Medication profile and polypharmacy in adults with pediatric-onset spinal cord injury

Abstract

Study design: Cross-sectional survey. Objectives: To describe the medications taken by individuals who had sustained a spinal cord injury (SCI) in childhood or adolescence (age o19 years) and to report the prevalence of polypharmacy and its association with demographic, injury-related and psychosocial factors. Setting: Community. Methods: Structured interviews of adults with pediatric-onset SCI. Routine medications and secondary health conditions (SHCs) experienced were recorded. Polypharmacy was defined as the concomitant use of five or more different types of medications. Bivariate analyses and multiple regression models were conducted to determine associations between polypharmacy and demographic factors, injury-related factors, number of SHCs and psychosocial outcomes (FIM, SF-12v2 Health Survey, CHART, PHQ-9). Results: A total of 159 participants (male, 63%; tetraplegia, 59%) with mean age 35.0 ± 6.2 years (range, 26.7-50.9 years) were included. Most common routine medications were muscle relaxants (50.3%), bladder medications (48.5%), bowel agents (41.5%), analgesics (26.4%) and antidepressants (16.9%). Polypharmacy was present in 30.8% (n, 49) and was more prevalent in those with tetraplegia (40.2% vs 17.9%; P = 0.003). Participants with polypharmacy were older, had lower FIM, CHART and SF-12v2 scores, and higher PHQ-9 scores. Regression models indicate the total number of SHCs, time since injury and tetraplegia to be significant positive predictors of polypharmacy. Conclusion: Duration of SCI and SHCs are risk factors for polypharmacy in this population of adults with SCI. Measures should be taken to prevent the occurrence of SHCs throughout adulthood so as to prevent the potentially adverse physiological effects and psychosocial outcomes associated with polypharmacy.

Medication adherence for persons with spinal cord injury and dysfunction from the perspectives of healthcare providers: A qualitative study

“…[6][7][8] As a result, treatment plans are often complex, 9,10 involving the concomitant use of multiple medications (i.e. polypharmacy), [11][12][13][14] which often include high-risk prescription drugs (e.g. opioids, benzodiazepines).…”

“The strategies are the same, the problems may be different”: a qualitative study exploring the experiences of healthcare and service providers with medication therapy management for individuals with spinal cord injury/dysfunction

“…People with spinal cord injury or dysfunction (SCI/D) typically take multiple medications (also known as polypharmacy) to manage secondary health complications (e.g., spasticity, urinary tract infections, pressure sores, respiratory infections) and multimorbidity (e.g., heart disease and diabetes) [1][2][3][4][5][6]. The reported polypharmacy rates among persons with SCI/D vary between 31 to 87% [6][7][8][9]. Pharmacotherapeutic treatment plans for persons with SCI/D often include a combination of prescription and over-the-counter medications and natural health products.…”

“…While a small body of research identifies a high prevalence of polypharmacy among persons with SCI/D [6][7][8][9], there remains a lack of critical research to help understand the experiences of different healthcare and service providers with MTM for this population. Therefore, the main purpose of this study is to understand the experiences of healthcare and service providers with MTM for persons with SCI/D, as well as the barriers and enablers of optimal MTM.…”

Polypharmacy and adverse drug events among propensity score matched privately insured persons with and without spinal cord injury

“…In 1998, Hope and Kailis [11] reported an average of more than eight prescription medications among 88 participants with SCI who were treated at a regional SCI center. More recent work [12] suggests that 30% of adults with pediatric onset SCI and 56% of persons with adult onset traumatic or non-traumatic SCI [13] take five or more concomitant medications. Among adults with pediatric onset SCI, those with tetraplegia and more secondary health conditions have the highest rates of polypharmacy [12].…”

“…More recent work [12] suggests that 30% of adults with pediatric onset SCI and 56% of persons with adult onset traumatic or non-traumatic SCI [13] take five or more concomitant medications. Among adults with pediatric onset SCI, those with tetraplegia and more secondary health conditions have the highest rates of polypharmacy [12]. Moreover, when compared to an age and gender-matched control population, persons with SCI are prescribed with significantly more total medications, drugs from high-risk categories, and multiple medications within drug categories [13].…”