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Pierson T, Arcand V, Farrell B, Gagnon CL, Leung L, McCarthy LM, Murphy AL, Persaud N, Raman-Wilms L, Silvius JL, Steinman MA, Tannenbaum C, Thompson W, Trimble J, Sadowski CA, McDonald EG. Proceedings of the Canadian Medication Appropriateness and Deprescribing Network's 2023 National Meeting. Drug Saf 2024; 47:829-839. [PMID: 38884849 PMCID: PMC11324714 DOI: 10.1007/s40264-024-01444-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2024] [Indexed: 06/18/2024]
Affiliation(s)
- Tiphaine Pierson
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Verna Arcand
- Kipohtakaw Education Centre, Alexander First Nations, Sturgeon County, AB, Canada
| | - Barbara Farrell
- Bruyėre Research Institute, Ottawa, ON, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
- University of Waterloo School of Pharmacy, Waterloo, ON, Canada
| | - Camille L Gagnon
- Canadian Medication Appropriateness and Deprescribing Network, Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Montréal, QC, Canada
| | - Larry Leung
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Lisa M McCarthy
- Bruyėre Research Institute, Ottawa, ON, Canada
- University of Waterloo School of Pharmacy, Waterloo, ON, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
- Institute for Better Health and Family Department, Trillium Health Partners, Mississauga, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Andrea L Murphy
- College of Pharmacy, Dalhousie University, Halifax, NS, Canada
| | - Nav Persaud
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Department of Family and Community Medicine, St Michael's Hospital, Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Lalitha Raman-Wilms
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Centre on Aging, University of Manitoba, Winnipeg, MB, Canada
| | - James L Silvius
- Canadian Medication Appropriateness and Deprescribing Network, Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Montréal, QC, Canada
- Provincial Seniors Health and Continuing Care, Alberta Health Services, Calgary, AB, Canada
- Division of Geriatric Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Michael A Steinman
- University of California San Francisco and San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Cara Tannenbaum
- Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Wade Thompson
- Department of Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - Cheryl A Sadowski
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada
| | - Emily G McDonald
- Canadian Medication Appropriateness and Deprescribing Network, Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Montréal, QC, Canada.
- Division of Experimental Medicine, Department of Medicine, McGill University Health Centre, Office 3E.03, 5252 De Maisonneuve Blvd, Montreal, QC, H4A3S9, Canada.
- Division of General Internal Medicine, Department of Medicine, McGill University Health Centre, Montréal, QC, Canada.
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Galicia Ernst I, Worf I, Tarantino S, Hiesmayr M, Volkert D. Obesity in European nursing homes participating in nutritionDay 2016-2021-Prevalence and resident characteristics. Clin Obes 2024:e12697. [PMID: 39098644 DOI: 10.1111/cob.12697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 06/27/2024] [Accepted: 07/20/2024] [Indexed: 08/06/2024]
Abstract
The objective of this study is to assess obesity prevalence and characterize European nursing home (NH) residents with obesity comprehensively. Cross-sectional nutritionDay data from 2016 to 2021. Descriptive characterization of European NH residents ≥65 years with and without obesity. Binomial logistic regression to identify factors associated with obesity. A total of 11 327 residents (73.8% female, 86.4 ± 7.9 years, mean body mass index 25.3 ± 5.4 kg/m2) from 12 countries were analysed. Obesity prevalence was 17.7%, mostly class I (13.0%). Taking ≥5 drugs/day (OR 1.633; 95% confidence intervals 1.358-1.972), female sex (1.591; 1.385-1.832), being bed/chair-bound (1.357; 1.146-1.606), and having heart/circulation/lung disease (1.276; 1.124-1.448) was associated with increased obesity risk, older age (0.951; 0.944-0.958), mild (0.696; 0.601-0.805) and severe (0.591; 0.488-0.715) dementia, eating less than ¾ of lunch on nutritionDay (0.669; 0.563-0.793), needing assistance for eating (0.686; 0.569-0.825), and being identified by NH staff at risk for (0.312; 0.255-0.380) or with malnutrition (0.392; 0.236-0.619) decreased obesity risk. Almost one in five residents in European NH participating in nutritionDay is affected by obesity. Through a wide exploratory analysis, including data from 12 European countries, we confirmed previous findings and identified additional factors associated with obesity that should be considered in the daily care of affected residents.
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Affiliation(s)
- Isabel Galicia Ernst
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
| | - Isabella Worf
- CeMSIIS - Center for Medical Statistics, Informatics and Intelligent Systems, Medical University Vienna, Vienna, Austria
| | - Silvia Tarantino
- CeMSIIS - Center for Medical Statistics, Informatics and Intelligent Systems, Medical University Vienna, Vienna, Austria
| | - Michael Hiesmayr
- CeMSIIS - Center for Medical Statistics, Informatics and Intelligent Systems, Medical University Vienna, Vienna, Austria
| | - Dorothee Volkert
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
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Kosana P, Wu K, Tassiopoulos K, Letendre S, Ma Q, Paul R, Ellis R, Erlandson KM, Farhadian SF. Polypharmacy Is Associated With Slow Gait Speed and Recurrent Falls in Older People With HIV. Clin Infect Dis 2024; 78:1608-1616. [PMID: 38147306 PMCID: PMC11175684 DOI: 10.1093/cid/ciad782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/01/2023] [Accepted: 12/12/2023] [Indexed: 12/27/2023] Open
Abstract
BACKGROUND Older people with human immunodeficiency virus (HIV, PWH) are prone to using multiple medications due to higher rates of medical comorbidities and the use of antiretroviral therapy (ART). We assessed the prevalence and clinical impact of polypharmacy among PWH. METHODS We leveraged clinical data from the AIDS Clinical Trials Group A5322 study "Long-Term Follow-up of Older HIV-infected Adults: Addressing Issues of Aging, HIV Infection and Inflammation" (HAILO). We included PWH aged ≥40 years with plasma HIV RNA levels <200 copies/µL. We assessed the relationship between polypharmacy (defined as the use of 5 or more prescription medications, excluding ART) and hyperpolypharmacy (defined as the use of 10 or more prescription medications, excluding ART) with slow gait speed (less than 1 meter/second) and falls, including recurrent falls. RESULTS Excluding ART, 24% of study participants had polypharmacy and 4% had hyperpolypharmacy. Polypharmacy was more common in women (30%) than men (23%). Participants with polypharmacy had a higher risk of slow gait speed (odds ratio [OR] = 1.78; 95% confidence interval [CI] = 1.27-2.50) and increased risk of recurrent falls (OR = 2.12; 95% CI = 1.06-4.23). The risk for recurrent falls was further increased in those with hyperpolypharmacy compared with those without polypharmacy (OR = 3.46; 95% CI = 1.32-9.12). CONCLUSIONS In this large, mixed-sex cohort of PWH aged ≥40 years, polypharmacy was associated with slow gait speed and recurrent falls, even after accounting for medical comorbidities, alcohol use, substance use, and other factors. These results highlight the need for increased focus on identifying and managing polypharmacy and hyperpolypharmacy in PWH.
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Affiliation(s)
- Priya Kosana
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA
| | - Kunling Wu
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Katherine Tassiopoulos
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Scott Letendre
- Department of Medicine, University of California San Diego, San Diego, California, USA
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
| | - Qing Ma
- School of Pharmacy and Pharmaceutical Sciences, University of Buffalo, Buffalo, New York, USA
| | - Robert Paul
- Department of Psychological Sciences, University of Missouri–St.Louis, St. Louis, Missouri, USA
| | - Ronald Ellis
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
- Department of Neurosciences, University of California San Diego, San Diego, California, USA
| | - Kristine M Erlandson
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Shelli F Farhadian
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA
- Department of Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, Connecticut, USA
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Alhalaseh L, Makahleh H, Al-Saleem B, Al-Omran F, Schoenmakers B. Functional Status in Relation to Common Geriatric Syndromes and Sociodemographic Variables - A Step Forward Towards Healthy Aging. Clin Interv Aging 2024; 19:901-910. [PMID: 38779378 PMCID: PMC11110820 DOI: 10.2147/cia.s462347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 05/04/2024] [Indexed: 05/25/2024] Open
Abstract
Purpose Geriatric syndromes (GS) are prevalent in the older population, with an impact on morbidity and disability. This study aimed to investigate the prevalence of functional dependence and ten GS in community older adults and to examine the different associations between these syndromes and sociodemographic variables and their impact on functional dependence. Patients and Methods A cross-sectional study of 342 outpatients seen at the geriatric clinic in the period 2015-2023. Results The mean age was 75±7.4. One-third had functional dependence and 96.2% had at least one GS. The mean number of GS was 3.11±1.74, ranging from 2.56±1.67 in the 60s to 3.55±1.70 in octogenarians. The most common GS found were polypharmacy (79.5%), musculoskeletal pain (49.7%), and Major Neurocognitive Disorder (MND) (32.7%). Polypharmacy was significantly associated with female sex and chronic pain, whereas sensory impairment was associated with male sex. MND, dizziness, and urinary incontinence were the only GS that significantly predicted functional dependence and were typically associated with increasing age. Conclusion Functional dependence increases as individuals age, paralleled by increases in MND, urinary incontinence, dizziness, sensory impairment, and constipation. Notably, only MND, incontinence, depression, and dizziness were significant predictors of functional dependence. Consequently, it is imperative to screen older adults presenting with these syndromes for early signs of functional decline to optimize their function and avert subsequent dependence, morbidity, and mortality.
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Affiliation(s)
- Lana Alhalaseh
- Department of Family and Community Medicine, School of Medicine, The University of Jordan, Amman, Jordan
| | - Hala Makahleh
- Department of Family and Community Medicine, School of Medicine, The University of Jordan, Amman, Jordan
| | - Bashayer Al-Saleem
- Department of Family and Community Medicine, School of Medicine, The University of Jordan, Amman, Jordan
| | - Farah Al-Omran
- Department of Family and Community Medicine, School of Medicine, The University of Jordan, Amman, Jordan
| | - Birgitte Schoenmakers
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium
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Zhang B, Wang J, Liu N, Liu W, Xi R, Wang P. Association between polypharmacy and chronic kidney disease among community-dwelling older people: a longitudinal study in southern China. BMC Nephrol 2024; 25:169. [PMID: 38760750 PMCID: PMC11100214 DOI: 10.1186/s12882-024-03606-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 05/10/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Polypharmacy would increase the risk of adverse drug events and the burden of renal drug excretion among older people. Nevertheless, the association between the number of medication and the risk of chronic kidney disease (CKD) remains controversial. Therefore, this study aims to investigate the association between the number of medication and the incidence of CKD in older people. METHODS This study investigates the association between the number of medications and CKD in 2672 elderly people (≥ 65 years older) of the community health service center in southern China between 2019 and 2022. Logistic regression analysis was used to evaluate the relationship between polypharmacy and CKD. RESULTS At baseline, the average age of the study subjects was 71.86 ± 4.60, 61.2% were females, and 53 (2.0%) suffer from polypharmacy. During an average follow-up of 3 years, new-onset CKD developed in 413 (15.5%) participants. Logistic regression analysis revealed that taking a higher number of medications was associated with increase of CKD. Compared with people who didn't take medication, a higher risk of CKD was observed in the older people who taken more than five medications (OR 3.731, 95% CI 1.988, 7.003), followed by those who take four (OR 1.621, 95% CI 1.041, 2.525), three (OR 1.696, 95% CI 1.178, 2.441), two drugs (OR 1.585, 95% CI 1.167, 2.153), or one drug (OR 1.503, 95% CI 1.097, 2.053). Furthermore, age, systolic blood pressure (SBP), white blood cell (WBC), blood urea nitrogen (BUN) and triglyceride (TG) were also independent risk factors CKD (P < 0.05). CONCLUSION The number of medications was associated with CKD in older people. As the number of medications taken increased, the risk of CKD was increased.
