Polypharmacy in older patients with chronic diseases: a cross-sectional analysis of factors associated with excessive polypharmacy

Rieckert, Anja; Trampisch, Ulrike; Klaaßen-Mielke, Renate; Drewelow, Eva; Esmail, Aneez; Johansson, Tim; Keller, Sophie; Kunnamo, Ilkka; Löffler, Christin; Mäkinen, Joonas; Piccoliori, Giuliano; Vögele, Anna; Sönnichsen, Andreas

doi:10.1186/s12875-018-0795-5

Cited by 90 publications

(107 citation statements)

References 43 publications

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“…First, polypharmacy was identified using all drugs with a prescription length ≥14 days during the study period. This approach differs from previous studies that analyzed polypharmacy, and might underestimate the number of drugs . In contrast, when a drug was switched to another during the study period, both drugs administered before and after the switch were counted in this study.…”

Section: Discussionmentioning

confidence: 99%

“…This approach differs from previous studies that analyzed polypharmacy, and might underestimate the number of drugs. 9,[11][12][13] In contrast, when a drug was switched to another during the study period, both drugs administered before and after the switch were counted in this study. This might result in overestimating the number of drugs.…”

Section: Discussionmentioning

confidence: 99%

“…Based on previous studies, we defined polypharmacy as the concomitant prescription of five or more drugs in an individual . Here, polypharmacy was divided into two categories: non‐excessive polypharmacy (5–9 drugs) and excessive polypharmacy (≥10 drugs) …”

Section: Methodsmentioning

confidence: 99%

“…11 Here, polypharmacy was divided into two categories: non-excessive polypharmacy (5-9 drugs) and excessive polypharmacy (≥10 drugs). [9][10][11]…”

Section: Identification Of Polypharmacymentioning

confidence: 99%

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Drug prescription patterns and factors associated with polypharmacy in >1 million older adults in Tokyo

Ishizaki

Mitsutake

Hamada

et al. 2020

Geriatrics Gerontology Int

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Aim To determine the patterns of concomitant drug use for chronic diseases and examine the risk factors of polypharmacy in older outpatients. Methods Data were extracted from an anonymized health insurance claims database of a public insurance program for older adults in Tokyo, Japan. We analyzed individuals aged ≥75 years who had visited an outpatient clinic, and were regularly prescribed orally administered drugs for chronic diseases for ≥14 days between May and August 2014. The prescription patterns for 16 main drug types were studied using exploratory factor analysis, and the risk factors of polypharmacy, defined as the concomitant prescription of five or more drugs, were identified using multivariate logistic regression models. Results A total of 1 094 199 outpatients were analyzed (mean age 81.8 years, 38.4% men). We identified five prescription patterns that explained almost 40% of all observed variance: edema/heart failure/atrial fibrillation‐related drugs, insomnia/anxiety‐related drugs, pain‐related drugs, lifestyle disease‐related drugs and dementia‐related drugs. The significant risk factors of polypharmacy included men, octogenarians and nonagenarians, higher number of medical institutions visited, use of physician home visits, and hospitalization during the study period. The main drug types most strongly associated with polypharmacy were analgesics, diuretics and antidiabetics. Conclusions Polypharmacy was found to be prevalent in older outpatients aged ≥75 years in Tokyo. These findings might provide useful evidence that can contribute to the development of practical countermeasures against adverse events associated with polypharmacy in clinical practice. Geriatr Gerontol Int 2020; 20: 304–311.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

“…11 Here, polypharmacy was divided into two categories: non-excessive polypharmacy (5-9 drugs) and excessive polypharmacy (≥10 drugs). [9][10][11]…”

Section: Identification Of Polypharmacymentioning

confidence: 99%

See 2 more Smart Citations

Drug prescription patterns and factors associated with polypharmacy in >1 million older adults in Tokyo

Ishizaki

Mitsutake

Hamada

et al. 2020

Geriatrics Gerontology Int

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“…4 It is likely that mismatches between patients' medication use and the physician's record are more of a problem in chronic diseases. These patients are often treated with a large number of drugs 5 and are cared for by multiple physicians. This is certainly true in advanced CKD, in which care can become fragmented because of the large number of collaborating care providers and suboptimal communication.…”

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confidence: 99%

The Relationship Between Medication Discrepancies and Hospitalization Risk Among Patients With Advanced CKD

