Abstract
PurposeThe aim of this study was to determine medication‐related problems (MRPs) in primary care patients over 65 years of age.MethodsCross‐sectional study based on the electronic health records of patients (65‐99 years of age) visited in 284 primary health care centers during 2012 in Catalonia. Variables: age, sex, sociodemographic variables, number of drugs, kidney and liver function and MRPs (duplicate therapy, drug‐drug interactions, potentially inappropriate medications [PIMs] and drugs contraindicated in chronic kidney disease and in liver diseases). Unconditional logistic regression models were used to identify the factors associated with MRPs in patients with multimorbidity.Results916 619 older people were included and 853 085 of them met the criteria for multimorbidity. Median age was 75 years and 57.7% of them were women. High percentages of MRPs were observed: PIMs (62.8%), contraindicated drugs in chronic kidney disease (12.1%), duplicate therapy (11.1%), contraindicated drugs in liver diseases (4.2%), and drug‐drug interactions (1.0%). These numbers were higher in the subgroup of patients with ≥10 diseases. The most common PIMs were connected to drugs that increase the risk of fall (66.8%), antiulcer agents without criteria for gastroprotection (40.6%), and the combination of drugs with anticholinergic effects (39.7%). In the multivariate analysis, the variables associated with all MRPs among the patients with multimorbidity were the number of drugs and the number of visits.ConclusionsThe coexistence of multimorbidity and polypharmacy is associated with an elevated risk of MRPs in older people. Medication safety for older patients constitutes a pressing concern for health services.
Highlights
People over 65 years of age are the fastest-growing segment of the world's population
Increased life expectancy is associated with multimorbidity, which frequently entails the prescription of multiple medications
The aim of this study was to determine the association between medication-related problems (MRPs) and multimorbidity in primary care patients over 65 years of age in Catalonia (Spain)
Summary
People over 65 years of age are the fastest-growing segment of the world's population. It is considered that by 2050 one in four persons living in Europe and North America will be 65 or over.[1] Increased life expectancy is associated with multimorbidity (coexistence of two or more chronic diseases), which frequently entails the prescription of multiple medications. In the short to medium term, the absolute number of older people that are prescribed multiple medications is expected to grow exponentially.[2,3]. Prescription of multiple medicines in older people has been associated with lack of adherence, increase in medication-related problems (MRPs), the emergence of geriatric syndromes and diminished functional capacity, resulting in a higher consumption of health resources.[4,5] An MRP is defined as an event or circumstance involving drug therapy that or potentially interferes with desired health outcomes.[6] Commonly observed MRPs in older people are lack of adherence and inappropriate prescribing.[7] Critically, physiological changes associated with aging can alter the pharmacokinetics and pharmacodynamics of drugs
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