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Affiliation(s)
- Bowen Zhang
- General Practice Center, The seventh Affiliated Hospital of Southern Medical University, Foshan, 528244, China
- School of Nursing and Health, Henan University, Kaifeng, 475004, China
| | - Jingrui Wang
- School of Nursing and Health, Henan University, Kaifeng, 475004, China
| | - Nan Liu
- School of Nursing and Health, Henan University, Kaifeng, 475004, China
- College of Public Health, Zhengzhou University, Zhengzhou, 540001, P. R. China
- Institute of Environment and Health, Health Science Center, South China Hospital, Shenzhen University, Shenzhen, 518116, P. R. China
| | - Weijia Liu
- School of Nursing and Health, Henan University, Kaifeng, 475004, China
| | - Ruihan Xi
- School of Nursing and Health, Henan University, Kaifeng, 475004, China
| | - Peixi Wang
- General Practice Center, The seventh Affiliated Hospital of Southern Medical University, Foshan, 528244, China.
- School of Nursing and Health, Henan University, Kaifeng, 475004, China.
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Yarycky L, Castillo LIR, Gagnon MM, Hadjistavropoulos T. Initiatives Targeting Patients: A Systematic Review of Knowledge Translation Pain Assessment and Management Studies Focusing on Older Adults. Clin J Pain 2024; 40:243-252. [PMID: 38204295 DOI: 10.1097/ajp.0000000000001192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024]
Abstract
OBJECTIVES Older adults frequently experience persistent pain but are often unaware of self-management and other strategies that can help improve their condition. In a related article, we reported on pain assessment and management knowledge translation initiatives related to older adults that were targeting health professionals. In this paper, we report on initiatives targeting older adults. MATERIALS AND METHODS Using systematic review methodology, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE, PsycInfo, and Web of Science databases were searched from inception to June 2023. Pain-related knowledge translation programs targeted towards older adults, their informal caregivers, and health care professionals were examined. RESULTS From an initial 21,669 search results, 172 studies met our inclusion criteria. Of these studies, 49 targeted older adults. These studies varied widely in focus and delivery format, but the majority were associated with a significant risk of bias. Older adults with musculoskeletal pain were the primary recipients of education. Most programs were classified as knowledge mobilization initiatives. The remainder were considered self-management programs. Knowledge users were satisfied with the suitability of the information presented, and patient outcomes were a primary concern across all studies. Behavioral changes and pain management outcomes, however, were underemphasized in the literature. CONCLUSION Knowledge acquisition outcomes are overrepresented in the current literature compared with behavioral outcomes changes. Nonetheless, older adults report benefitting from the guidance provided in self-management programs when applying knowledge to practice. Future research is needed to better understand the facilitators and barriers to pain management changes in this population.
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Affiliation(s)
- Laney Yarycky
- Department of Psychology and Centre on Aging and Health, University of Regina, Regina
| | - Louise I R Castillo
- Department of Psychology and Centre on Aging and Health, University of Regina, Regina
| | - Michelle M Gagnon
- Department of Psychology and Health Studies, University of Saskatchewan, Saskatoon, SK Canada
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Carmona Araújo A, Fernandes E, Franco Ruivo I, Machado MDC, Faria Vaz A, Furtado C. [Prevalence of Outpatient Use of Medicines by the Elderly Population in Portugal: A Cross-Sectional Study]. ACTA MEDICA PORT 2023; 36:792-801. [PMID: 37421145 DOI: 10.20344/amp.19254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 03/21/2023] [Indexed: 07/09/2023]
Abstract
INTRODUCTION Like in other countries, the age pyramid in Portugal has been changing considerably, with a substantial increase in the size of the older population and a significant reduction in the number of young people. With aging, co-occurrence of several conditions becomes frequent, often leading to the use of multiple medications (polypharmacy). Polypharmacy in the older population is particularly relevant considering the physiological changes of the ageing process, which increase the risk of drug interactions, poor adherence to treatment, and adverse drug reactions, especially in the oldest-old population (85 years or older). As the size of the older population is likely to increase significantly, it is important to characterize the pattern of medicines' use by the elderly while also identifying cases of polypharmacy in order to obtain evidence that can be used to develop specific measures to tackle the high prevalence of use and its associated risks. To this end, the aim of this study was to characterize medication use by older individuals in Portugal. METHODS Cross-sectional study with data from the National Health System's Control and Monitoring Center on reimbursed medicines that were prescribed and dispensed to individuals aged 65 years or older in 2019 in all community pharmacies of the Portuguese mainland. We performed a demographic and geographic analysis of the data by international nonproprietary name and therapeutic group. The number of reimbursed packages and the number of reimbursed packages per capita were the metrics used (data from Instituto Nacional de Estatística). RESULTS A higher consumption of medicines was observed in women, increasing with age, except in the oldest olds, in which the sex difference tended to shrink. Use per capita showed an opposite trend, with the oldest-old men surpassing the oldest-old women (mean reimbursed packages: 55.5 in men versus 55.1 in women). In women, consumption was led by cardiovascular medicines (31%), followed by central nervous system medications (30%) and antidiabetics (13%); in men, 37% of TOP 10 consumption was due to cardiovascular medications, antidiabetics (16%) and drugs for benign prostatic hypertrophy (14%). CONCLUSION In the elderly, there were sex differences in the pattern of medicines' use, and there were also significant age-related differences in 2019. To the best of our knowledge, our study is the first nationwide analysis of reimbursed medicines' consumption data in the elderly, which is essential to characterize the use of medicines in this age group in Portugal.
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Affiliation(s)
- Ana Carmona Araújo
- Direção de Informação e Planeamento Estratégico. Autoridade Nacional do Medicamento e Produtos de Saúde, I.P. (INFARMED). Lisboa; Instituto de Investigação do Medicamento (iMed.ULisboa). Faculdade de Farmácia. Universidade de Lisboa. Lisboa. Portugal
| | - Elisabete Fernandes
- Direção de Informação e Planeamento Estratégico. Autoridade Nacional do Medicamento e Produtos de Saúde, I.P. (INFARMED). Lisboa. Portugal
| | - Inês Franco Ruivo
- NOVA School of Science and Technology. Universidade NOVA de Lisboa. Lisboa. Portugal
| | | | - António Faria Vaz
- Direção de Informação e Planeamento Estratégico. Autoridade Nacional do Medicamento e Produtos de Saúde, I.P. (INFARMED). Lisboa; Comissão de Ética para a Saúde. Administração Regional de Saúde de Lisboa e Vale do Tejo. Lisboa. . Portugal
| | - Cláudia Furtado
- Direção de Informação e Planeamento Estratégico. Autoridade Nacional do Medicamento e Produtos de Saúde, I.P. (INFARMED). Lisboa; NOVA National School of Public Health. Universidade NOVA de Lisboa. Lisboa. . Portugal
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Kardas P, Mair A, Stewart D, Lewek P. Optimizing polypharmacy management in the elderly: a comprehensive European benchmarking survey and the development of an innovative online benchmarking application. Front Pharmacol 2023; 14:1254912. [PMID: 37915419 PMCID: PMC10616468 DOI: 10.3389/fphar.2023.1254912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/05/2023] [Indexed: 11/03/2023] Open
Abstract
Background: Polypharmacy, defined as the simultaneous use of multiple medications by a patient, is a worldwide problem of rising prevalence. Paving the way for drug interactions, adverse drug reactions and non-adherence, it leads to negative health outcomes, increased use of healthcare services and rising costs. Since it is closely related to multimorbidity, it peaks in older adults. So far, not many polypharmacy management programs in the elderly have been introduced in practice. However, due to the rapid ageing of European societies, there is an urgent need to implement them more widely. Objective: The aim of this study was to benchmark polypharmacy management programs in the elderly available in Europe and creating a dedicated benchmarking application. Methods: It was a cross-sectional study based on an online survey targeting healthcare professionals and other stakeholders across European countries. Data collected in the survey were reused to design an online benchmarking application. Results: As many as 911 respondents from all but two EU countries took part in this study. Out of the survey participants, 496 (54.4%) reported availability of various activities or formal programs targeting polypharmacy in the elderly that were known to them. These programs had multiple goals, of which improved patient safety was indicated as the most common objective (65.1% of the cases). The most typical settings for such programs was primary care (49.4%), with pharmacists and primary care doctors being indicated most often as those providing the programs (61.7% and 35.5% of cases, respectively). Vast majority of programs applied diverse forms of drug reviews. The identified programs were assessed against four predefined dimensions of effectiveness, applicability, scalability and cost-effectiveness. The lowest scores were obtained within the last of these categories, due to unavailability of relevant data. Based on the survey results, a benchmarking application was constructed. It allows for comparing an individual polypharmacy management program targeting the elderly against the other ones, and particularly, against the national and European context. Conclusion: By providing strong evidence, the findings of this study, coupled with the benchmarking application, can prove valuable in aiding clinicians and policymakers in the implementation and expansion of polypharmacy management programs for the elderly.
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Affiliation(s)
- Przemysław Kardas
- Department of Family Medicine, Medication Adherence Research Centre, Medical University of Lodz, Lodz, Poland
| | - Alpana Mair
- Effective Prescribing and Therapeutics Division, Edinburgh Napier University, Edinburgh, United Kingdom
| | - Derek Stewart
- College of Pharmacy, QU Health, Qatar University, Doha, Qatar
| | - Paweł Lewek
- Department of Family Medicine, Medication Adherence Research Centre, Medical University of Lodz, Lodz, Poland
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Navarro‐García C, Sarria‐Santamera A. The effect of older population on public health spending: Evidence from Spain. HEALTH CARE SCIENCE 2023; 2:306-316. [PMID: 38938585 PMCID: PMC11080808 DOI: 10.1002/hcs2.68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 07/29/2023] [Accepted: 09/13/2023] [Indexed: 06/29/2024]
Abstract
Background The gradual ageing of the population, and its effect on public spending, constitutes an urgent challenge for advanced economies. Through this study, we analyse the effect of older people, and their health and individual characteristics, on public health spending. Methods Using logistic regression methods, we have analysed the use of different health services and health technologies by older people in Spain, controlled for several health, socioeconomic, and other individual factors. Results The main factors that explain the consumption of both health services and health technology, above age, are related to the so-called need factors: self-reported health status, presence of chronic diseases, and disability. Conclusion Knowing the main factors that imply greater public health spending is a topic of special interest for designing efficient health policies, in a context of growth in public health spending. In this way, preventive attention on the so-called need factors may be an important driver to improve the effectiveness of spending.