Sakhiya

James

Jhaveri

et al. 2020

Kidney International Reports

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This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). M edication discrepancies are common in medicine, posing an ongoing threat to safe patient care. Discrepancies can be defined as any difference between the physician's records and the medications that the patient actually takes, including related dose and frequency. In clinical practice, medication discrepancies are common, occurring in 34% to 95% of patients newly admitted to hospitals. 1,2 The results of a systematic review indicated that 11% to 59% of discrepancies were clinically relevant, 3 and that 39% could potentially cause moderate to severe harm. 1 We have previously reported that medication discrepancies are particularly common in patients with advanced chronic kidney disease (CKD; estimated glomerular filtration rate 0 to 30 ml/min per 1.73 m 2 ) not yet on dialysis, with 55% of patients having at least 1 discrepancy. 4 It is likely that mismatches between patients' medication use and the physician's record are more of a problem in chronic diseases. These patients are often treated with a large number of drugs 5 and are cared for by multiple physicians. This is certainly true in advanced CKD, in which care can become fragmented because of the large number of collaborating care providers and suboptimal communication.The relationship between medication discrepancies and subsequent hospitalizations has been rarely studied in advanced CKD. 6 There are clear reasons to believe that such a relationship would exist. Patients with advanced CKD probably have a high rate of hospitalizations. Improper use of medications could lead to hospitalizations through adverse effects of misused drugs, medical complications, and diminution of anticipated efficacy. In the current study we have analyzed the relationship between the number medication discrepancies in advanced CKD and the risk for hospitalizations over up to a year of follow-up. RESULTSWe enrolled 713 patients with stage 4 to 5 CKD into the baseline cohort, with characteristics displayed in Table 1. The population skewed toward older age, with 62.7% being >65 years. There was a minor underrepresentation of Hispanic patients; comprising only 9% of patients. The vast majority of patients were hypertensive and approximately 50% had diabetes mellitus. During the 1-year assessment period, 23 patients died and 33 patients reached end-stage renal disease. A further 5 patients were lost to follow-up.A total of 392 patients (55.0% of the study population) had at least 1 medication discrepancy. The median number of discrepancies per patient (in patients with at least 1 discrepancy) was 2, (interquartile range, 1-4). A total of 646 patients (90.6%) had 0-5 discrepancies, 56 (7.8%) had 6-10 discrepancies, and 11 (1.5%) had more than 10 discrepancies. Types of discrepancies included patients taking a medication not on the nephrologist's list, patients not taking a medication on the nephrologist's list, different doses, and different dose frequencies. Medication...

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Polypharmacy and Potentially Inappropriate Medication Use in Older Adults With Systemic Lupus Erythematosus

Séguin

Peschken

Dolovich

et al. 2022

Arthritis Care & Research

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Objective To assess the prevalence and potential risk factors for polypharmacy and prescribing of the potentially inappropriate medications, opioids and benzodiazepines/Z‐drugs, in older adults with systemic lupus erythematosus (SLE). Methods The study population comprised adults age ≥50 years meeting American College of Rheumatology or Systemic Lupus International Collaborating Clinics classification criteria followed at a tertiary care rheumatology clinic. Information on prescriptions filled in the 4 months preceding chart review was obtained from the Manitoba Drug Program Information Network. Clinical data, including age, sex, Charlson Comorbidity Index (CCI) score, Systemic Lupus Erythematosus Disease Activity Index 2000 score, prednisone use, SLE duration, and rural residence were abstracted from electronic medical records. Logistic regression analyses were performed to assess any association between polypharmacy (using 2 definitions: ≥5 and ≥10 medications), potentially inappropriate medication use, and clinical features. Results A total of 206 patients (mean age 62 years, 91% female, 36% rural) were included: 148 (72%) filled ≥5 medications, 71 (35%) filled ≥10 medications, 63 (31%) used benzodiazepines/Z‐drugs, and 50 (24%) used opioids. Among the 77 patients age ≥65 years, 57 (74%) filled ≥5 medications, and 26 (34%) filled ≥10 medications, compared to 30% and 4%, respectively, of Manitobans age ≥65 years (National Prescription Drug Utilization Information System, 2016). The odds of polypharmacy were greater with prednisone use (adjusted odds ratio [OR] 3.70 [95% confidence interval (95% CI) 1.40–9.79] for ≥5 medications), CCI score (adjusted OR 1.62 [95% CI 1.20–2.17]), and rural residence (adjusted OR 2.05 [95% CI 1.01–4.18]). Odds of benzodiazepine/Z‐drug use were increased with polypharmacy (adjusted OR 4.35 [95% CI 1.69–11.22]), and odds of opioid use were increased with polypharmacy (adjusted OR 6.75 [95% CI 1.93–23.69]) and CCI score (adjusted OR 1.29 [95% CI 1.08–1.54]). Conclusion The prevalence of polypharmacy in this SLE cohort was higher than in the general Manitoban population. Polypharmacy is a strong marker for use of prescription benzodiazepines/Z‐drugs and opioids.

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Polypharmacy in older patients with chronic diseases: a cross-sectional analysis of factors associated with excessive polypharmacy

Cited by 90 publications

References 43 publications

Drug prescription patterns and factors associated with polypharmacy in >1 million older adults in Tokyo

Drug prescription patterns and factors associated with polypharmacy in >1 million older adults in Tokyo

The Relationship Between Medication Discrepancies and Hospitalization Risk Among Patients With Advanced CKD

Polypharmacy and Potentially Inappropriate Medication Use in Older Adults With Systemic Lupus Erythematosus

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