. The retrieved documents

received 33,124 citations (mean=30.9 citations per document),

with an average h-index of 88.

Evolution & Growth Trajectory of Publications & Citations

1,072 documents were published from the mid-1970s to

2022, with an average of 23.3 publications per year. The annual

growth in publications is shown in Figure 2. The growth

pattern showed two phases: the first (1974-2003) in which the

growth in publications was below 10 per year, and the second

(2004-2022) in which the growth showed a steep increase.

Core Journals

1,072 retrieved documents were disseminated across 411

different journals. Core journals are shown in Table 2.

Figure 1. PRISMA flowchart of number of retrieved documents at different stages of search strategy (Source: Authors’ own

elaboration)

Table 1. Types of documents on polypharmacy in elderly

Type of document

Frequency

% (n=1,072)

Article

780

72.8

Review

168

15.7

Letter

4.6

Editorial

2.8

Note

2.2

Short survey

1.4

Conference paper

0.6

Figure 2. Annual growth of publications on polypharmacy in

elderly as retrieved from Scopus database (Source: Authors’

own elaboration)

Table 2. Core journals publishing documents on polypharmacy in elderly

Rank

Journal

Frequency

% (n=1,072)

Normalized citations

Journal of the American Geriatrics Society

4.1

55.0

Drugs and Aging

3.5

66.6

Clinics in Geriatric Medicine

3.0

34.3

BMC Geriatrics

2.8

59.0

Geriatrics and Gerontology International

2.4

26.9

International Journal of Environmental Research and Public Health

1.6

5.2

Journal of Geriatric Oncology

1.6

23.2

Journal of the American Medical Directors Association

1.6

55.0

Journals of Gerontology Series A Biological Sciences and Medical Sciences

1.5

60.9

Clinical Interventions in Aging

1.2

40.5

European Geriatric Medicine

1.2

16.6

PLos ONE

1.2

33.2

4 / 9 Al-Taani et al. / ELECTRON J GEN MED, 2024;21(1):em555

Table 2 shows a minimum contribution of 10 documents

each. Journal of the American Geriatrics Society (n=44) was the

most prevalent journal, accounting for approximately 4.3% of

publications in dataset. Most journals in core list covered

medicine and gerontology fields. Mapping of core journals

according to normalized citation rate (i.e., number of citations

per document) indicated that the documents published in

Drugs and Aging Journal received the highest number of

citations, followed by those in Journal of Gerontology, Series A.

Leading Authors, Countries, & Institutions

Authors from 80 countries participated in publishing the

retrieved documents. The core researchers in the field are

shown in Table 3. Each researcher in the core list contributed

to a minimum of 10 documents. Core authors were from

Europe, Australia, and the US.

Mapping of scientific networking between authors with a

minimum contribution of five documents (n=65) yielded 15

clusters; two clusters each included over 10 researchers,

represented in red and green (Figure 3). Red cluster included

researchers mainly from Italy and Spain, while green cluster

included those from the United Kingdom (UK) and Ireland.

The core countries that contributed at least 10 publications

are shown in Table 4. The US (n=267, 24.9%) was the leader in

this field. The volume of publications from the US was nearly

three times that of those from the UK (n=92, 8.6%) and over 10

times that of those from China (n=30, 2.8%). The core list did

not include any country from Africa, the Eastern Mediterranean

region, Latin America, or Eastern Europe. The cross-country

collaborations among the countries in the core list are shown

in Figure 4. The most robust cross-country collaboration, as

measured using the thickness of the connecting line, was

between the UK and Ireland owing to geographic proximity and

the common language. The number of international research

collaborations was proportional to the node size. The US has

the highest number of articles with international researchers

while the UK has the highest percentage of articles with

international researchers.

