Risk Factors For Polypharmacy Research Articles

#325 Prescribing patterns in older people with advanced chronic kidney disease approaching the end of life

Abstract Background and Aims Advancing age and chronic kidney disease (CKD) are risk factors for polypharmacy—the regular daily intake of >5 medications. Polypharmacy is a key action area for the World Health Organization in its effort to reduce global medication-related harm. Deprescribing, the systematic review and rationalisation of potentially inappropriate medications, is a proposed way of addressing polypharmacy. Deprescribing is particularly relevant near the end of life, when preventative treatments provide less benefit. Prescribing practices for elderly people with advanced CKD in the last years of life are currently unknown. The aim of this study was to describe prescribing and deprescribing patterns in such a cohort. Method The EQUAL study [1] is an international, prospective cohort study of people ≥65 years with an incident estimated glomerular filtration rate (eGFR) of ≤20 ml/min/1.73 m2. We analysed data from participants who died during follow up, including 3-6 monthly study-visit-collected prescribed oral medications (POMs). Generalized additive models were used to explore trends leading up to death in the total number of POMs, and the proportion of participants taking specific medications. Data are presented for medications: a) identified as targets for deprescribing in the elderly with CKD (statins, proton-pump inhibitors (PPIs) and antihypertensives—alpha-blockers, beta-blockers, calcium-channel blockers (CCBs), diuretics and renin-angiotensin-aldosterone inhibitors (RAASis)); b) used for symptom control in kidney failure (opioids and gabapentinoids); and c) prescribed to >30% of the cohort (allopurinol, aspirin, vitamin D). Results Data from 563 participants were analysed, comprising 2793 study visits (median follow-up time 2.2 years (interquartile range (IQR) 1.1-3.8) pre-death), and 22,200 POMs. At baseline, mean age was 77.8 years (standard deviation (SD) 6.7), median eGFR 18.1 mls/min/1.73 m2 (IQR 15.0-21.2), and 87.2% were experiencing polypharmacy. The number of POMs increased over the time approaching death (Fig. 1)—7.3 (95% confidence interval (CI) 6.9-7.7) at 5 years pre-death, 8.3 (95% CI 8.0-8.6) at 2.5 years pre-death, and 8.7 (95% CI 8.4-9.1) at death. At their final study visit 90.1% were experiencing polypharmacy. Trends in the proportion of individuals prescribed specific medications differed by POM class (Fig. 2). Opioids, diuretics and PPIs increased in the last years of life; statins, RAASis, alpha-blockers and CCBs decreased; and allopurinol, beta-blockers and gabapentinoids remained stable. Aspirin and vitamin D showed phasic patterns, increasing then decreasing. Conclusion Elderly people with advanced CKD experience increasing levels of polypharmacy as they approach the end of life. Although there is evidence that certain medication classes are being deprescribed, this is outweighed by increased prescribing of other agents. Previous analyses of EQUAL decedents have shown that blood pressure decreases pre-death—we show this is despite reductions in most classes of antihypertensives. Our work suggests a high reliance upon pharmacological interventions (both symptom-directed and preventative) for older people with CKD who are approaching death. We cannot ascertain whether this reflects personalised prescribing, aligned with individuals’ preferences and prognoses; however, high levels of polypharmacy potentiate risks of side effects, medication burden and drug-drug interactions, and indicate a role for enhanced medication review in this setting.

Prevalence and predictors of polypharmacy in elderly patients discharged from a tertiary care teaching hospital in Swat, Pakistan: A retrospective cross-sectional study

Background: The use of polypharmacy in the elderly has been the subject of much consideration in recent years. However, its prevalence and risk factors are yet to be properly investigated in Pakistan. Objective: The study investigated the prevalence and risk factors of polypharmacy at discharge in Pakistan. Method: A retrospective cross-sectional study of elderly patients' medical profiles for the year 2021 was performed, and the profiles that met the inclusion criteria were included. Results: The total sample size was 800, and 51.9% of patients received polypharmacy at discharge. The authors found that the female gender (OR = 0.469) has comparatively less risk of receiving polypharmacy. Furthermore, patients with an increased length of stay and increased medication use in the hospital (OR 1.1295, OR = 17.189, respectively) have a high risk of receiving polypharmacy at discharge. Furthermore, patients diagnosed with peripheral vascular disease (OR = 4.689), cerebrovascular accident (OR = 2.764), chronic obstructive pulmonary disease (OR = 3.748), asthma (OR = 2.321), and diabetes mellitus (OR = 2.754) had higher risks of receiving polypharmacy. Conclusion: The study found a high prevalence of polypharmacy at discharge in Pakistan and identified several risk factors that could help to reduce polypharmacy by targeting vulnerable groups.

