Prevalence of Chronic Polypharmacy in Community-Dwelling Elderly People in Poland: Analysis of National Real-World Database Helps to Identify High Risk Group

Abstract

Introduction: Multimorbidity often comes with age, making elderly people particularly prone to polypharmacy. Polypharmacy, in turn, is a risk factor for adverse drug reactions, drug-drug interactions, non-adherence to medication, negative health outcomes, and increased healthcare services utilization. The longer the exposure to polypharmacy is, the higher the risk of these consequences is. Therefore, a detailed assessment of the prevalence and drivers of chronic polypharmacy in the elderly is particularly important.Aim of study: To find out the prevalence of chronic polypharmacy in the elderly population of Poland, and to characterize the subgroup with the highest risk of this problem, using real-world data.Methodology: A retrospective analysis of data on dispensation and healthcare services utilization held by the national payer organization for the year 2018. Chronic polypharmacy was defined as possession, as a result of dispensation, of five or more prescribed drugs within 80% of each of the consecutive 6 months.Results: Chronic polypharmacy was found in 554.1 thousand patients, i.e. in 19.1% of the national 65+ cohort. On average, those patients were 76 years old, and 49.3% of them were female. The vast majority (68.6%) continued their polypharmacy for the period of the whole year. There was a marked variation in geographical distribution of chronic polypharmacy with the highest value of 1.7 thousand per 100,000 inhabitants in the Łódź Voivodeship. Patients exposed to chronic polypharmacy filled prescriptions from 4.5±2.36 healthcare professionals. The average number of drugs they used was 8.3±3.84 DDD per patient per day. The most often prescribed drugs were Metformin, Atorvastatin and Pantoprazole. The average annual hospitalisation rate in those patients was 1.03±2.4.Conclusion: This study was the first of this kind involving a nationwide assessment of chronic polypharmacy in Polish elderly people. We found that this problem affected one fifth of Polish older adults and it remains stable due to its direct relation to chronic conditions. Thus, our results confirm that this phenomenon is highly important for the national health policy and requires relevant interventions. The planned introduction of pharmaceutical care in Poland is expected to help in solving the problem.

Aging and the Prevalence of Polypharmacy and Hyper-Polypharmacy Among Older Adults in South Korea: A National Retrospective Study During 2010–2019

“…These results for polypharmacy are similar or higher to those of previous studies, which found that 26–44% of the elderly patients had taken 5 or more medications ( Payne et al, 2014 ; Guthrie et al, 2015 ; Page et al, 2019 ; Khezrian et al. 2020 ; Mabuchi et al, 2020 ; Zhang et al, 2020 ; Kardas et al, 2021 ; Kardas et al, 2021 ; Young et al, 2021 ) and the polypharmacy prevalence in community-dwelling older adults ranged from 7 to 45% ( Hsu et al, 2021 ). The prevalence of hyper-polypharmacy was higher than those reported by other studies ( Guthrie et al, 2015 ; Nishtala and Salahudeen.…”

“…According to previous literature, the prevalence of patients who had been simultaneously prescribed 5 or more medications ranged from 26 to 44% ( Khezrian et al, 2020 ). The prevalence of polypharmacy (5 or more medications) among the elderly was 20.8% in Scotland ( Guthrie et al, 2015 ), 19.1% for chronic polypharmacy within consecutive 6 months in Poland ( Kardas et al, 2021 ), 41.2% in Switzerland ( Blozik et al, 2018 ), 36.8% in the United States ( Young et al, 2021 ), 28.7% in Japan ( Mabuchi et al, 2020 ), and 19% in Sweden ( Zhang et al, 2020 ).…”

Differences in healthcare service utilization in patients with polypharmacy according to their risk level by adjusted morbidity groups: a population-based cross-sectional study

“…The frequency of contacts with PC described for polypharmacy patients tripled that registered by non-polypharmacy patients, and the group of polypharmacy high risk patients registered the highest mean of contacts with PC, pursuant to the fact that the use of PC increases with the number of medicines consumed [ 12 , 21 , 22 , 25 , 34 ]. Almost all patients with polypharmacy used PC services, while a lower percentage of non-polypharmacy patients were PC users, in line with other studies of patients with chronic diseases and with or without polypharmacy [ 14 , 28 , 30 , 35 , 36 ]. The most common type of contact was medical contact in person, in agreement with other studies performed in the Community of Madrid involving patients with chronic diseases and geriatric patients [ 35 , 36 ].…”

“…The most prevalent comorbidities within the polypharmacy population were hypertension, dyslipidaemia, diabetes, osteoporosis, dysrhythmias, arthrosis and obesity, in accordance with other populations with polypharmacy [ 13 , 19 , 27 ] and with the elderly population with polypharmacy [ 12 , 15 , 18 , 21 , 24 – 26 , 28 ]. Our results agree with earlier findings that cardiovascular diseases are more prevalent in men, while arthritis, osteoporosis and thyroid disorder are more prevalent in women [ 12 , 15 , 16 , 18 , 26 ].…”

Pharmacotherapy Problems in Best Possible Medication History of Hospital Admission in the Elderly

“…Patients with renal impairment often experience polypharmacy especially in the later stages of CKD when patients develop numerous metabolic complications that require the prescription of multiple drugs according to guidelines [ 11 , 28 ]. The association between recent hospitalizations and polypharmacy in elderly patients can be explained by the fact that patients with a weaker health status have more complex pharmacotherapy and experience hospitalizations more frequently [ 29 ]. In our research, polypharmacy positively correlated with detected pharmacotherapy problems: PIMs, DDIs, and inappropriately prescribed RRDs and had the highest Spearman coefficient.…”