Drug burden index, polypharmacy and patient health outcomes in cognitively intact older residents of aged care facilities in Malaysia

Abstract

Background The complexity of drug regimens among older people tend to increase over time, as multiple medications are required to treat a single condition. Aim This study examined the association of the drug burden index (DBI) and polypharmacy with patient health outcomes among cognitively intact older residents in aged care facilities (ACFs). Methods A review of prescribed medications and related outcomes was conducted in a cross‐sectional sample of older adults (≥60 years), recruited from 11 ACFs in Peninsular Malaysia. Frailty and quality of life (QoL) were evaluated using the Groningen frailty indicator and ‘Older People's Quality of Life – 35’ questionnaire, respectively; patients’ exposure to anticholinergic and sedative medicines was quantified using the DBI; and the mental health of residents was evaluated using the Hospital Anxiety and Depression Scale. Results More than two‐thirds of a sampled population received at least one anticholinergic or sedative medication and more than one‐quarter was exposed to polypharmacy. Exposure to DBI‐associated medications was noted in three of every four frail participants and was significantly correlated with frailty (r = 0.184, p = 0.023). The frail population had significantly increased risk of polypharmacy (odds ratio 6.07; 95% confidence interval 1.71–21.56; p = 0.005), but exposure to DBI‐associated medications was not significantly associated with overall QoL and activity of daily living measures. Conclusion Polypharmacy and anticholinergic and sedative burden were noticed in a substantial number of older adults in residential aged care facilities and were associated with frailty. Investing in the recruitment of pharmacists may benefit recognition of residential ACF quality of care, because pharmacy services (including pharmacists) are virtually non‐existent in Malaysian residential ACFs.

Prevalence of Drug-Related Problems and Complementary and Alternative Medicine Use in Malaysia: A Systematic Review and Meta-Analysis of 37,249 Older Adults

“…The 27 studies included in the systematic review represented a pool of 37,249 patients, 29,342 of whom were further included in the meta-analysis. Fourteen studies were conducted in the Central region of Malaysia [6,13,[16][17][18][19][20][21][22][23][24][25][26][27], three in the Northern [14,28,29] and Eastern Regions each [11,30,31], and one in Borneo [15]. Three of them were nationwide studies [32][33][34], while the remaining three studies did not specify the participants' regions [35][36][37].…”

“…Six studies took place in nursing homes [14,18,19,21,28,36], 14 in healthcare facilities (hospitals and clinics) [6,11,[15][16][17]20,24,26,27,30,32,33,35,37] and seven in the community [13,22,23,25,29,31,34]. The appropriateness of drug use was assessed using either the medication appropriateness index [15,18], the Beers [13,14,18,21,36] or the START/STOPP criteria [14,18,21,28,30,35,36].…”

Findings from afar and translation closer to home

“…There are other papers to highlight, including the work of Hasan et al and its relevance to work underway in Australia, and of course the newly published Standard of Practice in Geriatric Medicine for Pharmacy Services…”

Residential Medication Management Reviews and continuous polypharmacy among older Australian women

“…Individuals residing in RACs are more frail than their communitydwelling counterparts [8], are likely to have multimorbidity and polypharmacy (five or more medications) [9,10,11], and are at higher risk of medication-related problems [12]. Polypharmacy increases risk of falls, drug interactions, adverse drug reactions, cognitive impairment and poor nutritional status among individuals in RACs [13,14]. Given the range of factors and possible cognitive impairment, these individuals require regular medication reviews and treatment adjustments to optimise medication use [15].…”