Polypharmacy and associated factors in South Korean elderly patients with dementia: An analysis using National Health Insurance claims data.

Dementia is accompanied by several symptoms, including cognitive function decline, as well as behavioral and psychological symptoms. Elderly patients with dementia often experience polypharmacy, the concurrent use of multiple medications, due to chronic comorbidities. However, research on polypharmacy in patients with dementia is limited. This study aimed to characterize polypharmacy and associated factors among elderly patients with dementia in South Korea, and compare the characteristics of patients with and without dementia patients. From the National Health Insurance Service (NHIS)-Senior cohort database, we extracted data on patients aged≥60 years who received outpatient treatment in 2019. Polypharmacy was defined as the concurrent use of five or more different oral medications for ≥90 days; excessive polypharmacy referred to the concurrent use of ten or more different oral medications for ≥90 days. We compared the prevalence of polypharmacy between patients with and without and identified the associated factors using a logistic regression model. About 70.3% and 23.7% of patients with dementia exhibited polypharmacy and excessive polypharmacy, respectively. After adjusting for conditions such as age and Charlson's comorbidity index, the likelihood of polypharmacy and excessive polypharmacy significantly increased over time after the diagnosis of dementia. Additionally, under the same conditions, Medical Aid beneficiaries with dementia were more likely to experience polypharmacy and excessive polypharmacy compared to patients with dementia covered by National Health Insurance (NHI). This study reports the latest evidence on the status and risk factors of polypharmacy in elderly patients with dementia. We proposed that careful monitoring and management are required for patients at high risk for polypharmacy.

Incidence and risk factors for polypharmacy among elderly people assisted by primary health care in Brazil

BackgroundPolypharmacy is recognized as a global public health problem and one of the greatest challenges related to the aging population. Few studies have investigated the incidence and risk factors for polypharmacy among elderly individuals. These studies provided important information on the issue but were developed in high-income countries. This study investigates the incidence and risk factors for polypharmacy among elderly people assisted by primary health care over a period of 11 years.MethodsThis was a census-based prospective longitudinal study that included people aged 60 years or older living in a small municipality in the state of Rio Grande do Sul, Brazil. The baseline occurred in 2010 and the second wave of the study occurred in 2021. The study population consisted of elderly individuals who did not use polypharmacy at baseline and were reinterviewed in 2021 (N = 128). Data collection in the first and second waves was performed through a household survey using a structured questionnaire. The dependent variable was polypharmacy, defined as the simultaneous use of 5 or more drugs. The independent variables included sociodemographic, health and functionality factors. For multivariate analyses, Poisson regression with robust variance was used, estimating the relative risk and 95% confidence intervals.ResultsThe incidence of polypharmacy was 46.1% in the 11-year period. The highest number of health problems was a risk factor for polypharmacy (RR = 1.177; 95% CI 1.093–1.267).ConclusionsThe incidence of polypharmacy among elderly people assisted in primary health care in Brazil is high. The number of diseases is a risk factor for polypharmacy. These results have implications for future primary health care practices and may support the development of policies, actions and services aimed at reducing polypharmacy and promoting the rational use of drugs in the population at higher risk.