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Maraud J, Bedhomme S, Pereira B, Trévis S, Jary M, Balayssac D. Self-Medication during and after Cancer: A French Nation-Wide Cross-Sectional Study. Cancers (Basel) 2023; 15:3190. [PMID: 37370800 DOI: 10.3390/cancers15123190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/13/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
(1) Background: Little data are available in Western countries regarding self-medication practices in the context of cancer. The aim of this study was to describe the prevalence of self-medication practices during (cancer patients) and after cancer (cancer survivors). (2) Methods: This multicenter, cross-sectional, and online study was designed to assess self-medication prevalence. Other objectives were explored, notably the medication types, the perceived risks, and the relation with symptoms and quality of life. (3) Results: Among the 518 patients analyzed, 56.4% declared they practiced self-medication. Dietary supplements and pain medications were used by more than half of the patients. Self-medication was practiced in order to manage the adverse effects of anticancer therapies (63.8%), for which pain was the leading indication (39%), and to improve the efficacy of anticancer therapies (43.8%, cancer patients). Patients believed that self-medication could not lead to drug interactions with anticancer therapies (84.9%, cancer patients), or to adverse effects (84.6%, cancer patients and survivors). Self-medication practices were associated with altered social functioning, pain, insomnia, and financial difficulties. (4) Conclusions: Self-medication was performed by more than half of the responders (ongoing or past cancer) and could be a marker of the undermanagement of cancer and treatment-related adverse effects.
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Affiliation(s)
- Julie Maraud
- UFR de Pharmacie, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France
| | - Sabrina Bedhomme
- UR ACCePPT, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France
| | - Bruno Pereira
- Direction de la Recherche Clinique et de l'Innovation, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France
| | - Sophie Trévis
- Pharmacie, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France
| | - Marine Jary
- Chirurgie et Oncologie Digestive, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France
| | - David Balayssac
- UMR1107, NEURO-DOL, INSERM, Direction de la Recherche Clinique et de l'Innovation, Université Clermont Auvergne, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France
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Manirajan P, Sivanandy P. Drug Utilisation Review among Geriatric Patients with Noncommunicable Diseases in a Primary Care Setting in Malaysia. Healthcare (Basel) 2023; 11:1665. [PMID: 37372782 DOI: 10.3390/healthcare11121665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 05/30/2023] [Accepted: 06/01/2023] [Indexed: 06/29/2023] Open
Abstract
A prospective cross-sectional study was conducted to analyse the drugs prescribed to the elderly population with noncommunicable diseases and to determine the polypharmacy at a primary care clinic in Negeri Sembilan, Malaysia. The study was conducted for 6 months at the primary care clinic of Gemas. Geriatric patients above the age of 65 and diagnosed with noncommunicable diseases were included upon providing written informed consent. The majority of the geriatric patients were between 65 and 69 years (mean: 69.72 ± 2.85) and prescribed 4 or more medications (mean: 5.18 ± 0.64, p = 0.007). More than 95% (n = 295) of the geriatrics were found to have multimorbidity, in which around 45% (n = 139) had type-2 diabetes together with hypertension and dyslipidaemia. Combination therapy was prescribed to more than 97% (n = 302) of the elderly, whereas cardiovascular and endocrine medications were the most commonly prescribed. Ten prescriptions were found to have drug-related problems, prescribing cascade (80%), lack of medicine optimisation (10%), and inappropriate prescription (10%). In this study, the majority of the elderly had multimorbidity; polypharmacy was commonly seen among geriatric patients. Polypharmacy is the biggest threat to the elderly population, as it increases the chances of falls and fall-related injuries. Medicine optimisation and deprescribing will reduce the chances of drug-related problems and morbidity and mortality associated with polypharmacy and over-consumption of medications. Hence, the study recommends the health fraternity look for medication optimisation and deprescribing to reduce the future complications associated with polypharmacy.
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Affiliation(s)
- Priya Manirajan
- Department of Pharmacy Practice, School of Pharmacy, International Medical University, Kuala Lumpur 57000, Malaysia
| | - Palanisamy Sivanandy
- Department of Pharmacy Practice, School of Pharmacy, International Medical University, Kuala Lumpur 57000, Malaysia
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12
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Iqbal A, Richardson C, Iqbal Z, O’Keefe H, Hanratty B, Matthews FE, Todd A. Are there socioeconomic inequalities in polypharmacy among older people? A systematic review and meta-analysis. BMC Geriatr 2023; 23:149. [PMID: 36934249 PMCID: PMC10024437 DOI: 10.1186/s12877-023-03835-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 02/20/2023] [Indexed: 03/20/2023] Open
Abstract
BACKGROUND Socioeconomic status (SES) may influence prescribing, concordance and adherence to medication regimens. This review set out to investigate the association between polypharmacy and an individual's socioeconomic status. METHODS A systematic review and meta-analyses of observational studies was conducted across four databases. Older people (≥ 55 years) from any healthcare setting and residing location were included. The search was conducted across four databases: Medline (OVID), Web of Science, Embase (OVID) and CINAHL. Observational studies from 1990 that reported polypharmacy according to SES were included. A random-effects model was undertaken comparing those with polypharmacy (≥ 5 medication usage) with no polypharmacy. Unadjusted odds ratios (ORs), 95% confidence intervals (CIs) and standard errors (SE) were calculated for each study. RESULTS Fifty-four articles from 13,412 hits screened met the inclusion criteria. The measure of SES used were education (50 studies), income (18 studies), wealth (6 studies), occupation (4 studies), employment (7 studies), social class (5 studies), SES categories (2 studies) and deprivation (1 study). Thirteen studies were excluded from the meta-analysis. Lower SES was associated with higher polypharmacy usage: individuals of lower educational backgrounds displayed 21% higher odds to be in receipt of polypharmacy when compared to those of higher education backgrounds. Similar findings were shown for occupation, income, social class, and socioeconomic categories. CONCLUSIONS There are socioeconomic inequalities in polypharmacy among older people, with people of lower SES significantly having higher odds of polypharmacy. Future work could examine the reasons for these inequalities and explore the interplay between polypharmacy and multimorbidity.
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Affiliation(s)
- Anum Iqbal
- grid.1006.70000 0001 0462 7212School of Pharmacy, Population Health Sciences Institute, Newcastle University, King George VI Building, King’s Road, Newcastle Upon Tyne, NE1 7RU England
| | - Charlotte Richardson
- grid.1006.70000 0001 0462 7212School of Pharmacy, Newcastle University, Newcastle Upon Tyne, England
| | - Zain Iqbal
- grid.419481.10000 0001 1515 9979Novartis International, Basel, Switzerland
| | - Hannah O’Keefe
- grid.1006.70000 0001 0462 7212Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, England
| | - Barbara Hanratty
- grid.1006.70000 0001 0462 7212Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, England
| | - Fiona E. Matthews
- grid.1006.70000 0001 0462 7212Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, England
| | - Adam Todd
- grid.1006.70000 0001 0462 7212School of Pharmacy, Newcastle University, Newcastle Upon Tyne, England
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13
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Herrera-Añazco P, Mougenot B, Benites-Meza JK, Barturén-Alvarado LC, Zumarán-Nuñez CJ, Boyd-Gamarra MA, Runzer-Colmenares FM, Benites-Zapata VA. Self-Medication Practices, Use of Brand-Name, and Over-the-Counter Medicines by Peruvian Older Adults. Can Geriatr J 2023; 26:187-199. [PMID: 36865404 PMCID: PMC9953501 DOI: 10.5770/cgj.26.631] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
Background Older adults are a particularly vulnerable group to drug use and self-medication. The aim of the study was to evaluate self-medication as a factor associated with the purchase of brand-name and over-the-counter (OTC) drugs in older adults in Peru. Methods A secondary analysis was performed using an analytical cross-sectional design of data from a nationally representative survey from 2014 to 2016. The exposure variable was self-medication, defined as the purchase of medicines without a prescription. The dependent variables were purchases of brand-name and OTC drugs, both as a dichotomous response (yes/no). Information of sociodemographic variables, health insurance, and the types of drugs purchased by the participants was collected. Crude prevalence ratios (PR) were calculated and adjusted using generalized linear models of the Poisson family, considering the complex sample of the survey. Results In this study, 1,115 respondents were evaluated, with a mean age of 63.8 years and a male proportion of 48.2%. The prevalence of self-medication was 66.6%, while the proportions of purchases of brand-name and OTC drugs were 62.4% and 23.6%, respectively. The adjusted Poisson regression analysis revealed an association between self-medication and the purchase of brand-name drugs (adjusted PR [aPR]=1.09; 95% confidence interval [CI]: 1.01-1.19). Likewise, self-medication was associated with the purchase of OTC medications (aPR=1.97; 95%CI: 1.55-2.51). Conclusions This study evidenced a high prevalence of self-medication in Peruvian older adults. Two-thirds of the surveyed people bought brand-name drugs, whereas one-quarter bought OTC drugs. Self-medication was associated with a greater likelihood of buying brand-name and OTC drugs.
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Affiliation(s)
- Percy Herrera-Añazco
- Facultad de Ciencias de la Salud, Universidad Privada del Norte, Trujillo, Peru,Red Internacional en Salud Colectiva y Salud Intercultural, Mexico City, Mexico
| | - Benoit Mougenot
- Facultad de Ciencias Empresariales, Universidad San Ignacio de Loyola, Lima, Peru,Centro de Excelencia en Investigaciones Económicas y Sociales en Salud, Universidad San Ignacio de Loyola, Lima, Peru
| | - Jerry K. Benites-Meza
- Sociedad Científica de Estudiantes de Medicina de la Universidad Nacional de Trujillo, Trujillo, Peru,Grupo Peruano de Investigación Epidemiológica, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru
| | - Luz C. Barturén-Alvarado
- Escuela Profesional de Medicina Humana de la Universidad Señor de Sipán, Chiclayo, Peru,Asociación Científica de Estudiantes de Medicina de la Universidad Señor de Sipán, Chiclayo, Peru
| | - Carlos J. Zumarán-Nuñez
- Grupo Peruano de Investigación Epidemiológica, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru,Asociación Científica de Estudiantes de Medicina de la Universidad Señor de Sipán, Chiclayo, Peru
| | - Maria A. Boyd-Gamarra
- Escuela Profesional de Medicina Humana de la Universidad Señor de Sipán, Chiclayo, Peru,Asociación Científica de Estudiantes de Medicina de la Universidad Señor de Sipán, Chiclayo, Peru
| | - Fernando M. Runzer-Colmenares
- Universidad Científica del Sur, Facultad de Ciencias de la Salud, Carrera de Medicina Humana, CHANGE Research Working Group, Lima, Peru
| | - Vicente A. Benites-Zapata
- Red Internacional en Salud Colectiva y Salud Intercultural, Mexico City, Mexico,Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru
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14
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Zheng Z, Feng Z, Zhang D, Sun X, Dong D, Luo Y, Feng D. Does self-medication reduce medical expenditure among the middle-aged and elderly population? A four-wave longitudinal study in China. Front Public Health 2023; 10:1047710. [PMID: 36711405 PMCID: PMC9874163 DOI: 10.3389/fpubh.2022.1047710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 12/16/2022] [Indexed: 01/12/2023] Open
Abstract
Introduction Self-medication has a high prevalence in the middle-aged and elderly population in China. Despite the published evidence demonstrating the economic benefits of self-medication, limited research has addressed the relationship between self-medication and individual medical expenditures, especially within the Chinese population. This study examined the effect of self-medication on individual medical expenditures in China and analyzed the heterogeneity between outpatient and inpatient cases. Methods We conducted a panel data analysis using data from four waves of the China Health and Retirement Longitudinal Study (CHARLS). Two-part mixed-effect models were implemented to estimate the effect of self-medication on total outpatient and inpatient expenses and out-of-pocket (OOP) costs, where mixed-effects logit regression was used as the first part, and generalized linear mixed models with log link and gamma distribution was used as the second part. Results We identified 72,041 responses representing 24,641 individuals, of which 13,185 responses incurred outpatient expenses and 9,003 responses incurred inpatient costs. Controlling for all covariates, we found that self-medication behaviors were significantly associated with a higher probability of outpatient service utilization (OR = 1.250, 95% CI = 0.179 to 0.269; P < 0.001), but displayed no significant association with outpatient expenses. Respondents who had taken self-medication were less likely to use inpatient services (OR = 0.865, 95% CI = -0.201 to -0.089; P < 0.001), and their inpatient expenses were significantly reduced by 9.4% (P < 0.001). Inpatient OOP costs were significantly reduced by 10.7% (P < 0.001), and outpatient OOP costs were significantly increased by 11.3% (P < 0.001) among respondents who had self-medicated. Conclusions This study allowed us to identify the economic value of self-medication among the middle-aged and elderly population in China. Future work should guide the middle-aged and elderly to take responsible self-medication to reduce their economic burden.
