Frequency and Nature of Medication‐Related Problems in Elderly Indian Inpatients

Abstract

Background: Geriatrics is an emerging clinical specialty in India. Although studies on medication use in the elderly have been conducted in India, data on medication-related problems (MRP) in the hospitalised elderly population are limited. Aim: To determine the prevalence, nature and predictors of MRP, and the significance of pharmacists' interventions following identification of MRP in elderly inpatients. Method: A prospective active surveillance study conducted over 9 months (July 2008 to March 2009) on the medical wards of JSS Hospital, Mysore, India. Patients 60 years and over that were admitted to the medical wards were evaluated. Pharmacists' interventions following identification of MRP were recorded and their potential clinical significance assessed. The organ systems affected and the management of MRP were investigated. Predictors of MRP were identified using bivariate analysis and subsequent multivariate logistic regression. Results: 411 patients were evaluated and 352 MRP were identified in 230 (56%) patients. Adverse drug reactions were the major (53%) MRP. Cardiovascular drugs accounted for 37% of MRP. Insulin (9.4%) was the most frequently implicated drug. MRP commonly involved the nervous system (19%). In 47% of cases, the drug was discontinued as a management strategy. The majority of pharmacists' interventions (314; 90%) were moderate or major in their level of clinical significance. Age was an influential predictor of MRP (OR 2.1; 95%CI 1.1-4.2; p = 0.03). Conclusion: Around half of the hospitalised elderly experienced an MRP. Pharmacists can contribute to geriatric inpatient care by reducing adverse consequences of MRP through early detection and providing advice in managing MRP.