Prevalence and Risk Factors of Polypharmacy among Elderly Patients

Background: Medications play a key role in the treatment and prevention of disease. There are a variety of medical conditions and diseases that cannot be controlled treated or prevented solely by the use of one medication. This will mandate polypharmacy which is the use of more than one medication or a combination of drugs. Polypharmacy can cause many complications, the most important are drug-related problems that should be taken under consideration. Objectives: Our aim in this prospective cross-sectional study is to determine the prevalence of polypharmacy among selected elderly patients and to investigate the factors associated with polypharmacy use. The patient is considered to be exposed to polypharmacy if he is on five concurrent medications or more for the management of chronic diseases. Methods: Data collection was done by targeting elderly patients in the internal medicine ward of Azadi Hospital utilizing a structured data collection form which is specially designed to fit the goals of this study. Results: To estimate the prevalence of polypharmacy, the frequency and proportion (%) were presented. The Chi-square test was used to investigate the factors associated with polypharmacy. Significant p-value set at < 0.05. Polypharmacy prevalence indicates that 27% (n= 53) of elderly patients were receiving more than five medications for chronic use. Heart diseases are the most common to be followed by hypertension and diabetes subsequently. Diabetes mellitus has shown the highest association with polypharmacy compared to the other factors. The Chi-square test result for this risk factor is χ2 = 6.76., df = 1, p < 0.05. To be followed by heart diseases, and age. Other factors have no association with polypharmacy according to our current study results. Conclusion: An approach or care plan should be developed in all health care settings to decrease the exposure of elderly patients to poly-pharmacy. Reducing polypharmacy should focus on the groups that are most prone to it. According to our research results, elderly people and those who are being treated with drugs for cardiovascular disease, and diabetes are of high priority.

A102 INTERDISCIPLINARY TELEHEALTH REFERRAL PATHWAY AND CONSULTATIONS TO IMPROVE OUTCOMES AMONG CANADIAN OLDER ADULTS WITH LIVER CIRRHOSIS

Abstract Background Telehealth and telemedicine have become indispensable healthcare delivery tools during the COVID-19 pandemic. Older individuals with cirrhosis have complex medical needs that are currently unmet due to the growing disease burden and decreased access to care. Delivering timely specialist care virtually to older adults with cirrhosis will likely be beneficial and acceptable to such patients; however, this has not yet been prospectively evaluated. Purpose The primary goal is to pilot the delivery of dual specialist care from a hepatologist and geriatrician, delivered virtually, for older adults living with liver cirrhosis who are at high risk of geriatric syndromes (age >/= 65 with frailty, undifferentiated cognitive impairment from dementia or hepatic encephalopathy, recurrent falls, risk factors for polypharmacy and moderate to severe malnutrition). Care is delivered using a dedicated hepatology-geriatric referral pathway. Primary objectives include evaluating the impact of this approach on emergency care and inpatient utilization, along with patient attitude and satisfaction to the virtual interdisciplinary care delivery model. Method This pilot quality improvement study was conducted in Halifax, Nova Scotia. Ethics approval was obtained from the Nova Scotia Health Research Ethics Board and the University of Alberta Research Ethics Board. Fifty to one hundred participants (age 65 years or older with at least one geriatric syndrome; diagnosis of liver cirrhosis by liver elastography or liver biopsy, or Fibrosis-4 Index for Liver Fibrosis greater than three and having radiological features of cirrhosis and/or portal hypertension) were recruited between September 2022 to December 2022 at the time of their hepatology consultation. After consent and screening, each patient underwent a telehealth appointment by zoom with a geriatrician within four weeks of their initial hepatology assessment. Follow-up by telephone using a standardized survey regarding ease of access and quality of their telehealth experience then occurred at 3-4 weeks, 3 months and 6 months for emergency room visits and hospital admission status. Result(s) Pending Conclusion(s) Pending Please acknowledge all funding agencies by checking the applicable boxes below Other Please indicate your source of funding; Pfizer Canada Disclosure of Interest J. Zhu Grant / Research support from: Pfizer Canada, F. Carr Grant / Research support from: Pfizer Canada, P. Tian: None Declared, M. McLeod: None Declared, M. MacFarlane: None Declared, S. De Coutere: None Declared, M. Sun: None Declared, K. Peltekian: None Declared

Polypharmacy and adverse events in atrial fibrillation: Main cause or reflection of multimorbidity?

