Combined Multimorbidity and Polypharmacy Patterns in the Elderly: A Cross-Sectional Study in Primary Health Care

Stafford, Grant; Villén, Noemí; Roso-Llorach, Albert; Troncoso-Mariño, Amelia; Monteagudo, Mónica; Violán, Concepción

doi:10.3390/ijerph18179216

Cited by 30 publications

(26 citation statements)

References 37 publications

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“…Interestingly, at the lifestyle behavior layer, our study found that a low medication adherence was a risk factor, while a moderate medication adherence was a protective factor for developing multimorbidity. The former was consistent with previous views [ 56 ], while the latter was probably due to our data being cross-sectional and could not determine causality between the variables, whereas older people with a high medication adherence tended to be those who were already suffering from disease or even multimorbidity [ 57 ], which is consistent with Domino’s study, which concluded that there was a lower non-adherence among patients with multimorbidity [ 58 ]. Older adults with lower levels of physical activity are more likely to suffer from multimorbidity.…”

Section: Discussionsupporting

confidence: 92%

Patterns and Determinants of Multimorbidity in Older Adults: Study in Health-Ecological Perspective

Chen

Shi

Zheng

et al. 2022

IJERPH

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(1) Background: Multimorbidity has become one of the key issues in the public health sector. This study aims to explore the patterns and health-ecological factors of multimorbidity in China to propose policy recommendations for the management of chronic diseases in the elderly. (2) Methods: A multi-stage random sampling method was used to conduct a questionnaire survey on 3637 older adults aged 60 and older in Shanxi, China. Association rule mining analysis (ARM) and network analysis were applied to analyze the patterns of multimorbidity. The health-ecological model was adopted to explore the potential associated factors of multimorbidity in a multidimensional perspective. A hierarchical multiple logistic model was employed to investigate the association strengths reflected by adjusted odds ratios and 95% confidence. (3) Results: Multimorbidity occurred in 20.95% of the respondents. The graph of network analysis showed that there were 6 combinations of chronic diseases with strong association strengths and 14 with moderate association strengths. The results of the ARM were similar to the network analysis; six dyadic chronic disease combinations and six triadic ones were obtained. Hierarchical multiple logistic regression indicated that innate personal traits (age, history of genetics, and body mass index), behavioral lifestyle (physical activity levels and medication adherence), interpersonal network (marital status), and socioeconomic status (educational level) were the common predictors of multimorbidity for older adults, among which, having no family history was found to be a relative determinant as a protective factor for multimorbidity after controlling the other covariates. (4) Conclusions: multimorbidity was prevalent in older adults and most disease combinations are associated with hypertension, followed by diabetes. This shows that diabetes and hypertension have a high prevalence among older adults and have a wide range of associations with other chronic diseases. Exploring the patterns and associated factors of multimorbidity will help the country prevent complications and avoid the unnecessary use of the health service, adopting an integrated approach to managing multimorbidity rather than an individual disease-specific approach and implementing different strategies according to the location of residence.

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Section: Discussionsupporting

confidence: 92%

Patterns and Determinants of Multimorbidity in Older Adults: Study in Health-Ecological Perspective

Chen

Shi

Zheng

et al. 2022

IJERPH

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“…The mean age of the enrolled samples was about 75 years, except for the work of McCracken et al [ 21 ], performed on older patients (mean age 85 years). Concerning the definition of polypharmacy, four studies considered the usual consumption of 5 or more medications per day [ 13 , 14 , 18 , 20 , 22 ], two studies of > 5 drugs/ day [ 17 , 19 ], one of ≥ 4 drugs/day [ 4 ], and one of ≥ 9 drugs per day [ 21 ]. One work reported the median number of medications taken, but not the frequency of polypharmacy [ 14 ].…”

Section: Resultsmentioning

confidence: 99%

“…Several works have shown that the frequency of polypharmacy increases with advancing age [ 3 , 4 ], in parallel with the accumulation of chronic diseases [ 5 ]. In this context, the interactions between multiple drugs and diseases can lead to more challenging management and control of chronic conditions.…”