Table 3. Core authors in publishing documents on

polypharmacy in elderly

Rank

Author name

Frequency

% (n=1,072)

Affiliation

Hughes CM

2.0

The UK

Cadogan CA

1.4

Ireland

Hilmer SN

1.4

Australia

Onder G

1.4

Italy

Nobili A

1.2

Italy

Ryan C

1.2

Ireland

Johnell K

1.1

Sweden

Nightingale G

1.0

The US

Bernabei R

0.9

Italy

Franchi C

0.9

Italy

Gnjidic D

0.9

Australia

Petrovic M

0.9

Belgium

Figure 3. Author collaboration networks (researchers with a

minimum of five publications were included [n=65]) (Source:

Authors’ own elaboration)

Table 4. Core countries in publishing documents on

polypharmacy in elderly

Country

Frequency

% (n=1,072)

The US

267

24.9

The UK

8.6

Italy

6.7

Australia

6.1

Japan

5.7

Germany

5.6

Spain

5.2

Canada

4.9

Netherlands

4.7

Ireland

3.5

Turkey

3.3

Sweden

3.1

Brazil

3.0

China

2.8

Switzerland

2.5

France

2.4

Belgium

2.3

Denmark

2.1

Taiwan

2.1

Israel

1.7

India

1.6

Portugal

1.6

New Zealand

1.5

Finland

1.3

Poland

1.3

Austria

1.2

Malaysia

1.2

Norway

1.0

Figure 4. Cross-country collaboration networks (the US had

largest number of documents with international

collaborations, which is proportional to node size, followed by

the UK, & Italy & strongest cross-country research

collaboration was noted between researchers from the UK &

Ireland, as indicated by thickness of connecting line) (Source:

Authors’ own elaboration)

Al-Taani et al. / ELECTRON J GEN MED, 2024;21(1):em555 5 / 9

At the institutional level, Karolinska Institute (n=29, 2.7%)

was the most productive in the field, followed by University of

Sydney (n=29, 2.7%). The core institutions in the field are shown

in Table 5, including four institutions in Italy.

Top-10 Impactful Documents

Top-10 cited documents reflected topics considered

hotspots in the field and received the highest number of

citations (Table 6). Three documents were review articles. The

article with the highest normalized citation rate was published

in BMC Geriatrics.

DISCUSSION

In this study, a comprehensive quantitative bibliometric

analysis of the published literature on polypharmacy was

conducted using Scopus database. Polypharmacy has become

increasingly prevalent owing to the global aging population.

Older adults often require multiple medications to manage

their health conditions. While living longer can be considered

an accomplishment, it also presents challenges regarding

healthcare resource allocation and medication management

owing to the higher prevalence of polypharmacy and

multimorbidity. Addressing the implications of polypharmacy

has emerged as a pressing concern for healthcare professionals

across various disciplines. Ensuring safe and effective use of

multiple medications is a priority for these professionals as

they strive to provide optimal patient care [38]. A bibliometric

analysis is a valuable tool for expanding the corpus of research

and knowledge. By employing written and visual techniques,

this analysis rigorously identifies and elucidates trends within

a vast array of published articles, facilitating the

summarization of emerging themes and patterns within

scientific literature. Typically focusing on a specific topic or

discipline of interest, a bibliometric analysis provides concrete

evidence of research trends, outputs, and future directions,

allowing a comprehensive understanding of the progression of

scientific inquiry [39-41]. In the context of the present study,

the increasing number of publications offers encouraging

insights into the growth of scientific evidence pertaining to

polypharmacy. This optimistic outlook can greatly assist

clinicians and scientists in effectively addressing the

challenges associated with polypharmacy, enabling them to

develop better strategies and approaches to managing this

complex phenomenon.

The growing body of literature on polypharmacy over time

underscores the significance and relevance of this subject. This

trend can be attributed to the steady rise in the elderly

population and the subsequent increase in outpatient visits.

The published literature encompasses a wide range of topics

related to polypharmacy, including descriptive studies

examining its prevalence and characteristics and studies

exploring established services or introducing innovative

approaches. These approaches aim to develop new

interventions and services to address the challenges posed by

Table 5. Top-10 active institutions in publishing documents on polypharmacy in elderly

Rank

Institution

Frequency

% (n=1,072)

