Abstract
Potential Inappropriate prescribing (PIP), Drug-Drug interactions (DDI) and polypharmacy are major risk factors for adverse drug reactions among older persons. Although these factors in many cases co-exist in prescriptions to older persons, very few studies have evaluated the inter-relationship between these factors concomitantly. This study aimed to evaluate PIP and DDI and to determine the associations between PIP, DDI, and polypharmacy among Nigerian older persons. This study was a retrospective evaluation of medicine utilization among older persons at Olabisi Onabanjo University Teaching Hospital, Nigeria, using a medical chart review. Older persons aged ≥60 years, with chronic diseases that attended the medical outpatient clinics of the hospital between 1st January and 31st December 2016 were included. Eligible patients’ records were randomly sampled. Information including patients’ demographics, medical and medication histories and current medications were extracted with a checklist. PIP and DDI were evaluated using the 2015 updated Beers Criteria. Associations were determined using Chi-squared test and a binary logistic regression. A total of 352 participants, mean age 69.03±7.35 years were evaluated. According to the Beers Criteria, PIP and DDI among the participants were (124/352, 35.2%) and (20/352, 5.7%) respectively. Majority of the participants (192/352, 54.5%) received polypharmacy. A few participants (12/352. 3.4%) received prescriptions containing PIP, DDI, and polypharmacy concomitantly. DDI was significantly associated with PIP in a logistic regression (OR=0.18, 95%CI=0.05-0.68, p=0.01) and with polypharmacy in a Chi-squared test (OR=3.55, 95%CI=1.16-10.83, p=0.02). This study concludes that PIP, DDI and polypharmacy are interrelated and should be considered when prescribing to older persons.
Highlights
The triad of Potential Inappropriate Prescribing (PIP), polypharmacy and Drug-Drug Interactions (DDI) are responsible for many Adverse Drug Reactions (ADRs) among older persons worldwide (Van der Stelt et al, 2016; Davies & O’Mahony, 2015; Obreli-Neto et al, 2012)
Drug-Drug interactions (DDI) was significantly associated with Potential Inappropriate prescribing (PIP) in a logistic regression (OR=0.18, 95%CI=0.05-0.68, p=0.01) and with polypharmacy in a Chi-squared test (OR=3.55, 95%CI=1.16-10.83, p=0.02)
Previous studies that applied the Beers Criteria to screen for PIP among older persons in the developed world reported a wide range of prevalence ranging between 15% and 44% depending on the study population and the clinical setting (Novaes, da Cruz, Lucchetti, Leite & Lucchetti, 2017; Narayan & Nishtala, 2015; Elliot & Stehlik, 2013)
Summary
The triad of Potential Inappropriate Prescribing (PIP), polypharmacy and Drug-Drug Interactions (DDI) are responsible for many Adverse Drug Reactions (ADRs) among older persons worldwide (Van der Stelt et al, 2016; Davies & O’Mahony, 2015; Obreli-Neto et al, 2012). Similar prevalence has been reported among older persons in many low and middle-income countries (LMICs) including Africa (Rakesh, Chowta, Shenoy, Shastry & Pai, 2017; van Heerden, Burger, & Gerber, 2016; Fadare, Agboola, Opeke, & Alabi, 2013; Eze & Olowu, 2011). In many of these previous studies, medication including anticholinergics, sedatives and gjhs.ccsenet.org
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