Polypharmacy leads to increased prevalence of potentially inappropriate medication in the Indonesian geriatric population visiting primary care facilities

Abdulah, Rizky; Insani, Widya N.; Destiani, Dika P.; Rohmaniasari, Nurul; Mohenathas, Nithya; Barliana, Melisa Intan

doi:10.2147/tcrm.s170475

Cited by 38 publications

(37 citation statements)

References 46 publications

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“…A study conducted in a university medical centre in Seoul, Korea, among the 25810 outpatients, 7132 (27.6%) did have at least one PIM (Lim et al, 2016). However, the difference in the prevalence of at least one PIM might be due to the difference in study settings, availability of medications, and prescribing pattern (Abdulah et al, 2018).…”

Section: Discussionmentioning

confidence: 99%

Prevalence, Factors and Cost Comparison due to Potentially Inappropriate Medications (PIMs) of Elderly Outpatients in a State Hospital in Malaysia.

Ang

Zulkepli

Safinaz

et al. 2021

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Introduction: Malaysia will be a full aging nation by 2030. The elderly (aged >65 years old) population often has multiple comorbidities, which increases the risk of polypharmacy and potentially inappropriate medications (PIMs). This study aims to investigate the prevalence, factors associated with PIMs among elderly outpatients, and its burden of direct pharmacotherapy cost to the Ministry of Health Malaysia. Materials and method: A cross-sectional study involving clinic prescriptions among the elderly with more than one-month prescribing duration received from a tertiary hospital specialist clinic pharmacy from March to April 2017. Patient identifiers were screened using the Pharmacy Information System (PhIS) by including prescriptions from other clinics while excluding multiple visits and duplicate prescriptions. Patients were categorised as PIM group and non-PIM groups using Beers Criteria 2015. Logistic regression analysis was conducted to examine the factors associated with PIMs. The median monthly prescription cost was compared between PIM and non-PIM groups by Mann-Whitney test. Results: Among 472 patients, 39.4% of patients had at least one PIM while 60.6% of patients did not receive any PIM. The number of medications prescribed was an independent risk factor contributing to PIMs (OR:2.04; 95% CI:1.40, 2.97). The median monthly prescription cost for the PIM group was MYR 29.50 (?USD 7.53) which was not statistically significant (p=0.735) compared with the non-PIM group which was MYR 28.50 (USD 7.28). Conclusion: PIM was frequently prescribed in our setting with the number of medications as the only factor. However, the prescribing of PIM did not add nor reduce the direct cost of pharmacotherapy.

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Section: Discussionmentioning

confidence: 99%

Prevalence, Factors and Cost Comparison due to Potentially Inappropriate Medications (PIMs) of Elderly Outpatients in a State Hospital in Malaysia.

Ang

Zulkepli

Safinaz

et al. 2021

JoP

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“…International studies have shown prevalence rates of 43% in Canada [ 15 ], 42,7% in New Zealand [ 11 ], and 46.1% in Portugal [ 41 ]. In Asian countries, the prevalence was 12.7% in Oman [ 42 ], 34.0% in India [ 43 ], 39.4% in Indonesia [ 44 ], 53,1% in Kuwait [ 14 ], and 59.3% in Thailand [ 45 ]…”

Section: Discussionmentioning

confidence: 99%

Potentially inappropriate medications for the elderly: Incidence and impact on mortality in a cohort ten-year follow-up

et al. 2020

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Introduction Pharmacological therapy plays an important role in disease control in the elderly; unfortunately, this comes with a high prevalence in the use of medications classified as potentially inappropriate. Objective To analyze the incidence, risk factors, and survival of elderly people using potentially inappropriate medications (PIM). Method A ten-year follow-up assessment of elderly participants residing in a capital of Central Brazil was conducted. The initial assessment (baseline) included 418 elderly people. Data were collected through home interviews guided by a questionnaire covering socioeconomic, demographic, living conditions, and health variables. The medication information obtained comprised active ingredient, dosage, route, and regimen for the medications. The PIMs were classified according to 2019 Beers Criteria. The analyses were performed using STATA 15.0. For survival analysis, a Cox Regression was performed with the respective Kaplan Meier curve. Results The incidence of PIM was 44.1 cases (95% CI: 35.2–54.7) per 1,000 people a year. The most used PIMs were nifedipine, glibenclamide, and sodium diclofenac. The risk factors were polypharmacy (aRR: 3.00; 95% CI: 1.31–6.88) and diabetes mellitus (aRR: 1.57; 95% CI: 1.03–2.39). We identified no statistically significant association between survival and the use of PIM. Conclusion The study highlights the high consumption of PIM among the elderly causing polypharmacy risks. Health professionals working in drug treatment need to be alert to polypharmacy risks to ensure the rational use of medications to prevent adverse reactions and other health problems.

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“…More than 40% of older adults aged 65 years and over and an even higher percentage of older nursing home residents have polypharmacy [ 1 , 2 ]. Polypharmacy can be problematic as it is associated with a higher risk of being prescribed potentially inappropriate medications (PIMs) [ 3 ]. One third of adults aged 65 years and over are taking at least one PIM [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

General practitioners’ deprescribing decisions in older adults with polypharmacy: a case vignette study in 31 countries

et al. 2021

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Background General practitioners (GPs) should regularly review patients’ medications and, if necessary, deprescribe, as inappropriate polypharmacy may harm patients’ health. However, deprescribing can be challenging for physicians. This study investigates GPs’ deprescribing decisions in 31 countries. Methods In this case vignette study, GPs were invited to participate in an online survey containing three clinical cases of oldest-old multimorbid patients with potentially inappropriate polypharmacy. Patients differed in terms of dependency in activities of daily living (ADL) and were presented with and without history of cardiovascular disease (CVD). For each case, we asked GPs if they would deprescribe in their usual practice. We calculated proportions of GPs who reported they would deprescribe and performed a multilevel logistic regression to examine the association between history of CVD and level of dependency on GPs’ deprescribing decisions. Results Of 3,175 invited GPs, 54% responded (N = 1,706). The mean age was 50 years and 60% of respondents were female. Despite differences across GP characteristics, such as age (with older GPs being more likely to take deprescribing decisions), and across countries, overall more than 80% of GPs reported they would deprescribe the dosage of at least one medication in oldest-old patients (> 80 years) with polypharmacy irrespective of history of CVD. The odds of deprescribing was higher in patients with a higher level of dependency in ADL (OR =1.5, 95%CI 1.25 to 1.80) and absence of CVD (OR =3.04, 95%CI 2.58 to 3.57). Interpretation The majority of GPs in this study were willing to deprescribe one or more medications in oldest-old multimorbid patients with polypharmacy. Willingness was higher in patients with increased dependency in ADL and lower in patients with CVD.

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Polypharmacy leads to increased prevalence of potentially inappropriate medication in the Indonesian geriatric population visiting primary care facilities

Cited by 38 publications

References 46 publications

Prevalence, Factors and Cost Comparison due to Potentially Inappropriate Medications (PIMs) of Elderly Outpatients in a State Hospital in Malaysia.

Prevalence, Factors and Cost Comparison due to Potentially Inappropriate Medications (PIMs) of Elderly Outpatients in a State Hospital in Malaysia.

Potentially inappropriate medications for the elderly: Incidence and impact on mortality in a cohort ten-year follow-up

General practitioners’ deprescribing decisions in older adults with polypharmacy: a case vignette study in 31 countries

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