Country

Karolinska Institutet

2.7

Sweden

University of Sydney

2.7

Australia

Royal College of Surgeons in Ireland

2.1

Ireland

Queen’s University Belfast

2.0

The UK

Stockholms universitet

1.8

Sweden

University of Utrecht

1.2

Netherlands

Thomas Jefferson University

1.5

The US

Università Cattolica del Sacro Cuore, Campus di Roma

1.5

Italy

Monash University

1.2

Australia

Istituto di Ricerche Farmacologiche Mario Negri

1.2

Italy

Istituto Nazionale Riposo e Cura Anziani

1.2

Italy

Table 6. Most impactful documents on polypharmacy in elderly

Title

Year

Source title

What is polypharmacy? A systematic review of definitions

2017

BMC Geriatrics

1,309

Review

218.2

Clinical consequences of polypharmacy in elderly

2014

Expert Opinion on Drug Safety

1,055

Review

117.2

Polypharmacy in elderly patients

2007

American Journal of Geriatric Pharmacotherapy

849

Article

53.1

Polypharmacy cutoff and outcomes: Five or more medicines

were used to identify community-dwelling older men at risk of

different adverse outcomes

2012

Journal of Clinical Epidemiology

768

Article

69.8

A randomized, controlled trial of a clinical pharmacist

intervention to improve inappropriate prescribing in elderly

outpatients with polypharmacy

1996

American Journal of Medicine

527

Article

19.5

Feasibility study of a systematic approach for discontinuation

of multiple medications in older adults: Addressing

polypharmacy

2010

Archives of Internal Medicine

441

Article

33.9

Polypharmacy and prescribing quality in older people

2006

Journal of American Geriatrics Society

420

Article

24.7

Health outcomes associated with polypharmacy in

community-dwelling older adults: A systematic review

2014

Journal of American Geriatrics Society

409

Review

45.4

Polypharmacy in the elderly: a literature review.

2005

Journal of American Academy of Nurse Practitioners

382

Review

21.2

Polypharmacy, adverse drug-related events, and potential

adverse drug interactions in elderly patients presenting to an

emergency department

2001

Annals of Emergency Medicine

361

Article

16.4

Note. CB: Cited by; DT: Document type, & NC: Normalized citations

6 / 9 Al-Taani et al. / ELECTRON J GEN MED, 2024;21(1):em555

polypharmacy effectively. The exploration of scientific

publications on polypharmacy can be traced back to as early as

1974, indicating the early recognition of its importance.

However, until 2003, the annual number of articles published

on this subject remained relatively low, with less than 10

published each year. From 2004 to 2022, there had been a

notable surge in interest, as demonstrated by the increasing

number of documents published during this period. One

plausible explanation for the spike in publication activity

starting in 2003 could be the 2002 release of WHO’s policy

framework on active aging [42]. This influential policy sparked

international interest in polypharmacy, prompting researchers

and scholars to delve deeper into its various aspects and

implications.

Polypharmacy is an escalating global concern, particularly

among older adults, who are highly susceptible to adverse drug

reactions and potential drug-drug interactions [43]. This

phenomenon is rooted in the concurrent use of multiple

medications, a practice that has garnered increasing attention

across various fields owing to enhanced scientific productivity.

In this study, Journal of the American Geriatrics Society

emerged as the prominent source of articles concerning

polypharmacy. This journal publishes geriatrics and

gerontology articles (quartile 1), and authors in these fields

have the relevant expertise to address this complex issue. It is

unsurprising that the geriatric population experiences

polypharmacy-related challenges, which is evident from the

high volume of research in this area. Furthermore, several of

the top-10 journals featuring polypharmacy articles were also

affiliated with the disciplines of geriatrics and gerontology,

such as Geriatrics and Gerontology International and Drugs and

Aging. This trend reinforces the significance of these fields in

exploring the multifaceted aspects of polypharmacy. Notably,

elderly patients residing in nursing homes, who are prescribed

over nine different medications on average, face a 2.33-fold

higher risk of experiencing adverse drug reactions than do

those residing in the community [44]. This statistic illustrates

the formidable challenge that polypharmacy poses to the

elderly population. The increased vulnerability stems from the

involvement of multiple medical practitioners in their care,

coupled with the presence of multiple comorbidities.

