Polypharmacy and Inappropriate Prescribing in Elderly Patients; A study at Buriadah Central Hospital

Abstract

Background Aging has been attributed to better access to health care and the availability of treatment for many diseases which were untreatable years ago. However, this resulted in more elderly patients being prescribed many drugs to treat different conditions. Although this helped them to live longer, being on multiple drugs increases the risk of drug-drug interactions (DDIs), medication errors, adverse drug reactions (ADR), poor adherence and multiple hospital admissions. This study aimed to investigate polypharmacy and inappropriate prescribing among elderly patients at Buriadah Central Hospital (BCH), Qassim region. Method This study was a mixed mode study of two phases; the first phase is a retrospective in which the electronic files of patients aged ≥ 60 years were reviewed and investigated for polypharmacy and inappropriately prescribed drugs using Beer's criteria 2019. The second phase is a prospective study (questionnaire survey) of polypharmacy and its consequences in elderly population aged ≥ 60 years. Results For the retrospective phase of the study 1123 patients met the eligibility criteria. Age range was 60–102 with a mean of 71.9 years. Three hundred eighty-seven patients (34.46%) were using five medications while the remaining was using more than five medications. The prevalence of potentially inappropriate medications (PIMs) was 66.25%. The most iv encountered PIMs prescribed were NSAIDS, baclofen, proton pump inhibitors, diuretics, and aspirin 11.3%, 10.6%, 10.1%, 8.46% and 5.6% respectively. PIMs involved also medications dispensed at unadjusted doses and DDIs. In the prospective phase, a total of 405 patients agreed to participate in the survey. Age range was 60–97 with a mean of 71.4 years. Of the 405 patients, 133 (32.8%) were prescribed five medications while the remaining 67.2% were using more than five medications. Fifty-two percent of the respondents reported suffering difficulties in tracking their medications, 29.3% found difficulty in taking their medications. More than 40% couldn’t describe the purpose of their medications. Moreover, around 50 % of the patients were not confident at describing the instructions of their medications and 49% of patients experienced at least one ADR. Conclusion This study showed that polypharmacy is a serious issue in elderly population comprising third of patients at or over the age of 60. Also, it showed a high prevalence of PIMs that should be avoided or used with caution in elderly patients. The prevalence of polypharmacy was found to be associated with aging and increased number of comorbidities. Furthermore, polypharmacy affects patients' ability to take, track and describe their medications in terms of dosing, indications and instruction of use. DDIs and ADRs are also common issues in elderly patients that require thorough monitoring. Moreover, renal and heart failure patients are at increased risk of inappropriate prescribing. Thus, clinicians are encouraged to be extra vigilant when processing medication orders for elderly patients especially those on polypharmacy.