High Prevalence of Multimorbidity and Polypharmacy in Elderly Patients With Chronic Pain Receiving Home Care are Associated With Multiple Medication-Related Problems

Abstract

Aim: To measure the extent of polypharmacy, multimorbidity and potential medication-related problems in elderly patients with chronic pain receiving home care.Methods: Data of 355 patients aged ≥65 years affected by chronic pain in home care who were enrolled in the ACHE study in Berlin, Germany, were analyzed. History of chronic diseases, diagnoses, medications including self-medication were collected for all patients. Multimorbidity was defined as the presence of ≥2 chronic conditions and levels were classified by the Charlson-Comorbidity-Index. Polypharmacy was defined as the concomitant intake of ≥5 medications. Potentially clinically relevant drug interactions were identified and evaluated; underuse of potentially useful medications as well as overprescription were also assessed.Results: More than half of the patients (55.4%) had moderate to severe comorbidity levels. The median number of prescribed drugs was 9 (range 0–25) and polypharmacy was detected in 89.5% of the patients. Almost half of them (49.3%) were affected by excessive polypharmacy (≥10 prescribed drugs). Polypharmacy and excessive polypharmacy occurred at all levels of comorbidity. We detected 184 potentially relevant drug interactions in 120/353 (34.0%) patients and rated 57 (31.0%) of them as severe. Underprescription of oral anticoagulants was detected in 32.3% of patients with atrial fibrillation whereas potential overprescription of loop diuretics was observed in 15.5% of patients.Conclusion: Multimorbidity and polypharmacy are highly prevalent in elderly outpatients with chronic pain receiving home care. Medication-related problems that could impair safety of drug treatment in this population are resulting from potentially relevant drug interactions, overprescribing as well as underuse.

Patterns of medication management and associated medical and clinical features among home-dwelling older adults: a cross-sectional study in central Portugal

“…Considering the sample's combination of multimorbidity, polypharmacy and a high prevalence of frailty, our participants were exposed to a high risk of MRPs. This nding was corroborated in other studies [44][45] reporting that age-related factors such as multimorbidity, chronic pain, polypharmacy and frailty should be considered when prescribing medication. Taken together, these ndings lead us to recommend the implementation of strategies to reduce modi able risk factors-such as prefrailty and moderate frailty-and to optimise medication adherence, reduce over-use and avoid under-use, all of which could be effective measures for decreasing the risk of MRPs and helping older adults to remain in their homes.…”

Life-course socioeconomic conditions, multimorbidity and polypharmacy in older adults: A retrospective cohort study

“…We see different reasons why the two cohorts have different sample sizes and why the results for multimorbidity and polypharmacy were different. First, while multimorbidity is often accompanied by polypharmacy, it not always does since not every patient with ≥2 chronic conditions regularly uses ≥5 regular medications [ 45 , 46 ]. This is due to the fact that there are also non-pharmacological treatment options for some chronic conditions (e.g., low calorie diet, physical activity, and weight loss for diabetes).…”

Drug-Drug Interaction Potential, Cytotoxicity, and Reactive Oxygen Species Production of Salix Cortex Extracts Using Human Hepatocyte-Like HepaRG Cells

“…The biggest consumers of prescription and over-the-counter medicines are older adults ( Qato et al, 2008 ; Qato et al, 2016 ), and self-medication ( Vacas Rodilla et al, 2009 ; Jerez-Roig et al, 2014 ) as well as consumption of non-prescription medicines, herbal and other dietary supplements in the first place, is widespread among them ( Izzo and Ernst, 2009 ; de Souza Silva et al, 2014 ; Raji et al, 2017 ). Conditions of chronic pain, or other chronic conditions, such as diabetes, heart disease, stroke, or cancer, may experience concurrent use of multiple medications ( Lunsky and Modi, 2018 ; Schneider et al, 2021 ). With the number of drugs, the risk of drug interactions increases exponentially while many drug interactions can be explained by changes in metabolic enzymes in the liver and other extrahepatic tissues.…”

“…Herbal preparations including Salix cortex extracts contain hundreds of phytochemicals that can act in different ways, encompassing the risk of drug interactions that is the ability to modify the action or effect of another drug administered successively or simultaneously. Considering that the usage of pain medication plays a major role in polypharmacy ( Marengoni et al, 2014 ; Schneider et al, 2021 ; Young et al, 2021 ), knowledge of the interaction potential of Salix species is of great importance, as this could help avoid drug-related problems that could affect patients’ safety. An important determinant in the occurrence of drug interaction is the drug metabolism via the cytochrome P450 (CYP450) system ( Guengerich, 2008 ).…”