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Affiliation(s)
- Zehao Zheng
- School of Pharmacy, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Zhanchun Feng
- School of Medicine and Health Management, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Donglan Zhang
- Division of Health Services Research, Department of Foundations of Medicine, New York University Long Island School of Medicine, Mineola, NY, United States
| | - Xiaobo Sun
- School of Statistics and Mathematics, Zhongnan University of Economics and Law, Wuhan, China
| | - Dong Dong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, China
| | - Youxi Luo
- School of Science, Hubei University of Technology, Wuhan, China
| | - Da Feng
- School of Pharmacy, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China,*Correspondence: Da Feng ✉
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15
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Cebrino J, Portero de la Cruz S. Polypharmacy and associated factors: a gender perspective in the elderly Spanish population (2011-2020). Front Pharmacol 2023; 14:1189644. [PMID: 37153776 PMCID: PMC10160439 DOI: 10.3389/fphar.2023.1189644] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 04/14/2023] [Indexed: 05/10/2023] Open
Abstract
Background: Few studies have examined the epidemiology of polypharmacy in non-institutionalized elderly adults with regard to sex differences. This study aimed to identify the prevalence of polypharmacy among people ≥65 years old residing in Spain, analyze trends in that prevalence from 2011/12 to 2020, describe the use of the medicines involved and study the possible relationship between polypharmacy and certain sociodemographic, health-related variables, as well as the use of care services by sex. Methods: A nationwide cross-sectional study with 21,841 non-institutionalized people ≥65 years old from the Spanish National Health Survey (2011/2012 and 2017) and the European Health Survey in Spain (2014 and 2020) was performed. We used descriptive statistics, performing two binary logistic regressions to determine the factors related to polypharmacy. Results: The prevalence of polypharmacy was 23.2% (women: 28.1%, men: 17.2%; p < 0.001). The most commonly consumed medicines were analgesics and tranquillizers, relaxants or sleeping pills in elderly women, compared with antihypertensives, antacids and antiulcer drugs and statins for elderly men. In both sexs, the positive predictors of polypharmacy included average, poor and very poor self-perceived states of health, people with overweight and obesity, being severely/non-severely limited due to a health problem, having ≥ three chronic conditions, visits to the family doctor and hospitalization. Among elderly women, negative predictors were alcohol intake, whereas in elderly men positive predictors were being 75-84 years old, being current smokers and having 1, 2 chronic conditions. Conclusion: Polypharmacy has a prevalence of 23.2%, with women accounting for 28.1% and men 17.2% of the total. Knowledge of positive and negative predictors of polypharmacy have important implications for public health efforts to develop or improve health guidelines and strategies for promoting the proper use of medication, particularly in the elderly population by sex.
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Affiliation(s)
- Jesús Cebrino
- Department of Preventive Medicine and Public Health, University of Seville, Seville, Spain
| | - Silvia Portero de la Cruz
- Department of Nursing, Pharmacology and Physiotherapy, University of Córdoba, Córdoba, Spain
- Research Group GC12 Clinical and Epidemiological Research in Primary Care, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Córdoba, Spain
- *Correspondence: Silvia Portero de la Cruz,
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16
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Vargas PM, Schneider BC, Costa CS, César JA, Bertoldi AD, Tomasi E, Demarco FF, Gonzalez MC, Bielemann RM. Age is the most important factor for change in body mass index and waist circumference in older people in southern Brazil. Nutrition 2022; 109:111956. [PMID: 36863112 DOI: 10.1016/j.nut.2022.111956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 12/05/2022] [Accepted: 12/22/2022] [Indexed: 12/28/2022]
Abstract
OBJECTIVES The aim of this study is to assess the changes in body mass index and waist circumference (WC) and their associations with sociodemographic, behavioral, and health characteristics in non-institutionalized older people in southern Brazil over a period of ≤6 y. METHODS This is a prospective study, with interviews conducted in 2014 and in 2019 to 2020. Of the 1451 individuals from Pelotas, Brazil, aged >60 y and interviewed in 2014, 537 were reevaluated in 2019 to 2020. An increase or decrease was defined as a variation of ≥5% in body mass index and WC in the second visit compared with the first. The association with changes in outcomes was assessed according to sociodemographic, behavioral, and health characteristics using multinomial logistic regression. RESULTS Approximately 29% of the older participants lost body mass. Regarding WC, there was an increase in 25.6% in the older participants. The older participants ages ≥80 y had greater odds of losing body mass (odds ratio [OR] = 4.73; 95% confidence interval [CI], 2.29-9.76) and of reducing WC (OR = 2.84; 95% CI, 1.59-6.94). Former smokers had, on average, 41% and 64% lower odds of losing and gaining body mass (95% CI, 0.37-0.95 and 95% CI, 0.19-0.68, respectively), and those who were on ≥5 medications had greater odds of gaining body mass (OR = 1.92; 95% CI, 1.12-3.28) and WC (OR = 1.79; 95% CI, 1.18-2.74). CONCLUSIONS Despite the high proportion of older people who kept their body mass index and WC stable during this period, many of them lost body mass and gained WC. The findings also highlighted the importance of age in the nutritional changes observed in the population.
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Affiliation(s)
- Priscila M Vargas
- Nutrititon and Food Graduate Program, Federal University of Pelotas, Pelotas, Brazil.
| | - Bruna C Schneider
- Epidemiology Graduate Program, Federal University of Pelotas, Pelotas, Brazil
| | - Caroline S Costa
- Epidemiology Graduate Program, Federal University of Pelotas, Pelotas, Brazil
| | - Juraci Almeida César
- Public Health Graduate Program, Federal University of Rio Grande, Pelotas, Brazil
| | - Andréa D Bertoldi
- Epidemiology Graduate Program, Federal University of Pelotas, Pelotas, Brazil
| | - Elaine Tomasi
- Epidemiology Graduate Program, Federal University of Pelotas, Pelotas, Brazil
| | - Flávio F Demarco
- Epidemiology Graduate Program, Federal University of Pelotas, Pelotas, Brazil; Dentistry Graduate Program, Federal University of Pelotas, Pelotas, Brazil
| | - Maria Cristina Gonzalez
- Epidemiology Graduate Program, Federal University of Pelotas, Pelotas, Brazil; Health and Behavior Graduate Program, Catholic University of Pelotas, Pelotas, Brazil
| | - Renata M Bielemann
- Nutrititon and Food Graduate Program, Federal University of Pelotas, Pelotas, Brazil
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17
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Cho HJ, Chae J, Yoon S, Kim D. Factors related to polypharmacy and hyper-polypharmacy for the elderly: A nationwide cohort study using National Health Insurance data in South Korea. Clin Transl Sci 2022; 16:193-205. [PMID: 36401587 PMCID: PMC9926077 DOI: 10.1111/cts.13438] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 09/27/2022] [Accepted: 09/27/2022] [Indexed: 11/21/2022] Open
Abstract
Polypharmacy may cause adverse health outcomes in the elderly. This study examined the prevalence of continuous polypharmacy and hyper-polypharmacy, factors associated with polypharmacy, and the most frequently prescribed medications among older adults in South Korea. This was a retrospective observational study using National Health Insurance claims data. In total, 7,358,953 Korean elderly patients aged 65 years and older were included. Continuous polypharmacy and hyper-polypharmacy were defined as the use of ≥5 and ≥10 medications, respectively, for both ≥90 days and ≥180 days within 1 year. A multivariate logistic regression analysis was conducted with adjustment for general characteristics (sex, age, insurance type), comorbidities (12 diseases, number of comorbidities, and Elixhauser Comorbidity Index [ECI] classification), and healthcare service utilization. Among 7.36 million elderly patients, 47.8% and 36.9% had polypharmacy for ≥90 and ≥180 days, and 11.9% and 7.1% of patients exhibited hyper-polypharmacy for ≥90 and ≥180 days, respectively. Male sex, older age, insurance, comorbidities (cardio-cerebrovascular disease, diabetes mellitus, depressive disorder, dementia, an ECI score of ≥3), and healthcare service utilization were associated with an increased probability of polypharmacy. The therapeutic class with the most prescriptions was drugs for acid-related disorders (ATC A02). The number of outpatient visit days more strongly influenced polypharmacy than hospitalizations and ED visits. This study provides health policymakers with important evidence about the critical need to reduce polypharmacy among older adults.
