High Prevalence of Multimorbidity and Polypharmacy in Elderly Patients With Chronic Pain Receiving Home Care are Associated With Multiple Medication-Related Problems.

Arlett Wenzel,Juliana Schneider,Dagmar Dräger,Andrea Budnick,Reinhold Kreutz,Engi Abd Elhady Algharably

doi:10.3389/fphar.2021.686990

Abstract

Aim: To measure the extent of polypharmacy, multimorbidity and potential medication-related problems in elderly patients with chronic pain receiving home care. Methods: Data of 355 patients aged ≥65 years affected by chronic pain in home care who were enrolled in the ACHE study in Berlin, Germany, were analyzed. History of chronic diseases, diagnoses, medications including self-medication were collected for all patients. Multimorbidity was defined as the presence of ≥2 chronic conditions and levels were classified by the Charlson-Comorbidity-Index. Polypharmacy was defined as the concomitant intake of ≥5 medications. Potentially clinically relevant drug interactions were identified and evaluated; underuse of potentially useful medications as well as overprescription were also assessed. Results: More than half of the patients (55.4%) had moderate to severe comorbidity levels. The median number of prescribed drugs was 9 (range 0–25) and polypharmacy was detected in 89.5% of the patients. Almost half of them (49.3%) were affected by excessive polypharmacy (≥10 prescribed drugs). Polypharmacy and excessive polypharmacy occurred at all levels of comorbidity. We detected 184 potentially relevant drug interactions in 120/353 (34.0%) patients and rated 57 (31.0%) of them as severe. Underprescription of oral anticoagulants was detected in 32.3% of patients with atrial fibrillation whereas potential overprescription of loop diuretics was observed in 15.5% of patients. Conclusion: Multimorbidity and polypharmacy are highly prevalent in elderly outpatients with chronic pain receiving home care. Medication-related problems that could impair safety of drug treatment in this population are resulting from potentially relevant drug interactions, overprescribing as well as underuse.

Highlights

Over the last few decades, the population of older adult has grown worldwide especially in the developed countries (Mathers et al, 2015)
It increases the risk of adverse drug reactions, adverse drug events, inappropriate medication, medication errors, drug-drug interactions (DDI) and increased risk of mortality (Maher et al, 2014; Chang et al, 2020)
The present study revealed that multimorbidity and polypharmacy along with the consequences of polypharmacy were highly prevalent in our cohort of older adults with chronic pain receiving home care that included patients with severe cognitive impairment

Summary

Introduction

Over the last few decades, the population of older adult has grown worldwide especially in the developed countries (Mathers et al, 2015). Defined as the concomitant use of ≥5 medications daily (Masnoon et al, 2017), polypharmacy is a formidable problem posing a multitude of negative health outcomes (Maher et al, 2014). Optimizing prescribing for elderly is of paramount importance as it can improve health outcomes in multimorbid vulnerable patients e.g., patients with chronic pain. Those patients are susceptible to high multimorbidity burdens as well as risk of polypharmacy (Hubbard et al, 2015; Nakad et al, 2020). We aimed to analyze the extent of multimorbidity and polypharmacy in elderly chronic pain patients receiving home care and assessed potential medication-related problems in this target group

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Discussion

Conclusion