Factors associated with polypharmacy in primary care: a cross-sectional analysis of data from The English Longitudinal Study of Ageing (ELSA)

Abstract

ObjectivesWhile older age and ill health are known to be associated with polypharmacy, this paper aims to identify whether wealth, body mass index (BMI), smoking and alcohol consumption are also associated with polypharmacy (5–9 prescribed medications) and hyperpolypharmacy prevalence (≥10 prescribed medications), among older people living in England.DesignCross-sectional study.SettingThe English Longitudinal Study of Ageing Wave 6 (2012–2013).Participants7730 participants aged over 50 years.Data synthesisTwo multivariate models were created. HR with corresponding 95% CI, for polypharmacy and hyperpolypharmacy, were calculated after adjusting for gender, age, wealth, smoking, alcohol consumption, BMI, self-rated health and the presence of a chronic health condition.ResultsLower wealth (lowest wealth quintile vs highest wealth quintile, adjusted HR 1.28; 95% CI 1.04 to 1.69, P=0.02) and obesity (adjusted HR 1.81; 95% CI 1.53 to 2.15, p<0.01) were significantly associated with polypharmacy. Increasing age (50–59 years vs 70–79 years, adjusted HR 3.42; 95% CI 2.81 to 4.77, p<0.01) and the presence of a chronic health condition (adjusted HR 2.94; 95% CI 2.55 to 3.39, p<0.01) were also associated with polypharmacy. No statistically significant association between smoking and polypharmacy (adjusted HR 1.06; 95% CI 0.86 to 1.29, P=0.56) was established; while, very frequent alcohol consumption (consuming alcohol >5 times per week) was inversely associated with polypharmacy (never drank alcohol vs very frequently, adjusted HR 0.64; 95% CI 0.52 to 0.78, p<0.01). The adjusted HR for hyperpolypharmacy was accentuated, compared with polypharmacy.ConclusionThis study has identified that lower wealth, obesity, increasing age and chronic health conditions are significantly associated with polypharmacy and hyperpolypharmacy prevalence. The effect of these factors, on polypharmacy and especially hyperpolypharmacy prevalence, is likely to become more pronounced with the widening gap in UK wealth inequalities, the current obesity epidemic and the growing population of older people. The alcohol findings contribute to the debate on the relationship between alcohol consumption and health.

Polypharmacy in a semirural community in Chile: Results from Maule Cohort

“…Consistent with our results, previous literature reported age, sex, higher BMI, and bad self‐reported health as factors increasing the odds of polypharmacy in middle‐aged adult and older populations . We further evaluated associations of polypharmacy with specific diseases: diabetes increased the odds of polypharmacy by 2.3‐fold, hypertension by 3.8‐fold, dyslipidemia by 2.8‐fold, and osteomuscular diseases by 2.4‐fold.…”

Ongoing activities to influence the prescribing of proton pump inhibitors within the Scottish National Health Service: their effect and implications

“…We believe the appreciably increased prescribing of PPIs over the years (Figure 1) has been influenced by the high prevalence of dyspepsia in the UK, concerns with the extent of admissions to UK hospitals due to GI bleeding, increasing elderly patients increasing the extent of polypharmacy and the need for anti-coagulation as well as studies demonstrating the effectiveness of PPIs versus H2 antagonists in preventing as well as healing ulcers (6,9,10,12,17,18,(73)(74)(75). However, we cannot say with certainty without further qualitative research.…”

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

“…Previous studies have investigated the prescription patterns of drugs that tend to be used concurrently in patients with hypertension, diabetes, psychiatric disorders and other diseases . However, few studies have identified the prescription patterns of drugs frequently administered concomitantly to older outpatients …”

“…7 However, few studies have identified the prescription patterns of drugs frequently administered concomitantly to older outpatients. 8 Polypharmacy in older adults can be identified through the examination of patient-level medication lists from medical institutions. However, a non-negligible proportion of older adults might receive care for chronic diseases at multiple clinics, making it difficult to obtain comprehensive data on all prescribed drugs.…”