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Affiliation(s)
- Ho Jin Cho
- Department of ResearchHealth Insurance Review and Assessment ServiceWonjuSouth Korea
| | - Jungmi Chae
- Department of ResearchHealth Insurance Review and Assessment ServiceWonjuSouth Korea
| | - Sang‐Heon Yoon
- Department of ResearchHealth Insurance Review and Assessment ServiceWonjuSouth Korea
| | - Dong‐Sook Kim
- Department of ResearchHealth Insurance Review and Assessment ServiceWonjuSouth Korea
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18
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Baracaldo-Santamaría D, Trujillo-Moreno MJ, Pérez-Acosta AM, Feliciano-Alfonso JE, Calderon-Ospina CA, Soler F. Definition of self-medication: a scoping review. Ther Adv Drug Saf 2022; 13:20420986221127501. [PMID: 36211626 PMCID: PMC9537481 DOI: 10.1177/20420986221127501] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 09/04/2022] [Indexed: 11/05/2022] Open
Abstract
Self-medication (SM) is a global and growing phenomenon. It represents a public
health problem due to antibiotic resistance, risk of adverse drug reactions,
drug–drug interactions, disease masking, and increased morbidity. There is not a
consensus on the definition of SM. The definitions found in different studies
make it difficult to address this problem from a theoretical perspective and
therefore find an adequate solution to this public health problem. The aim of
this article is to search the medical literature to characterize the current
understanding of SM in the medical community. We conducted a scoping review of
definitions of SM by searching on PubMed – Medline, Embase, and LILACS using the
following combination of keywords: ‘self-prescription’ or ‘self prescription’,
‘self-medication’ or ‘self medication’, or ‘automedication’ and ‘definition’ or
‘explanation’. The search was limited to articles containing the definition of
SM, with no limit on language or year. Duplicate studies and those that did not
mention the definition of SM were excluded from the final review. A total of 65
studies were included in the final selection. We found a vast heterogeneity in
the definition of SM. Most articles based their definition of SM on the process
of obtaining the drug, the nonparticipation of a specific health professional,
the source of the medication, and the reason for SM. Other interesting concepts
such as self-care, nonadherence to a prescription, reuse of stored drugs, and
sharing and lending medicines were also considered forms of SM by other authors,
however. This study highlights the need to reach a consensus regarding the
definition of SM to adequately propose strategies to address this global health
problem. This study shows the diverse concepts that need to be included in a
future definition of SM.
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Affiliation(s)
- Daniela Baracaldo-Santamaría
- Pharmacology Unit, Department of Biomedical
Sciences, School of Medicine and Health Sciences, Universidad del Rosario,
Bogota, Colombia
| | - Maria José Trujillo-Moreno
- Pharmacology Unit, Department of Biomedical
Sciences, School of Medicine and Health Sciences, Universidad del Rosario,
Bogota, Colombia
| | - Andrés M. Pérez-Acosta
- Observatory of Self-Medication Behavior, School
of Medicine and Health Sciences, Universidad del Rosario, Bogotá,
Colombia
| | | | - Carlos-Alberto Calderon-Ospina
- Pharmacology Unit, Department of Biomedical
Sciences, School of Medicine and Health Sciences, Universidad del Rosario,
Bogota, Colombia,Observatory of Self-Medication Behavior, School
of Medicine and Health Sciences, Universidad del Rosario, Bogotá,
Colombia,Center for Research in Genetics and Genomics -
CIGGUR, GENIUROS Research Group, School of Medicine and Health Sciences,
Universidad del Rosario, Bogotá, Colombia
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Dumitrescu I, Casteels M, De Vliegher K, Van Der Linden L, Van Leeuwen E, Dilles T. High-Risk Medication in Home Care Nursing: A Delphi Study. J Patient Saf 2022; 18:435-443. [PMID: 35532987 DOI: 10.1097/pts.0000000000001023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIMS The aims of the study were to reach consensus on which medications in home care nursing should be considered high-risk medication (HRM) and to obtain recommendations about which interventions home care nurses can perform to improve quality of care and safety in managing these HRM. DESIGN This is an international Delphi study with 13 purposively selected experts from 4 different countries. METHODS A 3-round iterative Delphi survey was conducted from May 2018 to October 2018, based on a list of 32 medications previously reported as HRM in community care. A proposal for HRM was based on this literature search, and experts were asked to reflect on which (groups of) medications should be considered HRM by home care nurses (completeness of the list, risk assessment per [group of] medication, the need for home care nurse interventions, and the need for an HRM care procedure). The cutoff point for consensus was set at 80% of expert agreement. RESULTS The panel assessed the initial list and added 30 (groups of) medications. In the last round, consensus of 80% or more was reached for 27 (groups of) medications to be considered HRM by home care nurses. For 28 medications, additional interventions by a home care nurse were considered warranted. A procedure or protocol for home care nurses was deemed necessary for 12 medications. CONCLUSIONS We identified a set of (groups of) medications that should primarily be considered HRM by home care nurses.Impact:• What problem did the study address? This study clarified which medications should be considered HRM by home care nurses.• What were the main findings? Experts identified a set of 27 (groups of) medications that should primarily be considered HRM by home care nurses.• Where and on whom will the research have an impact? The results provide essential information for home care agencies when setting up an HRM policy.
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Affiliation(s)
| | | | | | | | | | - Tinne Dilles
- From the Department of Nursing Science and Midwifery, Centre for Research and Innovation in Care (CRIC), Nurse and Pharmaceutical Care (NuPhaC), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp
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20
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Gharekhani A, Somi M, Ostadrahimi A, Hatefi A, Haji Kamanaj A, Hassannezhad S, Faramarzi E. Prevalence and Predicting Risk Factors of Polypharmacy in Azar Cohort Population. IRANIAN JOURNAL OF PHARMACEUTICAL RESEARCH 2022; 21:e126922. [PMID: 36060920 PMCID: PMC9420226 DOI: 10.5812/ijpr-126922] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 02/12/2022] [Accepted: 04/03/2022] [Indexed: 11/16/2022]
Abstract
Background As polypharmacy has some medically negative impacts, it has become a challenging issue for public health and affected people. Therefore, we decided to investigate the prevalence of polypharmacy and its predicting risk factors in the Azar cohort population. Methods In this cross-sectional population-based cohort study, the prevalence of polypharmacy was evaluated in 15,001 subjects who participated in the Azar cohort study. We measured demographic characteristics (age, gender, socioeconomic status, smoking status, marital status, and education level), physical activity level, body mass index (BMI), blood pressure, multimorbidity (coexistence of two or more chronic diseases (CDs)), and polypharmacy status (a daily intake of five or more medicines for a minimum of 90 days). Results Based on our results, 9.51% of the population had polypharmacy. The five most prescribed medications were drugs acting on the cardiovascular system (19.9%), central nervous system (16.7%), endocrine system (13.3%), NSAIDs (11.5%), and drugs used for musculoskeletal and joint diseases (11.4%). Being female, illiterate, and having the lowest tertile of physical activity level significantly increased the risk of polypharmacy. The risk of polypharmacy was 49.36 times higher in patients with four or more CDs than in those without. Conclusions Our study emphasized the importance of routine monitoring to evaluate polypharmacy among those aged 35 to 59 and the elderly. Physicians should carefully assess drug suitability, especially in multimorbid and obese patients, to prevent excessive polypharmacy and its potentially negative impacts.
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Affiliation(s)
- Afshin Gharekhani
- Department of Clinical Pharmacy (Pharmacotherapy), Sina Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammadhossein Somi
- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Alireza Ostadrahimi
- Nutrition Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ayda Hatefi
- Student Research Committee, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Arash Haji Kamanaj
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sina Hassannezhad
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Elnaz Faramarzi
- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Corresponding Author: Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Golgahsht st., Tabriz, Iran.
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21
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Polymedication and its association with individual factors in Portuguese older adults–a cross-sectional study. Porto Biomed J 2022; 7:e174. [PMID: 35801221 PMCID: PMC9257294 DOI: 10.1097/j.pbj.0000000000000174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 11/04/2021] [Indexed: 11/27/2022] Open
Abstract
Population aging is a reality resulting in polymedication and its harmful consequences. Therefore, determining polymedication state in Portugal and identifying its associated characteristics is vital.
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22
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Yoshida Y, Ishizaki T, Masui Y, Arai Y, Inagaki H, Ogawa M, Yasumoto S, Iwasa H, Kamide K, Rakugi H, Ikebe K, Gondo Y. Association of personality traits with polypharmacy among community-dwelling older adults in Japan: a cross-sectional analysis of data from the SONIC study. BMC Geriatr 2022; 22:372. [PMID: 35484487 PMCID: PMC9047377 DOI: 10.1186/s12877-022-03069-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 04/13/2022] [Indexed: 11/30/2022] Open
Abstract
Background Polypharmacy is a serious concern among older adults and is frequently related to adverse outcomes, including health problems, reduced quality of life, and increased medical expenses. Although personality traits are associated with health behaviors and diseases, the effect of polypharmacy on personality traits is unclear. Therefore, we examined the association of personality traits with polypharmacy among community-dwelling older adults. Methods This cross-sectional study analysed data on 836 community-dwelling older adults aged 69–71 years who participated in the Japanese longitudinal cohort study of Septuagenarians, Octogenarians, and Nonagenarians Investigation with Centenarians. Polypharmacy was defined as the intake of ≥ 5 medications concurrently. Personality traits were assessed using the Japanese version of the NEO-Five-Factor Inventory (NEO-FFI). A five-factor model of personality traits, including “neuroticism,” “extraversion,” “openness,” “agreeableness,” and “conscientiousness,” was measured by the NEO-FFI. Results The average number of medications was about 3 in both men and women. Among the participants, polypharmacy was observed in 23.9% of men and 28.0% of women. Multivariable logistic regression analysis showed that neuroticism (adjusted odds ratio [aOR] per 1 point increase = 1.078, 95% confidence interval [CI] = 1.015–1.144) in men and extraversion (aOR = 0.932, 95% CI = 0.884–0.983) in women were associated with polypharmacy. Conclusions Higher neuroticism in men and lower extraversion in women were associated with polypharmacy. This study suggests that personality traits may be involved in the process leading to the development of polypharmacy. Information on individual personality traits may help medical professionals in decision-making regarding medication management for lifestyle-related diseases.
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Affiliation(s)
- Yuko Yoshida
- Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, Japan.
| | - Tatsuro Ishizaki
- Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, Japan
| | - Yukie Masui
- Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, Japan
| | - Yasumichi Arai
- Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Hiroki Inagaki
- Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, Japan
| | - Madoka Ogawa
- Osaka University, 2-2 Yamadaoka, Suita, Osaka, Japan
| | | | - Hajime Iwasa
- Fukushima Medical University, 1 Hikariga-oka, Fukushima, Japan
| | - Kei Kamide
- Osaka University, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Hiromi Rakugi
- Osaka University, 2-2 Yamadaoka, Suita, Osaka, Japan
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23
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Gunnarsdottir Ms Rn GH, Sigurdardóttir Phd Rn AK, Ólafsson Ma K, Kristofersson Phd Rn Pmknp-Bc GK. Psychotropic Use among Older Adults Living at Home: Use of the Anatomical Therapeutic Chemical (ATC) Drug Classification System and Beers Criteria ®. Issues Ment Health Nurs 2021; 42:1138-1146. [PMID: 34197268 DOI: 10.1080/01612840.2021.1936709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The study examined medication use among older adults living at home and connection between background characteristics, urban/rural residency, and medication use according to Anatomical Therapeutic Chemical (ATC) drug classification system and Beers Criteria®. Population-based cross-sectional study, participants (N = 175) were randomly selected from the Icelandic national registry, randomized by age, gender, and residence. On average, participants took 2.9 medications: 20% used psychotropics and 15% used psychotropics in ATC groups N05/N06A, which are deemed inappropriate for this age group according to Beers Criteria. Beers Criteria are useful for recognizing possible inappropriate medications for older adults and can be utilized by mental health nurses to assess the appropriateness of geriatric pharmaceutical treatments.
