Abstract
Backround: We aimed at assessing the prevalence of polypharmacy and potential drug-drug interactions (DDIs) with clinical relevance in elderly patient on Emilia Romagna area. Both outpatients and residents in nursing homes were assessed, with only partially overlapping strategies. Methods: We defined a list of 190 pairs of potentially interacting drugs, based on literature appraisal and availability of therapeutic alternatives. January-June 2018 data on drug use in patients over 65 years-old were collected from nine Local Health Authorities of Emilia Romagna: data on community-dwelling subjects were extracted from archives of reimbursed prescriptions, while drug use in a sample of nursing homes was recorded from clinical charts in one index day within the same semester. The frequency of polypharmacy (at least five or at least 10 concurrent drugs) and of each DDI was calculated. Results: In line with different rates of polypharmacy (80% vs 16%), the risk of exposure to at least one interaction was 53.7% in nursing homes and 26.4% in outpatients. Among DDIs, in nursing homes antidepressants—anxiolytics (11.9%) ranked first, followed by antidepressants—aspirin (7.4%). In outpatients, ACE-inhibitors—non-steroidal anti-inflammatory drugs (NSAIDs) reached 7.2% followed by the calcium channel blockers—α-blockers (2.4%). Discussion: Polypharmacy and risk of DDIs appeared very different in the two settings, due to both technical and clinical reasons. In order to reduce use of benzodiazepines, NSAIDs, antidepressants and relevant DDIs, 1) defining alternative options for pain relief in elderly outpatients, and 2) implementing non-pharmacological management of insomnia and anxiety in nursing homes should be prioritized.
Highlights
According to the most recent reports released by the WHO (World Health Organization, 2015), the global prevalence of people over 65 years of age is growing rapidly, and it is assumed that by 2050 it will increase from 12 to 22%
1⁄4 of subjects residing in nursing homes (23.8%) received at least 10 concomitant drugs, while among community dwelling this rate was 0.5% (Table 1)
If from the list of interactions analyzed in nursing homes, we exclude the 40 pairs of interactions that cannot be studied among the dwelling communities, this risk of exposure decreases to 32.4%
Summary
According to the most recent reports released by the WHO (World Health Organization, 2015), the global prevalence of people over 65 years of age is growing rapidly, and it is assumed that by 2050 it will increase from 12 to 22%. In terms of clinical outcomes, the main concerns are represented by an increasing risk of adverse drug reactions (ADRs) and lack of effectiveness, especially due to Drug-Drug Interactions (DDIs) and impaired compliance. Risk of DDIs and relevant ADRs significantly increases with increasing polypharmacy. It is not a synonym of inappropriate drug use (Cadogan et al, 2016; Hughes, 2020), a defined threshold is still considered useful to identify patients to be primarily addressed to prescription reviewing process (Viktil et al, 2007; Onder et al, 2010; Masnoon et al, 2017)
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