Pharmacy and pharmacology are additional crucial aspects

addressed in publications regarding polypharmacy. This

emphasis underscores the significance of polypharmacy as a

prominent subject of interest for pharmacists. Comprehensive

annual evaluations of medications taken by patients with

polypharmacy are highly recommended. Furthermore, the

development and dissemination of tools that facilitate this

assessment process, such as the beers criteria, are of utmost

importance. With these tools, the potential adverse

consequences of polypharmacy, including side effects, drug

interactions, dosing difficulties, and drug-disease interactions,

can be significantly mitigated. These initiatives serve to

enhance patient safety and optimize therapeutic outcomes

[45]. Pharmacists are well equipped to deliver this service, and

its use is anticipated to be viewed favorably by the public.

The H-index stands out as a superior metric for assessing

scientific productivity, emphasizing the quality of publications

over their sheer quantity [46]. This measure considers citation

and publication metrics, making it a reliable indicator of

scholarly impact. In the current investigation, the top-10

journals exhibited an impressive range of h-indices, spanning

from 51 to 199. Notably, the average h-index of the articles we

retrieved was 81. The h-index can also be applied to evaluate

the performance of individual authors, institutions, and

countries. Furthermore, it is a valuable tool in determining the

impact of scientific productivity. Its significance extends

beyond the present moment, providing insights into the

quality of future research from individuals, journals, and

institutions [46].

Although an increasing number of scholars and scientists

question the suitability and universality of using citation

counts and journal impact factors as ideal standards, we opted

for these metrics in our present study due to their widespread

availability. At the moment, no superior metrics are universally

accessible for all indexed journals. F1000Prime, which

publishes recommendations for articles in biology and

medicine, emphasizes the need for editors and experts to

evaluate scientific research outputs [47]. A citation analysis is

recognized as one of the critical practices in bibliometric

evaluation in the biomedical sciences [48, 49]. The F1000 article

factor (FFa score), which measures the importance of articles

recommended (i.e., “good,” “very good,” or “exceptional”) by

faculty members, is another tool for research evaluation. Du et

al. found that nonprimary research (i.e., reviews) or evidence-

based research articles (i.e., systematic reviews, randomized

clinical trials, new findings, and technical advances) were more

highly cited by authors but not highly recommended by peer

reviewers across different research levels (e.g., basic, clinical,

and mixed research) [50]. In contrast, translational or

transformative research papers (i.e., articles with interesting

hypotheses, those assessing novel drug targets and changes in

clinical practice, and those presenting refutations) were less

likely to be cited by authors but were highly recommended by

peer reviewers. While the authors found that the research level

had minimal influence on the citations and FFa scores in

assessing the impact of publications, differences between the

recommendations and citations were related to the type of

research articles (i.e., technical advances and novel drug

target-related articles) [50].

The bibliometric data assessed in this study were

predominantly reported in English, widely recognized as the

language of contemporary science. English is utilized in over

80.0% of scientific journals indexed by Scopus [51], making it

the primary language for scholarly communication. Moreover,

English has become the predominant language on the Internet,

further reinforcing its role in disseminating scientific

knowledge. Research collaboration plays a pivotal role in

realizing significant research output. A substantial number of

articles retrieved for this study were found to be multi-

authored. The analysis revealed the existence of 14

collaboration networks, each comprising at least five authors.

This observation indicates the presence of various themes and

trends in collaboration, such as geographical locations and

modes of communication. Similarly, extensive collaboration

networks were discovered in previous studies focusing on

mobile health. These networks encompassed 30 clusters, each

involving a minimum of 10 authors and receiving at least 100

citations [52]. The disparity in the collaboration patterns

between the present and previous studies could be attributed

to the unique nature of the topic at hand, which necessitates

collaborations across numerous disciplines, such as

pharmacology, healthcare professional groups, and geriatrics.

Such interdisciplinary collaboration fosters the exchange of

ideas and expertise across different fields. Collaboration can be

facilitated through formal and informal interactions, which

Al-Taani et al. / ELECTRON J GEN MED, 2024;21(1):em555 7 / 9

commonly occur during professional and research conferences

and meetings. Additionally, the abundant communication

channels and the presence of professional organizations foster

collaboration among researchers. These means of interaction

have become the norm and are not limited to specific

professions or research areas. Moreover, several factors

increase collaboration among researchers, enhance

productivity, provide opportunities to benefit from

participating in well-known and prestigious research groups,

and improve access to funding opportunities [53]. These

benefits incentivize researchers to engage in collaborative

efforts, leading to synergistic outcomes and advancements in

their respective fields of study.

