Abstract
(1) Background: Ageing is associated with complex and dynamic changes leading to multimorbidity and, therefore, polypharmacy. The main objectives were to study an older community-dwelling cohort, to detect inappropriate prescriptions (IP) applying the Patient-Centred Prescription model, and to evaluate the most associated factors. (2) Methods: This was a prospective, descriptive, and observational study conducted from June 2019 to October 2020 on patients ≥ 65 years with multimorbidity who lived in the community. Demographic, clinical and pharmacological data were assessed. Variables assessed were: degree of frailty, using the Frail-VIG index; therapeutical complexity and anticholinergic and sedative burden; and the number of chronic drugs to determine polypharmacy or excessive polypharmacy. Finally, a medication review was carried out through the application of the Patient-Centred Prescription model. We used univariate and multivariate regression to identify the factors associated with IP. (3) Results: We recruited 428 patients (66.6% women; mean age 85.5, SD 7.67). A total of 50.9% of them lived in a nursing home; the mean Barthel Index was 49.93 (SD 32.14), and 73.8% of patients suffered some degree of cognitive impairment. The prevalence of frailty was 92.5%. Up to 90% of patients had at least one IP. An increase in IP prevalence was detected when the Frail-VIG index increased (p < 0.05). With the multivariate model, the relationship of polypharmacy with IP detection stands out above all. (4) Conclusions: 90% of patients presented one IP or more, and this situation can be detected through the PCP model. Factors with higher association with IP were frailty and polypharmacy.
Highlights
The objectives of the study were: (1) To determine the baseline situation and to calculate the frailty index (FI) of a cohort of older patients who lived in the community; (2) To assess the therapeutic plan through a PCP model and to analyse the prevalence of polypharmacy, number of inappropriate prescriptions (IP), medication complexity and anticholinergic and sedative burden; and (3) To identify the variables that are potentially most related to IP
They had moderate dependence for basic daily activities, with a mean Barthel Index of 49.93 (SD 32.14), a prevalence of frailty of 92.5%, with 73.8% of patients suffering some degree of cognitive impairment
Regarding ATC groups, we found that four of the 13 groups included in this classification accounted for almost 90% of IPs
Summary
High-income countries face significant population ageing [1,2], which is associated with complex and dynamic changes that lead to the appearance of one or more chronic diseases, giving rise to multimorbidity [3]. Older patients with multimorbidity often meet frailty criteria [3]. Frailty is defined as an increased vulnerability to stressors resulting from a decrease in the physiological reserves of different systems [4]. It has been determined by identifying a critical number of impairments in physical strength, physical activity, nutrition, and mobility [4]. It is known that frailty is associated with a higher need for healthcare resources and
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