BackgroundPrevious evidence indicated that atrial fibrillation (AF) patients with polypharmacy presented increased probability of adverse events. We investigated the prevalence of polypharmacy, risk factors for polypharmacy, and the impact of polypharmacy in clinical outcomes in a ‘real-world’ cohort of AF patients starting vitamin K antagonists (VKAs). MethodsProspective study including AF outpatients starting VKA therapy from July, 2016 to June, 2018. At inclusion, all concomitant drugs were carefully collected and recorded. Polypharmacy was defined as the intake of ≥ 5 concomitant drugs. During 2-years of follow-up, ischemic strokes/transient ischemic attacks (TIAs), fatal/nonfatal myocardial infarctions (MIs), bleeding events, venous thromboembolisms, and all-cause deaths were recorded. Results1050 patients (51.5 % females, median age 77 [69–83] years) were included, and the prevalence of polypharmacy was 32.9 % (345). Female sex (OR 1.5; 95 % CI 1.11–2.03), hypertension (OR 2.53; 95 % CI 1.51–4.22), diabetes (OR 3.11; 95 % CI 2.31–4.17), vascular disease (OR 3.08; 95 % CI 2.19–4.33), heart failure (OR 1.86; 95 % CI 1.35–2.58) and dyslipidemia (OR 2.61; 95 % CI 1.9–3.58) were independently associated to the polypharmacy. Patients with polypharmacy showed significantly higher incidence of major bleeding, net clinical outcomes (composite of major bleeding, ischemic stroke/TIA, and mortality), MACE (composite of ischemic stroke/TIA, MI, and cardiovascular death), and composite thrombotic/thromboembolic events; being an independent risk factor for major bleeding (HR 1.77, 95 % CI 1.07–2.92), and composite thrombotic/thromboembolic events (HR 1.55, 95 % CI 1.05–2.31). ConclusionIn this “real world” AF cohort, polypharmacy was highly prevalent and conditioned worse prognosis due to its association with bleeding and thromboembolic events.

Comparisons in polypharmacy over a decade in community-dwelling older adults-findings from Israel national health and nutrition surveys

BackgroundPolypharmacy increases with age and is associated with serious health and economic costs. This study reports changes over a decade in medication-use patterns and polypharmacy, in Israeli community-dwelling older adults aged ≥ 65 years.MethodsDemographic and health data from two representative national health cross-sectional surveys – MABAT ZAHAV 1 (MZ1) in 2005–2006, and MZ2 in 2014–2015 were analyzed. Polypharmacy was defined as use of ≥ 5 medications. Risk factors for polypharmacy were estimated by multivariable logistic regression with adjusted odds ratios (aOR) and their 95% confidence intervals (CI).ResultsSelf-reported data on medications taken were available for 1647 participants (91.5%) in MZ1, and for 833 participants (80.2%) in MZ2, 55% women, and about 20% aged ≥ 80, in both surveys. The prevalence of polypharmacy was significantly lower in MZ2 than in MZ1: 64.2% versus 56.3%, p = .0001; with an aOR (95%CI) of 0.64 (0.52, 0.80). The most commonly taken drugs were for hypertension (27.0%, 25.3%), dyslipidemia (9.7%, 12.4%) and anticoagulation (9.2%, 9.8%). For approximately 10% of drugs, indications were either unknown or incorrect. Polypharmacy was significantly associated with poor self-health assessment 2.47 (1.99, 3.06), ≥ 4 versus 1–3 chronic illnesses 6.36 (3.85, 10.50), and age ≥ 80 versus younger 1.72 (1.32, 2.24). Similar associations were observed with major polypharmacy of ≥ 8 medications.ConclusionPolypharmacy, although reduced in the last decade, requires constant attention, especially concerning lack of knowledge of indications which leads to poor adherence and adverse side effects. Health-care teams should carry out regular medicine reconciliation in at-risk elderly patients.

Polypharmacy difference between older people with and without diabetes: Evidence from the English longitudinal study of ageing

AimTo study the association between diabetes and the prevalence of and risk factors for polypharmacy among adults aged 50 and older in England. MethodsA cross-sectional study (2012–2013) of the English Longitudinal Study of Ageing. Polypharmacy was defined as taking 5–9 long-term medications a day and heightened polypharmacy as 10 or more. Diabetes included diagnosed and undiagnosed cases (glycated haemoglobin ≥ 6.5% (48 mmol/mol)). ResultsOf 7729 participants, 1100 people had diabetes and showed higher prevalence rates of polypharmacy (41.1% vs 14.8%) and heightened polypharmacy (5.8% vs 1.7%) than those without diabetes, even when antihyperglycemic medications were excluded. Risk factors for polypharmacy also differed according to diabetes status. Among people with diabetes, risk factors for polypharmacy and heightened polypharmacy were having more long-term conditions (relative risk ratio (RRR) = 1.86; 3.51) and being obese (RRR = 1.68; 3.68), while females were less likely to show polypharmacy (RRR = 0.51) and heightened polypharmacy (RRR = 0.51) than males. Older age (RRR = 1.04) was only related to polypharmacy among people without diabetes. ConclusionsAdults with diabetes had higher prevalence rates of polypharmacy and heightened polypharmacy than those without diabetes, regardless of including antihyperglycemic drugs. Early detection of polypharmacy among older people with diabetes needs to focus on co-morbidities and obesity.