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Affiliation(s)
- G H Gunnarsdottir Ms Rn
- School of Health Sciences, University of Akureyri, Akureyri, Iceland.,Akureyri Nursing Homes, Vestursida, Akureyri, Iceland
| | - A K Sigurdardóttir Phd Rn
- School of Health Sciences, University of Akureyri, Akureyri, Iceland.,Akureyri Hospital, Iceland Eyrarlandsvegi, Akureyri
| | - K Ólafsson Ma
- School of Humanities and Social Sciences, University of Akureyri, Akureyri Iceland
| | - G K Kristofersson Phd Rn Pmknp-Bc
- School of Health Sciences, University of Akureyri, Akureyri, Iceland.,Outpatient Psychiatric Ward, Akureyri Hospital, Eyralandsvegi, Akureyri Iceland
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24
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Kardas P, Lichwierowicz A, Urbański F, Chudzyńska E, Czech M, Kardas G. Prevalence of Chronic Polypharmacy in Community-Dwelling Elderly People in Poland: Analysis of National Real-World Database Helps to Identify High Risk Group. Front Pharmacol 2021; 12:739740. [PMID: 34867347 PMCID: PMC8637161 DOI: 10.3389/fphar.2021.739740] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 11/01/2021] [Indexed: 11/28/2022] Open
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.
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Affiliation(s)
- Przemysław Kardas
- Department of Family Medicine, Medical University of Lodz, Łódź, Poland
| | | | | | | | - Marcin Czech
- Department of Pharmacoeconomics, Institute of Mother and Child, Warsaw, Poland
| | - Grzegorz Kardas
- Department of Internal Diseases, Asthma and Allergy, Medical University of Lodz, Łódź, Poland
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25
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Enríquez-Gómez A, Ortega-Navarro C, Fernández-Cordón C, Díez-Villanueva P, Martínez-Sellés M, de Lorenzo-Pinto A, de Miguel-Yanes JM. Comparison of a polypharmacy-based scale with Charlson comorbidity index to predict 6-month mortality in chronic complex patients after an ED visit. Br J Clin Pharmacol 2021; 88:1795-1803. [PMID: 34570393 DOI: 10.1111/bcp.15096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 09/13/2021] [Accepted: 09/16/2021] [Indexed: 11/30/2022] Open
Abstract
AIMS The aim of this study was to test whether a newly designed polypharmacy-based scale would perform better than Charlson's Comorbidity Index (CCI) to predict outcomes in chronic complex adult patients after a reference Emergency Department (ED) visit. METHODS We built a polypharmacy-based scale with prespecified drug families. The primary outcome was 6-month mortality after the reference ED visit. Predefined secondary outcomes were need for hospital admission, 30-day readmission, and 30-day and 90-day mortality. We evaluated the ability of the CCI and the polypharmacy-based scale to independently predict 6-month mortality using logistic regression, receiver operating characteristic (ROC) curves, and cumulative survival curves using Kaplan-Meier estimates and the log-rank test for three-category distributions of the polypharmacy-based scale and the CCI. Finally, we sought to replicate our results in two different external validation cohorts. RESULTS We included 201 patients (53.7% women, mean age = 81.4 years), 162 of whom were admitted to the hospital at the reference ED visit. In separate multivariable analyses accounting for gender, age and main diagnosis at discharge, both the polypharmacy-based scale (P < .001) and the CCI (P = .005) independently predicted 6-month mortality. The polypharmacy-based scale performed better in the ROC analyses (area under the curve [AUC] = 0.838, 95% confidence interval [CI] = 0.780-0.896) than the CCI (AUC = 0.628, 95% CI = 0.548-0.707). In the 6-month cumulative survival analysis, the polypharmacy-based scale showed statistical significance (P < .001), whereas the CCI did not (P = .484). We replicated our results in the validation cohorts. CONCLUSIONS Our polypharmacy-based scale performed significantly better than the CCI to predict 6-month mortality in chronic complex patients after a reference ED visit.
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Affiliation(s)
- Andrés Enríquez-Gómez
- Internal Medicine Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Cristina Ortega-Navarro
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Clara Fernández-Cordón
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Manuel Martínez-Sellés
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.,Facultad de Ciencias Biomédicas y de la Salud, Universidad Europea, Madrid, Spain
| | - Ana de Lorenzo-Pinto
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - José M de Miguel-Yanes
- Internal Medicine Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
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Jukka L, Hannu V, Ellinoora R, Laura J, Ritva N, Vuokko A. The survival time of restorations is shortened in patients with dry mouth. J Dent 2021; 113:103794. [PMID: 34481930 DOI: 10.1016/j.jdent.2021.103794] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 08/21/2021] [Accepted: 08/25/2021] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES The aim of this retrospective data collection study was to determine the effect size of dry mouth on the survival of restorations and teeth. METHODS The data were collected from the electronic patient files of City of Oulu Public Dental Services (Finland). Study population consisted of 71 dry mouth patients and 142 control patients. The survival of 3208 restorations were analyzed using Kaplan-Meier survival curves and multivariate Cox regression analysis with shared frailty for patients. Separate analyses were performed for the survival of the teeth. RESULTS The hazard ratio of restorations in dry mouth patients was 2.08 (95% CI: 1.65-2.63) compared to the control patients. For the dry mouth patients, the fixed prosthetic crowns outlasted composite fillings of all sizes, but the difference increased concomitantly with the filling size. The dry mouth patients had hazard ratio of 1.98 (95% CI: 1.02-3.82) for tooth extractions compared to the control patients. The teeth with fixed prosthetic crowns outlasted the teeth with direct restorative materials. CONCLUSIONS The survival time of restorations and teeth are severely shortened in patients with dry mouth. Especially the survival time of the large composites is short in dry mouth patients whereas fixed prosthetic crowns have acceptable survival time also in dry mouth patients. CLINICAL SIGNIFICANCE When informing a dry mouth patient on the expected survival of a restoration or tooth, one should take into account that dry mouth patients´ restorations and teeth have severely shortened survival time.
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Affiliation(s)
- Leinonen Jukka
- Department of Clinical Dentistry, Faculty of Health Sciences, UiT The Arctic University of Norway, Hansine Hansens veg 18, 9019 Tromsø, Norway; Research Unit of Oral Health Sciences, Faculty of Medicine, University of Oulu, Aapistie 3, 90220 Oulu, Finland.
| | - Vähänikkilä Hannu
- Northern Finland Birth Cohorts, Arctic Biobank, Infrastructure for Population Studies, Faculty of Medicine, University of Oulu, Aapistie 5, 90220 Oulu, Finland.
| | - Raninen Ellinoora
- Research Unit of Oral Health Sciences, Faculty of Medicine, University of Oulu, Aapistie 3, 90220 Oulu, Finland.
| | - Järvelin Laura
- Research Unit of Oral Health Sciences, Faculty of Medicine, University of Oulu, Aapistie 3, 90220 Oulu, Finland.
| | - Näpänkangas Ritva
- Research Unit of Oral Health Sciences, Faculty of Medicine, University of Oulu, Aapistie 3, 90220 Oulu, Finland.
| | - Anttonen Vuokko
- Research Unit of Oral Health Sciences, Faculty of Medicine, University of Oulu, Aapistie 3, 90220 Oulu, Finland; Medical Research Center, Oulu University Hospital and University of Oulu, Kajaanintie 50, 90220 Oulu, Finland.
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Dios-Guerra C, Carmona-Torres JM, Morales-Cané I, Rodríguez-Borrego MA, López-Soto PJ. Evolution in the use of health services by older people in Spain (2009-2017). HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:e11-e20. [PMID: 33211360 DOI: 10.1111/hsc.13229] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 08/26/2020] [Accepted: 10/24/2020] [Indexed: 06/11/2023]
Abstract
As people age, they tend to increase their use of health services. For this, the aims of this study were to analyse the frequency and variability in the use of different health services by people over 65 years, their evolution from 2009 to 2017 and the factors associated it. We carried out a cross-sectional study with 25,465 people over 65 years who participated in the National Health Survey in Spain in 2011/2012 and 2017 and the European Health Survey in Spain in 2009 and 2014. A descriptive analysis was performed using the attendance records of family/general physicians, nurse consultations, or both over the last 12 months as well as these data over the following years of study. Our findings show that approximately 93.2% of the participants had consulted with a family/general physician over the last year, and women were almost twice as likely to do so compared with men (61.2% vs. 38.8%). The use of health services gradually increased from 2009 to 2017, being the visits to nursing that more increased their frequency. Being a woman and a widower as well as having no higher education, a low social class, a serious or long-term illness, obesity and bed restraint were associated with a greater use of health services. Findings suggested that the increased health services due to ageing and comorbidities associated with it present new challenges. It is necessary to determine realistic plans that can meet future healthcare demands and not lead to a collapse of the health system. For this it is very important the primary prevention of chronic diseases, functional limitations, obesity and disability.
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Affiliation(s)
- Caridad Dios-Guerra
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
- Área de Enfermería, Universidad de Córdoba, Córdoba, Spain
- UGC Occidente. Distrito Sanitario Córdoba y Guadalquivir, Córdoba, Spain
| | - Juan Manuel Carmona-Torres
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
- Facultad de Fisioterapia y Enfermería, Universidad de Castilla-La Mancha (UCLM), Toledo, Spain
| | - Ignacio Morales-Cané
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
- Área de Enfermería, Universidad de Córdoba, Córdoba, Spain
- Hospital Universitario Reina Sofía de Córdoba, Córdoba, Spain
| | - María Aurora Rodríguez-Borrego
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
- Área de Enfermería, Universidad de Córdoba, Córdoba, Spain
- Hospital Universitario Reina Sofía de Córdoba, Córdoba, Spain
| | - Pablo Jesús López-Soto
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
- Área de Enfermería, Universidad de Córdoba, Córdoba, Spain
- Hospital Universitario Reina Sofía de Córdoba, Córdoba, Spain
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28
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Min HK, Sung SA, Chung W, Kim YH, Chae DW, Ahn C, Oh KH, Park SK, Lee SW. Polypharmacy and the Progression of Chronic Kidney Disease: Korean Cohort Study for Outcome in Patients with Chronic Kidney Disease. Kidney Blood Press Res 2021; 46:460-468. [PMID: 34091449 DOI: 10.1159/000516029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 03/20/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The renal hazard of polypharmacy has never been evaluated in predialysis chronic kidney disease (CKD) patients. OBJECTIVE We aimed to analyze the renal hazard of polypharmacy in predialysis CKD patients with stage 1-5. METHOD The data of 2,238 patients from a large-scale multicenter prospective Korean study (2011-2016), excluding 325 patients with various missing data, were reviewed. Polypharmacy was defined as taking 6 or more medications at the time of enrollment; renal events were defined as a ≥50% decrease in kidney function from baseline values, doubling of the serum creatinine levels, or initiation of renal replacement treatment. Hazard ratio (HR) and 95% confidence interval (CI) were calculated using Cox proportional-hazard regression analysis. RESULTS Of the 1,913 patients, the mean estimated glomerular filtration rate was 53.6 mL/min/1.73 m2. The mean medication count was 4.1, and the prevalence of polypharmacy was 27.1%. During the average period of 3.6 years, 520 patients developed renal events (27.2%). Although increased medication counts were associated with increased renal hazard with HR (95% CI) of 1.056 (1.007-1.107, p = 0.025), even after adjusting for various confounders, adding comorbidity score and kidney function nullified the statistical significance. In mediation analysis, 55.6% (p = 0.016) of renal hazard in increased medication counts was mediated by the kidney function, and there was no direct effect of medication counts on renal event development. In subgroup analysis, the renal hazard of the medication counts was evident only in stage 1-3 of CKD patients (p for interaction = 0.014). CONCLUSIONS We cannot identify the direct renal hazard of multiple medications, and most of the potential renal hazard was derived from intimate relationship with disease burden and kidney function.
