Diseases Linked to Polypharmacy in Elderly Patients

Vrettos, Ioannis; Voukelatou, Panagiota; Katsoras, Apostolos; Theotoka, Despoina; Kalliakmanis, Andreas

doi:10.1155/2017/4276047

Cited by 28 publications

(29 citation statements)

References 24 publications

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“…Cardiovascular conditions such as hypertension, coronary artery disease, heart failure, and atrial fibrillation are among the strongest predictors of polypharmacy. 38 Our regression models suggest similar findings, with combined cardiopulmonary diagnoses associated with an estimated 11-fold increase in odds for moderate-severe dyspnea group membership. Clusters of drug prescribing patterns for specific conditions such as cardiovascular conditions, depression-anxiety, or pulmonary conditions may be able to inform optimal approaches to deimplement medications in older adults.…”

Section: Discussionsupporting

confidence: 75%

Polypharmacy Increases Risk of Dyspnea Among Adults With Serious, Life-Limiting Diseases

Akgün

Krishnan

Feder

et al. 2019

Am J Hosp Palliat Care

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Background: Polypharmacy is associated with dyspnea in cross-sectional studies, but associations have not been determined in longitudinal analyses. Statins are commonly prescribed but their contribution to dyspnea is unknown. We determined whether polypharmacy was associated with dyspnea trajectory over time in adults with advanced illness enrolled in a statin discontinuation trial, overall, and in models stratified by statin discontinuation. Methods: Using data from a parallel-group unblinded pragmatic clinical trial (patients on statins ≥3 months with life expectancy of 1 month to 1 year, enrolled in the parent study between June 3, 2011, and May 2, 2013, n = 308/381 [81%]), we restricted analyses to patients with available baseline medication count and ≥1 dyspnea score. Polypharmacy was assessed by self-reported chronic medication count. Dyspnea trajectory group, our primary outcome, was determined over 24 weeks using the Edmonton Symptom Assessment System. Results: The mean age of the patients was 73.8 years (standard deviation [SD]: ±11.0) and the mean medication count was 11.6 (SD: ±5.0). We identified 3 dyspnea trajectory groups: none (n = 108), mild (n = 130), and moderate–severe (n = 70). Statins were discontinued in 51.8%, 48.5%, and 42.9% of patients, respectively. In multivariable models adjusting for age, sex, diagnosis, and statin discontinuation, each additional medication was associated with 8% (odds ratio [OR] = 1.08 [1.01-1.14]) and 16% (OR = 1.16 [1.08-1.25]) increased risk for mild and moderate–severe dyspnea, respectively. In stratified models, polypharmacy was associated with dyspnea in the statin continuation group only (mild OR = 1.12 [1.01-1.24], moderate–severe OR = 1.24 [1.11-1.39]) versus statin discontinuation (mild OR = 1.03 [0.95-1.12], and moderate–severe OR = 1.09 [0.98-1.22]). Conclusion: Polypharmacy was strongly associated with dyspnea. Prospective interventions to decrease polypharmacy may impact dyspnea symptoms, especially for statins.

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Section: Discussionsupporting

confidence: 75%

Polypharmacy Increases Risk of Dyspnea Among Adults With Serious, Life-Limiting Diseases

Akgün

Krishnan

Feder

et al. 2019

Am J Hosp Palliat Care

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“…In this study, the number of medications used was not associated with frailty. However, number of medications used (1-3 medications) was found to be associated with pre-frailty, whereas taking four or more medications was not associated with pre-frailty [48]. When the illness is not well controlled and becomes more severe, the number of medications used is prescribed to achieve optimal control.…”

Section: Discussionmentioning

confidence: 96%

Prevalence and Potential Predictors of Frailty among Community-Dwelling Older Persons in Northern Thailand: A Cross-Sectional Study