Section: Introductionmentioning

confidence: 99%

Prevalence and impact of polypharmacy in older patients with type 2 diabetes

et al. 2022

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Background Polypharmacy is a prevalent condition in older adults, especially those with multiple chronic diseases, and has been largely associated with adverse outcomes, including disability, hospitalizations, and death. Aims This systematic review focused on diabetes and aimed to investigate the prevalence and impact of polypharmacy in older adults affected by such disease. Methods Observational (either cross-sectional or longitudinal) or experimental studies investigating the frequency and impact of polypharmacy in older adults with diabetes were identified from scientific databases and grey literature until August 2021. The prevalence and the 95% Confidence Interval (95% CI) of polypharmacy in older people with diabetes were summarized by a random-effects meta-analysis. Results From a total of 1465 records, 9 were selected for the qualitative synthesis, and 8 for the quantitative synthesis. Most studies defined polypharmacy using a cut-off for the minimum number of medications ranging from 4 to 6 drugs/day. The pooled prevalence of polypharmacy in older people with diabetes was 64% (95% CI 45–80%). Considering studies that used the same definition of polypharmacy (i.e. ≥ 5 drugs/day), the pooled prevalence was 50% (95% CI 37–63%). The between-studies heterogeneity was high. Across the selected studies, polypharmacy seemed to negatively influence both diabetes-specific (poor glycemic control and risk of hypoglycemia) and health-related (risk of incident falls, syncope, hospitalization, and death) outcomes. Conclusion This systematic review confirms the high prevalence of polypharmacy in older people with diabetes and its strong impact on several health-related outcomes, including mortality. These results strengthen the need to improve care strategies for management of these patients.

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“…Regarding the concept of polypharmacy, four studies [9][10][11][12][13] looked at the typical intake of five or more medications per day, two studies 14,15 looked at more than five, one study 16 looked at less than four, and one looked at more than nine drugs per day. 17 In this prospective observational study, we evaluated the effects of T2DM on the number of medications administered to diabetic patients older than 40 years old as well as the effects of polypharmacy on diabetic patients.…”

Section: Discussionmentioning

confidence: 99%

Impact of polypharmacy in older patients with type 2 diabetes in rural population in South India

2022

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Background: The World Health Organization describes polypharmacy as a safe and efficient treatment that complies with evidence-based medicine and uses at least five different medications. Aims and Objectives: The aim of our study was to investigate the impact of polypharmacy in older patients with type 2 diabetes mellitus (T2DM) in rural population in South India. Materials and Methods: The study comprised a total of 100 patients, who were referred to the Government General Hospital, Nizamabad, between January 2020 and March 2022. The records of 50 randomly chosen non-diabetic patients who visited our hospital for other ailments were compared to those of the 50 T2DM patients. Results: In this study, a total of 100 patients were enrolled, out of which 62 were male (62%) and 38 were female (38%). The duration of diabetes was noted to be 0–5 years in 28 patients, 6–10 years in52 patients and >10 years in 20 patients. In our study, we observed that more than five drugs were prescribed to 45 patients in the case group and only ten patients in the control group. Conclusion: Our study shows that older adults with diabetes have a high prevalence of polypharmacy and that this condition may have a significant impact on a number of health-related outcomes. Each patient should receive a customized course of treatment with the right number of medications for their particular ailment. The danger of side effects increases with the number of medications.

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Combined Multimorbidity and Polypharmacy Patterns in the Elderly: A Cross-Sectional Study in Primary Health Care

Cited by 30 publications

References 37 publications

Patterns and Determinants of Multimorbidity in Older Adults: Study in Health-Ecological Perspective

Patterns and Determinants of Multimorbidity in Older Adults: Study in Health-Ecological Perspective

Prevalence and impact of polypharmacy in older patients with type 2 diabetes

Impact of polypharmacy in older patients with type 2 diabetes in rural population in South India

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