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Affiliation(s)
- Hyang Ki Min
- Department of Internal Medicine, Nowon Eulji Medical Center, Eulji University, Seoul, Republic of Korea
| | - Su Ah Sung
- Department of Internal Medicine, Nowon Eulji Medical Center, Eulji University, Seoul, Republic of Korea
| | - Wookyung Chung
- Department of Internal Medicine, Gachon University, Gil Hospital, Incheon, Republic of Korea
| | - Yeong Hoon Kim
- Department of Internal Medicine, Inje University, Busan Paik Hospital, Busan, Republic of Korea
| | - Dong-Wan Chae
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnamsi, Republic of Korea
| | - Curie Ahn
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kook-Hwan Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sue K Park
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Cancer Research Institute, Seoul National University, Seoul, Republic of Korea.,Department of Biomedical Science, Seoul National University Graduate School, Seoul, Republic of Korea
| | - Sung Woo Lee
- Department of Internal Medicine, Uijeongbu Eulji University Medical Center, Uijeongbu, Republic of Korea
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29
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Anticoagulation Control with Acenocoumarol or Warfarin in Non-Valvular Atrial Fibrillation in Primary Care (Fantas-TIC Study). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115700. [PMID: 34073370 PMCID: PMC8199061 DOI: 10.3390/ijerph18115700] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/06/2021] [Accepted: 05/18/2021] [Indexed: 12/15/2022]
Abstract
Introduction: The use of vitamin K antagonists (VKAs) in non-valvular atrial fibrillation (NVAF) is complicated due to the narrow therapeutic margin they present and their unpredictable dose–response relationship. Most studies are based on warfarin, with the results being extrapolated to acenocoumarol. However, studies comparing the two treatments in terms of the degree of anticoagulation control are scarce, justifying the present study. Main factors associated with poor control of time in therapeutic range (TTR) of anticoagulated patients are also studied. Methods: Cross-sectional study, with real-world data from patients treated in primary care (PC). Data were obtained from the System for the Improvement of Research in PC (SIDIAP) database, covering 60,978 NVAF-anticoagulated patients from 287 PC centres in 2018. Descriptive statistics were derived, and odds ratios were estimated by multivariate logistic regression. Results: 41,430 patients were considered: 93% were being treated with acenocoumarol and 7% with warfarin. There was no difference in poor control of TTR between the two types of VKA treatment, acenocoumarol and warfarin (38.9 vs. 38.4; p = 0.610). Poor anticoagulation control was mainly associated with advanced alcoholism (OR = 1.38), liver failure (OR = 1.37) and intracranial haemorrhage (OR = 1.35) as well as female sex, age < 60 years, cardiovascular history, diabetes mellitus and other variables. Conclusions: There is no association between poor anticoagulation control and the type of VKA treatment administered. Factors associated with poor control of TTR must be considered in clinical practice to improve control and decision-making.
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Kardas P, Urbański F, Lichwierowicz A, Chudzyńska E, Kardas G, Czech M. Prevalence and Age Structure of Polypharmacy in Poland: Results of the Analysis of the National Real-World Database of 38 Million Citizens. Front Pharmacol 2021; 12:655364. [PMID: 33935769 PMCID: PMC8082447 DOI: 10.3389/fphar.2021.655364] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 03/15/2021] [Indexed: 12/05/2022] Open
Abstract
Introduction: Polypharmacy is a risk factor for adverse health outcomes, higher use of medical services and additional costs. The problem has gained attention as a consequence of aging and related multimorbidity. Therefore, there is an urgent need to adopt effective interventions aimed at reducing its burden. In order to achieve this, in-depth understanding of the prevalence of polypharmacy is required. Of particular interest is, however, assessing prevalence of polypharmacy in various age groups, to reach the right target for these interventions. So far, only limited data on polypharmacy among non-elderly individuals have been available. Aim of study: To assess overall prevalence of polypharmacy in Poland as well as its distribution in various age groups using real-world data. Methodology: A retrospective analysis of complete dispensation data of national payer organization for the years 2018–2019. The analyzed dataset included data on dispensation of reimbursed drugs, and exclusively for 2019, also non-reimbursed drugs. Polypharmacy was defined as dispensation of ≥5 prescription medications within six months. Results: In the analyzed national cohort of 38 million Polish citizens, the prevalence of polypharmacy was found to be 11.7% in 2018 and 11.6% in 2019. With age, the prevalence of polypharmacy increased, reaching the value of 56.0% in those aged 80+ in 2018, and 55.0% in 2019. Altogether, among those aged 65+, the polypharmacy was present in 43.1% in 2018, and 42.1% in 2019. In the youngest group of citizens, i.e., among those aged below 20 years, polypharmacy was found in 0.9%, and 0.8% in 2018 and 2019, respectively. Prevalence of polypharmacy, calculated for 2019 according to dispensation of five or more reimbursed and non-reimbursed drugs for the whole Polish population, was 21.8% for January-June, and 22.4% for July-December 2019. Among those aged 65+, the relevant numbers were 62.3%, and 62.9%, respectively. Conclusion: This study, being the first nationwide assessment of polypharmacy in Poland, confirmed its high prevalence. We found polypharmacy present in over one fifth of Polish society. Peaking in the elderly, polypharmacy occurred in each age group. These results lay the foundations for future interventions focused on reducing the scope of this problem in Poland.
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Affiliation(s)
- Przemysław Kardas
- Department of Family Medicine, Medical University of Lodz, Łódź, Poland
| | | | | | | | - Grzegorz Kardas
- Department of Internal Diseases, Asthma and Allergy, Medical University of Lodz, Łódź, Poland
| | - Marcin Czech
- Department of Pharmacoeconomics, Institute of Mother and Child, Warsaw, Poland
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Hellemans L, Nuyts S, Hias J, van den Akker M, Van Pottelbergh G, Rygaert X, Spriet I, Vaes B, Tournoy J, Van der Linden L. Polypharmacy and excessive polypharmacy in community-dwelling middle aged and aged adults between 2011 and 2015. Int J Clin Pract 2021; 75:e13942. [PMID: 33340210 DOI: 10.1111/ijcp.13942] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 12/14/2020] [Indexed: 01/03/2023] Open
Abstract
AIMS We aimed to assess the prevalence, components and evolution of polypharmacy and to evaluate risk factors associated with polypharmacy. METHODS A retrospective dynamic cohort study was performed, using a primary healthcare database comprising Flemish community-dwelling adults aged ≥40 years between 2011 and 2015. Polypharmacy and excessive polypharmacy were defined as the use of 5-9 or minimum 10 different medications during 1 year, respectively. Temporal changes were analysed using an autoregressive error model. Risk factors for polypharmacy were evaluated using logistic regression. RESULTS In total, 68 426 patients were included in the analysis. The prevalence of polypharmacy was 29.5% and 16.1% for excessive polypharmacy in 2015. The age-standardised prevalence rate of patients using minimum five medications increased with 1.3% per year (95% confidence interval (CI): 0.1968-2.4279). The mean number of unplanned hospital admissions was 0.07 (standard deviation (SD) 0.33) for polypharmacy patients and 0.19 (SD 0.53) for excessive polypharmacy patients. Four risk factors were found to be significantly correlated with polypharmacy: age (odds ratio (OR) 1.015; 95% CI: 1.013-1.017), female gender (OR 1.161; 95% CI: 1.108-1.216), number of chronic diseases (OR 1.126; 95% CI: 1.114-1.139) and number of general practitioner contacts (OR 1.283; 95% CI: 1.274-1.292). CONCLUSION The prevalence of polypharmacy increased between 2011 and 2015. Polypharmacy and excessive polypharmacy patients appeared to differ based on our observations of characteristics, drug therapy and outcomes. Age, female gender, number of chronic diseases and number of general practitioner contacts were associated with polypharmacy.
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Affiliation(s)
- Laura Hellemans
- Pharmacy Department, University Hospitals Leuven, Leuven, Belgium
| | - Shauni Nuyts
- Academic Centre of General Practice/Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
- L-BioStat, KU Leuven, Leuven, Belgium
| | - Julie Hias
- Pharmacy Department, University Hospitals Leuven, Leuven, Belgium
| | - Marjan van den Akker
- Academic Centre of General Practice/Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
- Institute of General Practice, Johann Wolfgang Goethe University, Frankfurt, Germany
- Department of Family Medicine, School CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Gijs Van Pottelbergh
- Academic Centre of General Practice/Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | | | - Isabel Spriet
- Pharmacy Department, University Hospitals Leuven, Leuven, Belgium
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Bert Vaes
- Academic Centre of General Practice/Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Jos Tournoy
- Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
- Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Leuven, Belgium
| | - Lorenz Van der Linden
- Pharmacy Department, University Hospitals Leuven, Leuven, Belgium
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
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Carmona-Torres JM, Cobo-Cuenca AI, Pozuelo-Carrascosa DP, Latorre-Román PÁ, Párraga-Montilla JA, Laredo-Aguilera JA. Physical Activity, Mental Health and Consumption of Medications in Pre-Elderly People: The National Health Survey 2017. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1100. [PMID: 33530650 PMCID: PMC7908116 DOI: 10.3390/ijerph18031100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 01/22/2021] [Accepted: 01/23/2021] [Indexed: 12/12/2022]
Abstract
Background: The promotion of Physical Activity (PA) is an important public health goal to reduce comorbidity and diseases associated with aging such as anxiety and depression. Aim: To investigate the association between level of PA, mental health and the consumption of medications among a representative cohort of Spanish pre-elderly people. Methods: Cross-sectional study with 5977 participants aged 50 to 64 years who participated in the National Health Survey in Spain 2017. The levels of PA were evaluated using the International Physical Activity Questionnaire and the mental conditions were measured by the Goldberg Health Questionnaire-12 (GHQ-12). The chi-square test was used for qualitative variables; Pearson's correlation was conducted between GHQ-12 score with different quantitative variables; and a logistic regression was used to determine the association between PA and mental health with the sociodemographic characteristics. Results: The participants were 51.9% women and 48.1% men with a mean age of 56.79 years, and 35.5% of participants had a low level of PA. A low level of PA was associated with cases of mental health vulnerability, anxiety and depression (in women), the consumption of more medications and greater multimorbidity. Conclusion: It is important that people reach old age with an optimal health status in order to reduce age-related disability and morbidity. More than a third of the Spanish pre-elderly do not reach the levels of PA recommended by the WHO. People who had low level of PA consumed more medications and had higher mental health vulnerability and greater multimorbidity.
