Abstract
Objective: To evaluate influence of education level of older patients on polypharmacy, potentially inappropriate medications (PIMs) listed in Beer’s Criteria, and unplanned hospitalization. Methods: A cross-sectional study was conducted among older people aged ≥65 years between 1 December 2017 and 28 February 2018. For data analysis, descriptive statistics and logistic regression analysis were employed. Results: Among 385 older patients, 88.8% were prescribed PIMs and 56.4% underwent PIMs associated unplanned hospitalization. Older people were less exposed to polypharmacy or excessive polypharmacy as their education levels increased (no formal education vs. primary vs. secondary vs. tertiary, 74% vs. 69.8% vs. 60.5% vs. 58.1%). Patients having higher education were also accompanied by significantly lower prescription of PIMs (no formal education vs. primary vs. secondary vs. tertiary, 96% vs. 87.3% vs. 84.5% vs. 79.1%) as well as unplanned hospitalization (no formal education vs. primary vs. secondary vs. tertiary, 64.7% vs. 76.2% vs. 40.3% vs. 46.5%). Results of regression analysis revealed that no formal education (OR = 1.202, 95% CI = 1.032–2.146, p-value = 0.003) and primary education level (OR = 1.175, 95% CI = 1.014–1.538, p-value = 0.039) were significantly associated with the use of polypharmacy among older people. On the other hand, no formal education was significantly associated with the prescription of PIMs (OR = 1.898, 95% CI = 1.151–2.786, p-value = 0.007). Furthermore, older people with no formal education (OR = 1.402, 95% CI = 1.123–1.994, p-value = 0.010) and primary education level (OR = 1.775, 95% CI = 1.281–3.018, p-value = <0.001) were significantly more likely to undergo unplanned hospitalization. Conclusions: Patients having low literacy level are more likely to receive PIMs, polypharmacy, and undergo unplanned hospitalization in comparison to highly educated patients. Hence, promotion of health literacy for patients is crucial to overcome these problems.
Highlights
Worldwide, the over-utilization of healthcare resources by the older population is a result of the increase in number of patients belongs to this age group [1,2]
Two-thirds (67%, n = 258) were subjected to polypharmacy or excessive polypharmacy while 88.8% were prescribed with potentially inappropriate medications (PIMs) and just over one half (56.4%, n = 217) underwent PIMs associated unplanned hospitalization
The present study concluded that PIMs were commonly utilized among older patients
Summary
The over-utilization of healthcare resources by the older population is a result of the increase in number of patients belongs to this age group [1,2]. The chances of unexpected admission of older people to the inpatient departments of healthcare settings because of medicine associated adverse health outcomes become several folds higher that cannot be managed in outpatient settings and it is termed as “unplanned hospitalization” [10]. The prescribing practices of potentially inappropriate medications (PIMs), especially when better and effective drugs are available, refer to the use of such medicines whose risk may outweigh the beneficial therapeutic outcomes. The prescribing of these medications can be termed as potentially inappropriate prescribing (PIP) [11]. The utilization of PIMs by the older patients is common globally
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