In the present study, the most cited paper was published in

BMC Geriatrics and was a review article. The paper’s topic is the

consequences of polypharmacy in elderly individuals, which is

expected to draw attention, as it provides extensive

information of interest to broad sectors of scientists and

healthcare providers. It is well known that review articles,

articles published in high-impact factor journals, and articles in

open-access journals receive more citations. The number of

citations may be related to the year of publication and whether

publications included international collaboration [54]. Thus,

authors can sometimes relate the number of citations received

by an article to the impact factor of the journal it appears in,

but this is not always the case. In the present research, we

examined authors who have produced a significant number of

publications on polypharmacy. We observed that these active

authors have also published many articles on subjects

unrelated to polypharmacy. This list included authors from

Europe, Australia, and US. Such bibliometric data are helpful in

measuring research success and guiding decisions among

researchers, such as granting promotion and research funding

[15, 18].

The global distribution of articles was addressed in the

present study in terms of the country affiliation of the authors.

The US authors contributed the most to the field. This finding

was expected owing to the results obtained in previous studies

highlighting the leading role of the US in medical research.

However, there is room for competition from non-anglophone

researchers publishing articles in English [55], and the number

of publications from such researchers is expected to increase

in the future. The number of publications from a country can be

affected by its population size; for example, the US population

is large, yielding a large number of publications. However, this

is not always the case since the number of publications on

polypharmacy from China was not proportional to the

population size. Thus, we hypothesize that a country’s interest

at the public level could be an overriding factor. In support of

this notion, papers on the herbal medicine artemisinin were

found to be published most frequently by authors from China,

where this medicine is widely used and is considered an area of

interest at the country level [56]. Similar to the present

findings, a previous bibliometric analysis assessing scientific

publications related to idiopathic intracranial hypertension

revealed that the largest number of publications was from

authors in the US [57]. Another bibliometric study revealed that

the US published the largest proportion of articles on

tuberculosis and probiotics in pediatrics [24]. Notably, authors

from developing countries contributed few publications on

polypharmacy. The prevalence of authors from developing

countries differs across research topics; for example, authors

from India and China have contributed to numerous

tuberculosis articles [24]. Even though China may not have

emerged as the leader in publishing articles exclusively

focused on polypharmacy, it’s crucial to acknowledge China’s

significant standing in worldwide scientific publishing across

diverse domains. Consequently, the previously held notion

that developing countries generate fewer scientific outputs

than other nations due to deficiencies in their research

infrastructure is no longer applicable.

Limitations

The present study analyzed only articles indexed in Scopus

database. Therefore, relevant articles not indexed in Scopus

database may have been missing. However, the number of

such articles should be negligible, given that Scopus database

indexes a large number of peer-reviewed journals (>20,000),

includes all journals indexed in Medline, comprises more

documents than does the Web of Science core collection, and

is a more accurate and judicious tool than Google Scholar [39].

CONCLUSIONS

A systematic bibliometric analysis was conducted covering

documents published in Scopus database describing

polypharmacy in elderly individuals. In general, many studies

on polypharmacy have been published, and the number of

such studies is increasing. In this study, the most common

journal in which polypharmacy articles were published was

Journal of the American Geriatrics Society. Hughes CM (Queen’s

University Belfast, Belfast, the UK) published the most articles

related to polypharmacy. Most of the articles were published

by authors affiliated with the US and the UK institutions. The

present study illustrates the momentum gained in

polypharmacy research and highlights important publication-

related issues and indicators. Publications in scientific journals

in the pharmacy field are well disseminated and influential and

demonstrate good visibility. Our study highlights the value of

bibliometric analyses as a tool for healthcare professionals as

well as the need to address polypharmacy-related issues in the

clinical setting.

Author contributions: All authors have sufficiently contributed to the

study and agreed with the results and conclusions.

Funding: No funding source is reported for this study.

Ethical statement: This study does not require IRB approval as it does

not involve human subjects/data.

Declaration of interest: No conflict of interest is declared by authors.

Data sharing statement: Data supporting the findings and

conclusions are available upon request from the corresponding author.

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