Cross sectional study on the prevalence of polypharmacy and potentially inappropriate medications among elderly patients in a tertiary care centre in central Kerala

Background: Polypharmacy or the concurrent use of multiple medications, is on the rise, especially in the elderly population as they suffer from multiple co-morbidities. Polypharmacy has been reported to increase the risks for inappropriate medication intake. Objectives: The aim was to investigate the prevalence of polypharmacy and usage of potentially inappropriate medication using Beer’s criteria and to find out the various risk factors of polypharmacy in hospitalised elderly.Methods: A cross sectional study was done in patients aged 60 years and above using a pre designed semi structured questionnaire and from their case records to assess the pattern of polypharmacy by different socio-demographic characteristics and also to found out the risk factors of polypharmacy.Results: 50 patients aged 60 and above were involved in our study out of which, 46% were females and 54% were males. Mean age of our study population was 71.5±8.3. Among them, 30 were hypertensive, 27 were diabetic, 9 of them had dyslipidaemia and 8 of them had coronary artery disease Mean number of medication use was 5.1±4.1. Polypharmacy was observed in 42% of the patients. 20% patients received potentially inappropriate drugs from Beer’s list. We also found significant association of polypharmacy with diabetes mellitus and hypertension.Conclusions: The present study has shown polypharmacy and usage of potentially inappropriate medication as an emerging public health concern. Diabetes mellitus and hypertension were found to be risk factors of polypharmacy. Deprescription should be integrated into clinical care and prescribers need to be educated about Beers criteria and encouraged for rational prescription.

Polypharmacy and excessive polypharmacy in community-dwelling middle aged and aged adults between 2011 and 2015.

We aimed to assess the prevalence, components and evolution of polypharmacy and to evaluate risk factors associated with polypharmacy. A retrospective dynamic cohort study was performed, using a primary healthcare database comprising Flemish community-dwelling adults aged ≥40years between 2011 and 2015. Polypharmacy and excessive polypharmacy were defined as the use of 5-9 or minimum 10 different medications during 1year, respectively. Temporal changes were analysed using an autoregressive error model. Risk factors for polypharmacy were evaluated using logistic regression. In total, 68426 patients were included in the analysis. The prevalence of polypharmacy was 29.5% and 16.1% for excessive polypharmacy in 2015. The age-standardised prevalence rate of patients using minimum five medications increased with 1.3% per year (95% confidence interval (CI): 0.1968-2.4279). The mean number of unplanned hospital admissions was 0.07 (standard deviation (SD) 0.33) for polypharmacy patients and 0.19 (SD 0.53) for excessive polypharmacy patients. Four risk factors were found to be significantly correlated with polypharmacy: age (odds ratio (OR) 1.015; 95% CI: 1.013-1.017), female gender (OR 1.161; 95% CI: 1.108-1.216), number of chronic diseases (OR 1.126; 95% CI: 1.114-1.139) and number of general practitioner contacts (OR 1.283; 95% CI: 1.274-1.292). The prevalence of polypharmacy increased between 2011 and 2015. Polypharmacy and excessive polypharmacy patients appeared to differ based on our observations of characteristics, drug therapy and outcomes. Age, female gender, number of chronic diseases and number of general practitioner contacts were associated with polypharmacy.

