Use of potentially inappropriate medication and polypharmacy in older adults: a repeated cross-sectional study

Abstract

Background: With age, the number of chronic conditions increases along with the use of medications. For several years, polypharmacy has been found to be on the increase in western societies. Polypharmacy is associated with an increased risk of adverse drug events (ADE). Medications called potentially inappropriate medications (PIM) have also been found to increase the risk of ADEs in an older population. In this study, which we conducted during a national information campaign to reduce PIM, we analysed the prevalence of PIM in an older adult population and in different strata of the variables age, gender, number of chronic conditions and polypharmacy and how that prevalence changed over time. Methods: This is a registry-based repeated cross-sectional study including two cohorts. Individuals aged 75 or older listed at a primary care centre in Blekinge on the 31st March 2011 (cohort 1) or on the 31st December 2013 (cohort 2) were included in the respective cohorts. Using a chi2 test, the two cohorts were compared on the variables age, gender, number of chronic conditions and polypharmacy. Use of five or more medications at the same time was the definition for polypharmacy. Results: Use of PIM decreased from 10.60% to 7.04% (p-value <0.001) between 2011 and 2013, while prevalence of five to seven chronic conditions increased from 20.55% to 23.66% (p-value <0.001). Use of PIM decreased in all strata of the variables age, gender number of chronic conditions and polypharmacy. Except for age 80 to ≤ 85 and males, where it increased, prevalence of polypharmacy was stable in all strata of the variables. Conclusions: Use of potentially inappropriate medications had decreased in all variables between 2011 and 2013; this shows the possibility to reduce PIM with a focused effort. Polypharmacy does not increase significantly compared to the rest of the population.

Polypharmacy and Health-Related Quality of Life/Psychological Distress Among Patients With Chronic Disease

“…The 14-item Hospital Anxiety and Depression Scale (HADS) (25) is a brief instrument to determine the presence of anxiety and depressive states. Each item has a 4-point response scale (range, 0-3); 7 items are related to anxiety and 7 items to depression.…”

Polypharmacy and lack of joy predict physical frailty among northern Japanese community-dwellers from the ORANGE cohort study

“…polypharmacy). 16 In Japan, the "Guidelines for Medical Treatment and its Safety in the Elderly 2015" reported that an increase in occurrence of adverse drug events (ADE) is associated with the number of medications, such as six or more kinds of medication. 17 Considering the current information on polypharmacy domestically and overseas, we recorded the follow de nition; (i) polypharmacy of international classi cation based on use of ve or more medications (polypharmacy-IC) and (ii) polypharmacy of Japanese classi cation based on use of six or more medications (polypharmacy-JC), as reported by Kojima et al 17 For this study, we analyzed the presence of polypharmacy in different strata of frailty.…”

Prevalence, predisposing factors and strategies to reduce polypharmacy among older patients in Poland

“…The literature provides a broad and thorough description of the negative medical, economic, and social consequences of polypharmacy (PP), defined as taking 5 and more drugs, and excessive polypharmacy (EPP), which stands for using at least 10 drugs [4]. The negative implications of PP and EPP are a strong motivation for the continuous monitoring of pharmacotherapy in older adults in many countries around the world [5][6][7][8]. There is also growing recognition of the need for implementing deprescribing defined as the process of withdrawal or dose reduction of a drug for which the risk outweighs the benefit in the individual [9].…”