Thinuan

Siviroj

Lerttrakarnnon

et al. 2020

IJERPH

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This study aimed to determine the prevalence and associated factors of frailty among Thai older persons. A cross-sectional study was conducted with a representative sample of 1806 older persons aged 60 years or older. Frailty was assessed by Fried’s frailty phenotypes, which consists of five criteria, namely, unintended weight loss, exhaustion, slow walking, weak handgrip and decreased physical activity. Older people who met 3 in 5, 1–2 in 5, and none of the criteria were considered frail, pre-frail and non-frail respectively. The prevalence was calculated and multinomial logistic regression was performed. Prevalence rates of frailty, pre-frailty and non-frailty were 13.9% (95% CI 9.9 to 18.8), 50.9% (95% CI 47.5 to 54.1) and 35.1% (95% CI 31.5 to 39.9), respectively. Increasing age, lower education, having no spouse, poorer health perception, increasing number of comorbidities, osteoarthritis and smaller mid-arm circumference increased the risk of frailty (p < 0.001). The prevalence of geriatric frailty syndrome in this study was much higher than that of developed countries but was lower than that of less developed countries. Factors associated with frailty reflect common characteristics of disadvantaged older persons in Thailand.

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“…Moreover, all of the patients with T2DM had two or more comorbidities. Older patients with T2DM are usually required to take multiple drug regimens to control glycaemic condition and T2DM-associated complications [ 25 ]. The average number of drugs prescribed per prescription during a hospital stay was nine, which is on the higher side compared to the previous studies done on older patients in India (eight), and the USA (eight) [ 26 , 27 , 28 ].…”

Section: Discussionmentioning

confidence: 99%

Potentially Inappropriate Medication Use in Older Hospitalized Patients with Type 2 Diabetes: A Cross-Sectional Study

et al. 2020

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Background: Older patients with type 2 diabetes mellitus (T2DM) are at greater risk of receiving potentially inappropriate medications (PIM) during hospitalization which may result in adverse outcomes. Aim: To evaluate the extent of PIM use in the older population with T2DM during hospitalization in a tertiary care hospital in India. Methods: A cross-sectional study was carried out from August 2019 to January 2020 in a tertiary care teaching hospital among the older population (aged ≥ 65 years) hospitalized with T2DM. Medications prescribed during hospitalization were reviewed following Beers Criteria 2019 to identify the extent of polypharmacy and PIM use. Binary logistic regression was applied to determine the factors associated with PIM use. Results: The mean age of the 150 patients hospitalized with T2DM was 68.85 ± 5.51 years, most of whom were men (54.7%). The participants had at least four comorbidities and were receiving an average of nine medications per day; the median length of hospital stay was 8 days (interquartile range (IQR): 4–19 days). Overall, three quarters (74%) of the participants had at least one PIM prescribed during their hospitalization as per Beers Criteria. Significant factors associated with the use of PIM during hospitalization are patients taking a higher number of medications (odds ratio (OR): 7.85, 95% CI 1.49–41.10), lower creatinine clearance values (OR: 12.90, 95% CI 2.81–59.28) and female patients (OR: 2.29; 95% CI: 1.05–4.97). Conclusions: PIM use is frequently observed in older T2DM patients during hospitalization. Polypharmacy, reduced renal function and female gender are associated with higher PIM use. Engaging clinical pharmacists in evaluating medication appropriateness can improve the outcomes of older patients.

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Diseases Linked to Polypharmacy in Elderly Patients

Cited by 28 publications

References 24 publications

Polypharmacy Increases Risk of Dyspnea Among Adults With Serious, Life-Limiting Diseases

Polypharmacy Increases Risk of Dyspnea Among Adults With Serious, Life-Limiting Diseases

Prevalence and Potential Predictors of Frailty among Community-Dwelling Older Persons in Northern Thailand: A Cross-Sectional Study

Potentially Inappropriate Medication Use in Older Hospitalized Patients with Type 2 Diabetes: A Cross-Sectional Study

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