Deprescribing is essential for good prescribing

In 2017 the World Health Organization recognized the potential patient-related harm of polypharmacy as a matter in need of attendance in the years to come and it was set as a priority in the Medication without Harm Initiative. Polypharmacy is rather common in the elderly patients due to their multimorbidities and in patients with chronic pain. It has been related to drug adverse reactions, increased length of hospital stay, falls and increased morbidity. All these are augmented by the number of different drugs and the nature of the disease. Risk factors of polypharmacy are increasing age, female gender, low educational level and socio-economic status, multimorbidity and number of hospitalizations. The term deprescribing comes to confront this issue by means of establishing a well designed plan of discontinuing or tapering off drugs that can cause potential harm to the patient. It is based on the principles of revision of all inappropriate drugs, of gradual reduction, dicontinuation or replacement of these drugs, of designing a certain plan of action along with the patients’ education and cooperation. Guidelines already exist for certain kind of drugs (antihypertensives, statins, antipshychotics a, benzodiazepines) with positive outcomes. In the case of opioid deprescribing in chronic pain management the challenge escalates since there are further issues to be addressed. Opioid withdrawal, the fear of changing the pain management status quo and a level of uncertainty regarding the optimum tapering opioid plan are barriers in the process. Guidelines on opioid deprescribing are in need to address all these matters of concern.

Frequency and risk factors of polypharmacy and drug interactions among patients in general intensive care unit of Golestan Hospital, Ahvaz, southwest of Iran

<abstract><sec> <title>Objective</title> <p>This study was aimed to evaluate polypharmacy and drug interactions in intensive care units.</p> </sec><sec> <title>Materials and methods</title> <p>This epidemiologic-descriptive study was performed on the records of 80 patients admitted to the intensive care unit with a duration of more than 48 hours from 2018-10-23 to 2019-01-21. The patients' records, including polypharmacy, type and number of drug interactions as well as factors such as age, gender, hospitalization duration, number of drug-prescribing physicians were investigated. To determine drug interactions, Free <italic>Lexi-Comp</italic> <italic>iOS</italic> software version 4.0.1 was used.</p> </sec><sec> <title>Findings</title> <p>Of 80 participants in this study, 58, and 22 patients (72.5%, and 27.5%) were respectively male and female, with a mean age of 39.9 years; besides, 46.2%, and 25.3% of patients were hospitalized due to trauma, and non-traumatic cerebral hemorrhage, respectively. The average hospitalization was six days. The average number of drug-prescribing physicians and medications received was 5 and 10, respectively. The majority of patients (91.2%) received over five drugs. The majority of drug interactions (70%) were in C-Class, and 1.2% were in X-Class. Also, 85% of the studied samples had at least one drug interaction.</p> </sec><sec> <title>Conclusion</title> <p>Polypharmacy and drug interactions were common in patients hospitalized in the intensive care unit ward. Risk factors for increasing drug interactions were the length of stay and number of medications prescribed, and for polypharmacy, length of stay, number of medications-prescribing physicians, and number of prescription medications.</p> </sec></abstract>

POLYPHARMACY IN DIABETIC PEOPLE: EVIDENCE FROM THE ENGLISH LONGITUDINAL STUDY OF AGEING (ELSA)

Diabetes among older people is becoming more common worldwide, and usually accompanied by polypharmacy. However, the role of polypharmacy in older people with diabetes remains uncertain. A nationally representative cross-sectional study, ELSA 2012/2013, was used and 7729 participants aged 50-109 were investigated. Polypharmacy was defined as taking five to nine long-term used medications daily for chronic diseases or chronic symptoms, while using ten or more medications was excessive polypharmacy. The presence of illness was defined as either self-reported diagnosis or being prescribed specific medications for the condition. Data showed the prevalence of polypharmacy was 21.4%, and only 3% was excessive polypharmacy. 51.6% of diabetic people reported polypharmacy and 10.2% excessive polypharmacy. These rates were significantly higher than the 16.4% polypharmacy and 1.8% excessive polypharmacy among people without diabetes (p < 0.001). Among people with three or more comorbidities, polypharmacy was present in 61.5% of people with diabetes, compared with 36.0% in people without diabetes. Significant risk factors for polypharmacy were diabetes (Relative-risk ratios/RRR=4.06, 95% CI 3.38, 4.86), older age (RRR=1.02, 95% CI 1.01, 1.03), male (RRR=0.64, 95% CI 0.55, 0.75), more comorbidity (RRR=2.46, 95% CI 2.30, 2.62), living with a partner (RRR=1.20, 95% CI 1.01, 1.42), and less wealth (RRR=0.93, 95% CI 0.87, 0.98). However, age, cohabitation, and wealth were not significantly related to excessive polypharmacy. Diabetes and the number of comorbidities were predominant risk factors for excessive polypharmacy. Current evidences confirmed both health condition and socioeconomic status were associated with medication use in older adults.

