Factors associated with polypharmacy and the high risk of medication-related problems among older community-dwelling adults in European countries: a longitudinal study

Abstract

Background Polypharmacy can be defined as using five or more medications simultaneously. “Medication-related problems”, an extension of polypharmacy, includes inappropriate prescribing, poor adherence, overdosage, underdosage, inappropriate drug selection, inadequate monitoring, adverse drug effects, and drug interactions. Polypharmacy and the high risk of medication-related problems among older people are associated with adverse health consequences due to drug-drug interactions, drug-disease interactions, and adverse drug effects. This study aims to assess the factors associated with polypharmacy and the high risk of medication-related problems among community-dwelling older people in the Netherlands, Greece, Croatia, Spain, United Kingdom. Method This longitudinal study used baseline and follow-up data from 1791 participants of the Urban Health Center European project. Polypharmacy and the risk of medication-related problems were evaluated at baseline and follow-up using the Medication Risk Questionnaire. We studied factors in the domains (a) sociodemographic characteristics, (b) lifestyle and nutrition, and (c) health and health care use. Hierarchical logistic regression analyses were used to examine the factors associated with polypharmacy and the high risk of medication-related problems. Results Mean age was 79.6 years (SD ± 5.6 years); 60.8% were women; 45.2% had polypharmacy, and 41.8% had a high risk of medication-related problems. Women participants had lower odds of polypharmacy (OR = 0.55;95%CI:0.42–0.72) and a high risk of medication-related problems (OR = 0.50; 95%CI:0.39–0.65). Participants with a migration background (OR = 1.67;95%CI:1.08–2.59), overweight (OR = 1.37; 95%CI:1.04–1.79) and obesity (OR = 1.78;95%CI:1.26–2.51) compared to ‘normal weight’, with lower physical HRQoL (OR = 0.96, 95%CI:0.95–0.98), multi-morbidity (OR = 3.73, 95%CI:2.18–6.37), frailty (OR = 1.69, 95%CI:1.24–2.30), visited outpatient services (OR = 1.77, 95%CI: 1.09–2.88) had higher odds of polypharmacy. The associations with the high risk of medication-related problems were similar. Conclusions Multiple factors in demography, lifestyle, nutrition, and health care use are associated with polypharmacy and the high risk of medication-related problems. Polypharmacy is a single element that may reflect the number of medications taken. The broader content of medication-related problems should be considered to assess the context of medication use among older people comprehensively. These provide starting points to improve interventions to reduce polypharmacy and high risk of medication-related problems. In the meantime, health professionals can apply these insights to identify subgroups of patients at a high risk of polypharmacy and medication-related problems. Trial registration The intervention of the UHCE project was registered in the ISRCTN registry as ISRCTN52788952. The date of registration is 13/03/2017.

Identificando medicações potencialmente inapropriadas em pacientes idosos em ambulatório de Geriatria do Distrito Federal utilizando os Critérios de Beers®

“…Uma pesquisa realizada na universidade da Croácia evidenciou que a polifarmácia foi prevalente em idosos homens mais velhos, que moravam sozinhos (6). Contrariamente, o presente estudo encontrou uma maior prevalência de uso de múltiplos medicamentos no sexo feminino e entre idosos que residem com outros familiares.…”

“…O envelhecimento populacional é um fenômeno global e está associado a muitos desafios em termos de políticas de saúde pública (1)(2)(3). O aumento da longevidade está frequentemente associado ao incremento no número de doenças, incapacidades físicas, cognitivas e mentais, que muitas vezes levam ao uso desproporcional e exagerado de medicamentos, instituindo-se assim a polifarmácia, definida como uso concomitante de 5 ou mais medicamentos (4)(5)(6).…”

Older adults’ attitudes towards deprescribing and medication changes: a longitudinal sub-study of a cluster randomised controlled trial

“…The following variables were used to adjust the analyses: gender, age, educational status, number of chronic conditions, living situation, capable of leaving the house (yes/no), patients’ satisfaction with medications and number of GP visits in the 6 months prior to the study enrolment. The included variables were based on the literature of the factors associated with number of medications/polypharmacy and the factors associated with potentially inappropriate medication use/medication appropriateness considering the data available from the OPTICA trial 28–34…”

Prevalence and Predictors of Excessive Polypharmacy in Geriatric Inpatients: A Retrospective Cross-Sectional Study in Indonesia

“…7 Furthermore, poor self-reported health, diabetes mellitus, depression, pain, heart diseases, and obstructive pulmonary diseases have been identified as risk factors. 8 However, most studies on polypharmacy were conducted in developed countries, while data from low-to-middle-income countries, including Indonesia, are scarce.…”