Patient and physician factors contributing to polypharmacy among older patients

Martinez, Kathryn A.; Linfield, Debra T.; Gupta, Neena; Alapati, Mohana Vamsi; Moussa, Daniel; Hu, Bo; Kim, Luke Dogyun; Lam, Simon W.; Russo-Alvarez, Giavanna; Rothberg, Michael B.

doi:10.1080/03007995.2021.1982683

Cited by 3 publications

(4 citation statements)

References 21 publications

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“…Income is directly associated with ownership of private medical health insurance [ 44 ], which contribute to the increase of polypharmacy, corroborating previous studies [ 13 , 14 , 19 , 45 , 46 ]. The possession of private health plans can favor access to health services and, consequently, to doctors and specialists [ 47 ].…”

Section: Discussionsupporting

confidence: 85%

“…Despite the hypothesis supported by some studies that polypharmacy is associated with sociodemographic factors such as age [ 15 , 16 ], gender [ 15 , 16 ], income [ 17 ], worse health conditions [ 18 ], and access to health services [ 19 , 20 ], this information is mostly from studies conducted in high-income countries and information for Latin America, including Brazil, is scarce [ 13 ]. The identification of polypharmacy determinants can contribute to the screening of vulnerable individuals in the early stages and reduce inappropriate polypharmacy [ 20 ], in addition to supporting the implementation of strategies to monitor the use of medications and prevent adverse events in the older population.…”

Section: Introductionmentioning

confidence: 99%

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Polypharmacy among older adults in Brazil: Association with sociodemographic factors and access to health services

Ramos

Boing

Andrade

et al. 2022

Dialogues in Health

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Section: Discussionsupporting

confidence: 85%

Section: Introductionmentioning

confidence: 99%

Polypharmacy among older adults in Brazil: Association with sociodemographic factors and access to health services

Ramos

Boing

Andrade

et al. 2022

Dialogues in Health

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“…However, it may be speculated that it relates to Greenland mainly consisting of small communities with only a few doctors, as the number of prescribers has been found to have a positive association with the number of prescribed drugs among care home residents. 14 , 31 In addition, recent hospital discharge 6 , 13 has been found to correlate positively with the number of prescribed drugs, and as the only hospital in Greenland is located in Nuuk, care home residents outside of the capital are often treated locally by their regular physicians. It could also be speculated that residents outside of the capital may be underdiagnosed and therefore undertreated due to lack of access to advanced diagnostics, and the Charlson comorbidity index (CCI) score has been found to be positively correlated with the number of prescribed drugs.…”

Section: Discussionmentioning

confidence: 99%

Polypharmacy and potential drug–drug interactions among Greenland’s care home residents

Albertsen

Sommer

Olsen

et al. 2022

Therapeutic Advances in Drug Safety

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Background: As lifetime expectancy in Greenland is steadily increasing, so is the proportion of elderly Greenlanders. Old age is associated with polypharmacy, and in this study, we aim to describe the prevalence and characteristics of polypharmacy among the care home residents in Greenland. Methods: Eight care homes in Greenland were visited between 2010 and 2016. Questionnaires including information on prescribed medication and comorbidities were collected and analyzed. Drugs were categorized according to Anatomical Therapeutic Chemical (ATC) category, and potential drug–drug interactions (pDDIs) were assessed using the Danish Interaction Database. Polypharmacy was defined as five or more prescribed drugs. Results: All 244 eligible residents were included in the study. The median number of prescribed drugs per resident was six, and women were prescribed more drugs than men (median six versus five). More than 60% of all residents fulfilled the criteria for polypharmacy. The residents in the polypharmacy group had a higher body mass index (26.9 versus 24.3) and more chronic diseases (median two versus one), and more often pulmonary (14% versus 1%) or endocrine disease (22% versus 2%) than in the non-polypharmacy group. The most prescribed drugs belonged to ATC category N (nervous system, 78% of the residents). Finally, pDDIs were found among 61% of the residents and were more common in the capital (77%), which also had the highest proportion of residents with polypharmacy (77%). Conclusion: This is the first study to describe the patterns of polypharmacy and pDDIs among the elderly in care homes in Greenland. Our findings indicate that polypharmacy is as common in Greenland as elsewhere in the Western world, but there are local differences in the prevalence. Plain Language Summary Polypharmacy among the elderly in care homes in Greenland The lifetime expectancy of the Greenlandic population is increasing, and so is the number of elderly Greenlanders. Previous studies have shown that the elderly have a higher risk of being treated with five drugs or more which is called polypharmacy. Polypharmacy can cause unwanted interactions and side effects. In this study, we examine the characteristics of the residents in Greenlandic care homes belonging to this group. Using questionnaires, we gathered information from 244 residents from care homes in eight different towns and settlements in Greenland. Data included types of medication prescribed to the resident, age, gender, cause of stay, and medical history, which allowed us to compare the results between genders and towns. We found that among 244 residents, more than half of all residents were prescribed five or more different drugs, and women were generally prescribed more drugs than men. Those prescribed five or more drugs had a higher body mass index and more diseases than those prescribed fewer drugs. We also found that certain types of medication, mainly painkillers, were the most prescribed. Finally, residents in the care home in Greenland’s capital Nuuk were more often prescribed five or more drugs than elsewhere in Greenland, indicating local differences in Greenland. Our results give an essential insight into the health and medication of the most fragile elderly in Greenland. Polypharmacy seems to be as common here as elsewhere in the Western world and is a point of focus.