Polypharmacy and oral antidiabetic treatment for type 2 diabetes characterised by drug class and patient characteristics: A Japanese database analysis

Polypharmacy (PP) occurs in patients with type 2 diabetes (T2DM) owing to multimorbidity. We evaluated concomitant PP and medication adherence in T2DM 3 years after initiation of administration of a hypoglycaemic agent using a nationwide claim-based database in Japan. Factors associated with medication PP and imperfect adherence were identified using multivariable logistic regression. PP was defined as using ≥6 medications. Patients with proportion of days covered (PDC) of <80% were defined as having poor medication adherence. A total of 884 patients were analysed. Multivariate analysis revealed that age, total number of consultations and body mass index (BMI) are factors that influence PP. Factors associated with PDC < 80% were 2–3, 4–5 and ≥ 6 medications compared with 1 medication, male sex, <17 consultations and age 50–59 and ≥ 60 years compared with <40 years. In conclusion, older age, high total number of consultations and BMI ≥ 25 kg/m2 are risk factors for PP. PP influenced good medication adherence at the end of the observation period.

Polypharmacy among community-dwelling elderly in Singapore: Prevalence, risk factors and association with medication non-adherence

Background:Polypharmacy, given its link with drug interactions, potentially inappropriate medications and medication non-adherence, may pose a significant health risk, especially among the elderly. A comprehensive understanding of the epidemiology of polypharmacy is essential for countries facing population ageing and growing chronic disease burden, like Singapore.Objectives:We assessed the prevalence and risk factors of polypharmacy (⩾5 prescription medications) among community-dwelling elderly in Singapore and established the association of polypharmacy with medication non-adherence.Methods:We used data from a national sample of 1499 community-dwelling elderly aged ⩾66 years. Using logistic regression, we assessed the association of socio-demographic, health and healthcare use variables with polypharmacy, and polypharmacy with medication non-adherence.Results:The weighted prevalence of polypharmacy was 14.5%. In multivariable analysis, elderly who were men (versus women), with ⩾2 (versus 0–1) chronic diseases, aged ⩾85 (versus 66–69) years, and of Malay and Indian (versus Chinese) ethnicity were significantly more likely to have polypharmacy; healthcare use variables were not associated. Polypharmacy was significantly correlated with medication non-adherence.Conclusions:The prevalence of polypharmacy among community-dwelling elderly in Singapore is lower than that reported in other countries; however, polypharmacy is associated with medication non-adherence. Elderly subgroups, defined by gender, health status, age and ethnicity, who are at a higher risk of polypharmacy will benefit from medication review and de-prescribing services.

Risk Factors for Polypharmacy in Elderly Patients With Cancer Pain.

Polypharmacy (PP) is a burden in elderly patients with cancer pain; however, risk factors for PP remain unclear. The purpose of this study was to investigate the risk factors for PP in this patient population. We retrospectively reviewed the medical charts of patients aged ≥65 years with cancer pain who were treated at Osaka University Hospital between February 2014 and June 2016 according to the World Health Organization 3-step ladder for cancer pain relief. We defined PP as ≥5 medications and conducted exploratory research to examine the association between PP and patient characteristics. Performance status (PS) was estimated according to the Eastern Cooperative Oncology Group system and is categorized as good PS (0-1) and poor PS (2-4). We reviewed 206 patients (122 men and 84 women) with a median age of 71 years (range, 65-89 years) and found that 174 patients (84.5%) had PP. In multivariate logistic analysis, PP was significantly associated with an increased number of comorbidities (odds ratio [OR]: 4.93, 95% confidence interval [CI], 2.57-11.42, P < .001), poor PS (OR: 4.50, 95% CI, 1.06-31.68, P = .039), and administration of an anticancer or molecular targeted drug (OR: 2.78, 95% CI, 1.13-7.16, P = .025). An increased number of comorbidities, poor PS, and administration of an anticancer or molecular targeted drug were considered risk factors for PP in elderly patients with cancer pain. Sharing these risk factors with medical staff will help reduce the occurrence of problems associated with PP.

Risk factors for polypharmacy in older adults in a primary care setting: a cross-sectional study.

PurposePolypharmacy (PP) is a clinical challenge in older adults. Therefore, assessment of daily drug consumption (DDC) and its relationships is important. First-line health services have a crucial role in monitoring and preventing PP. In this study, we aimed to assess DDC and investigate the risk factors for higher DDC among older adults in a primary care setting.Patients and methodsA total of 1,000 patients aged ≥65 years who visited Melek Hatun Family Practice Center between December 1, 2014, and August 1, 2017, were enrolled in the study. All patients were seen either at the center or in their homes, and informed consent was obtained. Comprehensive geriatric assessment was performed for each subject. Data were analyzed using SPSS software (version 17). The daily number of medicines that each patient used (DDC) regardless of whether they were prescribed was the dependent variable. Relationships between DDC and other continuous variables were examined using Pearson’s correlation. For between-group comparisons of DDC, Student’s t-tests were performed.ResultsUnivariate tests showed relationships between DDC and various demographic and clinical parameters. The variables that remained significant at the last step of a stepwise linear regression analysis were metabolic syndrome, chronic pain, incontinence, increased serum creatinine level, increased Geriatric Depression Scale scores, reported gastric disturbances, and neutrophil/lymphocyte ratio.ConclusionAlong with certain chronic conditions, depressive symptoms and an inflammatory marker (neutrophil/lymphocyte ratio) were significantly and independently related to higher DDC. Longitudinal and larger studies are needed to further explore the multifaceted relationships of PP.

Polypharmacy Among Headache Patients: A Cross-Sectional Study.

BackgroundPolypharmacy can appropriately treat multiple chronic conditions, but it can also increase potential harm. Polypharmacy information for primary headaches is minimal, despite drugs being the main tools to manage headaches.ObjectiveThe aim was to evaluate the prevalence, characteristics and risk factors of polypharmacy in patients with primary headaches and examine whether these variables differ between episodic and chronic headache patients.MethodsWe analysed polypharmacy (simultaneous use of five or more medications), medication type, comorbidity, and risk factors in 300 patients (mean age 42.81 ± 13.21 years) with primary headaches, divided into episodic and chronic, afferent to a headache centre.ResultsPatients took an average of 4.37 medications. Polypharmacy was common in 40.7% of patients, and among chronic patients, it reached 58.8%. Most patients used medications (mainly nonsteroidal anti-inflammatory drugs; 73.5%) to treat acute headaches, and 30.4% of episodic and 64.7% of chronic sufferers underwent prophylactic treatment (P < 0.0001), mostly using antidepressants (77.3%). Up to 76.7% of the cohort was taking other medications, primarily for acid-related disorders (21.7%). Comorbidities were present in 59.7% of the cohort. Variables significantly associated with polypharmacy were comorbidities, prophylactic treatment, and triptans (P < 0.001).ConclusionsPatients with primary headaches, mainly young adults, are exposed to high polypharmacy, comparable to that of the elderly. Because increased numbers of drugs increase the risk of adverse reactions, the many medications concomitantly taken by primary headache sufferers should be frequently reviewed.Electronic supplementary materialThe online version of this article (10.1007/s40263-018-0522-8) contains supplementary material, which is available to authorized users.

To Study the Level, Pattern and the Risk Factors of Polypharmacy among Elderly Admitted in a Tertiary Care Centre

The proportion of older adults exposed to polypharmacy defined as use of multiple medications, is rapidly increasing in the last two decades. There are many negative medical consequences associated with polypharmacy apart from greater health care costs. Studies in developed world have revealed that people aged 65-69 years fill an average of 14 prescriptions per year and adults aged 80-84 years, and average of 18 prescriptions per year. The reduced homeostatic ability as people age, given changes in pharmacokinetics, pharmacodynamics and physiological reserve affects different regulatory systems in elderly subjects. Aim and Objective: The aim of the present study was to explore level and pattern and; the risk factors of polypharmacy among elderly admitted and discharged in Department of Medicine, Government Medical College, Jammu. Materials and Methods: The prospective study was carried out in the departments of general medicine, in government medical college hospital Jammu. A total of 650 patients who were admitted in the medicine ward of the hospital during this period were studied, out of which 100 patients aged 65 or more were included in the study. Conclusion: Our study suggests that current practice in our hospital is associated with greater polypharmacy and inappropriate medication use. A regular medication chart review particularly in the elderly, by the clinical pharmacist to discontinue unnecessary medication will reduce the polypharmacy and inappropriate medication use.