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“…However, it can also hint at (in)appropriateness because some of the variability may be due to medication over- (or under-)use, and the risk of prescribing potentially inappropriate medications is higher among physicians with a more liberal attitude towards prescribing. ( Martinez et al, 2021 ). Hence, several studies have investigated practitioner variability in polypharmacy: A study from Swedish general practice found that the prevalence of polypharmacy varied by a factor of six among all GPs, whereas studies from Germany and the Netherlands found factors of 3.6 and 2.4, respectively ( Bjerrum et al, 1999 ; Grimmsmann and Himmel, 2009 ; Sinnige et al, 2016 ).…”

Section: Discussionmentioning

confidence: 99%

Prescription Rates, Polypharmacy and Prescriber Variability in Swiss General Practice—A Cross-Sectional Database Study

et al. 2022

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Purpose: The frequency of medication prescribing and polypharmacy has increased in recent years in different settings, including Swiss general practice. We aimed to describe patient age- and sex-specific rates of polypharmacy and of prescriptions of the most frequent medication classes, and to explore practitioner variability in prescribing.Methods: Retrospective cross-sectional study based on anonymized electronic medical records data of 111 811 adult patients presenting to 116 Swiss general practitioners in 2019. We used mixed-effects regression analyses to assess the association of patient age and sex with polypharmacy (≥5 medications) and with the prescription of specific medication classes (second level of the Anatomical Therapeutic Chemical Classification System). Practitioner variability was quantified in terms of the random effects distributions.Results: The prevalence of polypharmacy increased with age from 6.4% among patients aged 18–40 years to 19.7% (41–64 years), 45.3% (65–80 years), and 64.6% (81–92 years), and was higher in women than in men, particularly at younger ages. The most frequently prescribed medication classes were antiinflammatory and antirheumatic products (21.6% of patients), agents acting on the renin-angiotensin system (19.9%), analgesics (18.7%), and drugs for acid related disorders (18.3%). Men were more often prescribed agents targeting the cardiovascular system, whereas most other medications were more often prescribed to women. The highest practitioner variabilities were observed for vitamins, for antiinflammatory and antirheumatic products, and for mineral supplements.Conclusion: Based on practitioner variability, prevalence, and risk potential, antiinflammatory drugs and polypharmacy in older patients appear to be the most pressing issues in current drug prescribing routines.

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Patient and physician factors contributing to polypharmacy among older patients

Cited by 3 publications

References 21 publications

Polypharmacy among older adults in Brazil: Association with sociodemographic factors and access to health services

Polypharmacy among older adults in Brazil: Association with sociodemographic factors and access to health services

Polypharmacy and potential drug–drug interactions among Greenland’s care home residents

Prescription Rates, Polypharmacy and Prescriber Variability in Swiss General Practice—A Cross-Sectional Database Study

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