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Affiliation(s)
- Juan Manuel Carmona-Torres
- Facultad de Fisioterapia y Enfermería, Campus de Fábrica de Armas, Universidad de Castilla-La Mancha, Av de Carlos III, nº 21, 45071 Toledo, Spain; (J.M.C.-T.); (A.I.C.-C.); (J.A.L.-A.)
- Grupo de Investigación Multidisciplinar en Cuidados (IMCU), Campus de Fábrica de Armas, Universidad de Castilla-La Mancha, Av de Carlos III, nº 21, 45071 Toledo, Spain
| | - Ana Isabel Cobo-Cuenca
- Facultad de Fisioterapia y Enfermería, Campus de Fábrica de Armas, Universidad de Castilla-La Mancha, Av de Carlos III, nº 21, 45071 Toledo, Spain; (J.M.C.-T.); (A.I.C.-C.); (J.A.L.-A.)
- Grupo de Investigación Multidisciplinar en Cuidados (IMCU), Campus de Fábrica de Armas, Universidad de Castilla-La Mancha, Av de Carlos III, nº 21, 45071 Toledo, Spain
| | - Diana P. Pozuelo-Carrascosa
- Facultad de Fisioterapia y Enfermería, Campus de Fábrica de Armas, Universidad de Castilla-La Mancha, Av de Carlos III, nº 21, 45071 Toledo, Spain; (J.M.C.-T.); (A.I.C.-C.); (J.A.L.-A.)
- Grupo de Investigación Multidisciplinar en Cuidados (IMCU), Campus de Fábrica de Armas, Universidad de Castilla-La Mancha, Av de Carlos III, nº 21, 45071 Toledo, Spain
| | - Pedro Ángel Latorre-Román
- Departamento de Didáctica de la Expresión Musical, Plástica y Corporal, Universidad de Jaén, Campus Las Lagunillas s/n, 23071 Jaén, Spain; (P.Á.L.-R.); (J.A.P.-M.)
| | - Juan Antonio Párraga-Montilla
- Departamento de Didáctica de la Expresión Musical, Plástica y Corporal, Universidad de Jaén, Campus Las Lagunillas s/n, 23071 Jaén, Spain; (P.Á.L.-R.); (J.A.P.-M.)
| | - José Alberto Laredo-Aguilera
- Facultad de Fisioterapia y Enfermería, Campus de Fábrica de Armas, Universidad de Castilla-La Mancha, Av de Carlos III, nº 21, 45071 Toledo, Spain; (J.M.C.-T.); (A.I.C.-C.); (J.A.L.-A.)
- Grupo de Investigación Multidisciplinar en Cuidados (IMCU), Campus de Fábrica de Armas, Universidad de Castilla-La Mancha, Av de Carlos III, nº 21, 45071 Toledo, Spain
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Rahman S, Singh K, Dhingra S, Charan J, Sharma P, Islam S, Jahan D, Iskandar K, Samad N, Haque M. The Double Burden of the COVID-19 Pandemic and Polypharmacy on Geriatric Population - Public Health Implications. Ther Clin Risk Manag 2020; 16:1007-1022. [PMID: 33116550 PMCID: PMC7586020 DOI: 10.2147/tcrm.s272908] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 09/21/2020] [Indexed: 01/08/2023] Open
Abstract
COVID-19 pandemic is inducing acute respiratory distress syndrome, multi-organ failure, and eventual death. Respiratory failure is the leading cause of mortality in the elderly population with pre-existing medical conditions. This group is particularly vulnerable to infections due to a declined immune system, comorbidities, geriatric syndrome, and potentially inappropriate polypharmacy. These conditions make the elderly population more susceptible to the harmful effects of medications and the deleterious consequences of infections, including MERS-CoV, SARS-CoV, and SARS-CoV-2. Chronic diseases among elderlies, including respiratory diseases, hypertension, diabetes, and coronary heart diseases, present a significant challenge for healthcare professionals. To comply with the clinical guidelines, the practitioner may prescribe a complex medication regimen that adds up to the burden of pre-existing treatment, potentially inducing adverse drug reactions and leading to harmful side-effects. Consequently, the geriatric population is at increased risk of falls, frailty, and dependence that enhances their susceptibility to morbidity and mortality due to SARS-CoV-2 respiratory syndrome, particularly interstitial pneumonia. The major challenge resides in the detection of infection that may present as atypical manifestations in this age group. Healthy aging can be possible with adequate preventive measures and appropriate medication regimen and follow-up. Adherence to the guidelines and recommendations of WHO, CDC, and other national/regional/international agencies can reduce the risks of SARS-CoV-2 infection. Better training programs are needed to enhance the skill of health care professionals and patient’s caregivers. This review explains the public health implications associated with polypharmacy on the geriatric population with pre-existing co-morbidities during the COVID-19 pandemic.
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Affiliation(s)
- Sayeeda Rahman
- School of Medicine, American University of Integrative Sciences, Bridgetown, Barbados
| | - Keerti Singh
- Faculty of Medical Science, The University of the West Indies, Cave Hill Campus, Wanstead, Barbados
| | - Sameer Dhingra
- School of Pharmacy, Faculty of Medical Sciences, The University of the West Indies, St. Augustine Campus, Eric Williams Medical Sciences Complex, Mount Hope, Trinidad & Tobago
| | - Jaykaran Charan
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Paras Sharma
- Department of Pharmacognosy, BVM College of Pharmacy, Gwalior, India
| | - Salequl Islam
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh
| | - Dilshad Jahan
- Department of Hematology, Asgar Ali Hospital, Dhaka 1204, Bangladesh
| | - Katia Iskandar
- School of Pharmacy, Lebanese University, Beirut, Lebanon
| | - Nandeeta Samad
- Department of Public Health, North South University, Bashundhara, Dhaka 1229, Bangladesh
| | - Mainul Haque
- The Unit of Pharmacology, Faculty of Medicine and Defence Health Universiti Pertahanan, Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, Kem Perdana Sungai Besi, Malaysia
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Medication use and climacteric syndrome: a cross-sectional population-based study. ACTA ACUST UNITED AC 2020; 26:1133-1140. [PMID: 31361701 DOI: 10.1097/gme.0000000000001381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate medication use during the climacteric period and assess its association with sociodemographic factors, morbidities, and climacteric symptoms. METHODS Secondary analysis of data from a previous exploratory cross-sectional population-based study, conducted with 749 women (45-60 y), with the help of home interviews. Associations between medication use and climacteric symptoms were analyzed, and their correlations with other variables were made. Univariate analysis was made using the χ test, followed by Bonferroni correction (multiple comparison method). Values were adjusted for age using the polytomic logistic multivariate regression analysis. Using Poisson regression analysis, simple and multiple, we identified the main factors for medication use, with forward stepwise variable selection criteria (95% CI). RESULTS The mean age was 52.5 years and menopause occurred at 46.5 years (mean). The overall prevalence of medication use was 68.8%. The use of exclusive medications for relieving climacteric symptoms was associated with the absence of diseases (prevalence ratio [PR] = 8.2; 95% CI = 3.5-18.9; P<0.001) and menopause onset between 40 and 44 years (PR = 4.9; 95% CI = 2.0-11.9; P<0.001). Polypharmacy was associated with the highest number of diseases (PR = 10.6; 95% CI = 4.6-24.2; P<0.001) and somatic Menopause Rating Scale (MRS) score >3 (PR = 1.4; 95% CI = 1.01-1.96; P = 0.044). CONCLUSIONS The prevalence of medication use among middle-aged women was high and was associated with the age of menopause onset, chronic diseases, and obesity/overweight status.
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Brandão GR, Teixeira L, Araújo L, Paúl C, Ribeiro O. Self-medication in older European adults: Prevalence and predictive factors. Arch Gerontol Geriatr 2020; 91:104189. [PMID: 32717589 DOI: 10.1016/j.archger.2020.104189] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/14/2020] [Accepted: 07/18/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND/OBJECTIVES Self-medication, despite some benefits, carries many risks, especially when practiced by older adults who are polymedicated. Information addressing the prevalence and associated factors of self-medication in older age in a European context is scarce and sometimes contradictory. This paper aims to estimate the prevalence of self-medication among older adults across Europe and to identify its predictive factors. DESIGN Cross-sectional study. SETTING Micro-data from the European Health Interview Survey (2006-2009) was used. PARTICIPANTS The sample comprised 31,672 community-dwelling individuals aged 65 and over living in private households in 14 European countries. MEASUREMENTS The analyses explored the use, over the last two weeks, of any medicines, supplements, or vitamins that were not prescribed by a doctor. RESULTS The mean self-medication prevalence was 26.3 %, being the highest in Poland (49.4 %) and the lowest in Spain (7.8 %). Greater odds of self-medication were found for women and for participants who were younger, divorced, or presented a higher educational degree. The presence of long-standing illness and physical pain or not using prescribed medication also significantly increased the possibility of self-medication. A wide variation in the odds of self-medication between countries was also observed (up to 8 times more for Poland, compared to Spain). CONCLUSION Self-medication is a prevalent problem among older Europeans, and even though some think it is risk-free, dangers tend to be greater with advancing age. This study will help identify the groups most likely to have this behavior so that we can focus on targeted educative and preventive initiatives.
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Affiliation(s)
- Gabriela Rangel Brandão
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto. Porto, Portugal; Universidade Federal de Ciências da Saúde de Porto Alegre. Porto Alegre, Brazil
| | - Laetitia Teixeira
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto. Porto, Portugal; Centro de Investigação em Tecnologias e Serviços de Saúde (CINTESIS), Aveiro/Porto, Portugal.
| | - Lia Araújo
- Centro de Investigação em Tecnologias e Serviços de Saúde (CINTESIS), Aveiro/Porto, Portugal; Escola Superior de Educação, Instituto Politécnico de Viseu, Viseu, Portugal
| | - Constança Paúl
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto. Porto, Portugal; Centro de Investigação em Tecnologias e Serviços de Saúde (CINTESIS), Aveiro/Porto, Portugal
| | - Oscar Ribeiro
- Centro de Investigação em Tecnologias e Serviços de Saúde (CINTESIS), Aveiro/Porto, Portugal; Departamento de Educação e Psicologia, Universidade de Aveiro, Aveiro, Portugal
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Prevalence of polypharmacy and the association with non-communicable diseases in Qatari elderly patients attending primary healthcare centers: A cross-sectional study. PLoS One 2020; 15:e0234386. [PMID: 32525902 PMCID: PMC7289385 DOI: 10.1371/journal.pone.0234386] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 05/26/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Polypharmacy has become a global public health concern particularly in the elderly population. The elderly population is the most susceptible to the negative effects of polypharmacy due to their altered pharmacokinetics and decreased drug clearance. Therefore, polypharmacy can lead to poor health status and higher rates of morbidity and mortality. OBJECTIVE The objective of this study was to determine the prevalence of polypharmacy (≥ 5 drugs) and its association with non-communicable diseases (NCDs) in elderly (≥65 years) Qatari patients attending Primary Healthcare (PHC) centers in Qatar. METHODS A retrospective cross-sectional analysis was conducted using the Electronic Medical Record (EMR) database of all PHC centers in Qatar for six months (April-September 2017). RESULTS Out of 5639 patients screened, 75.5% (95% CI: 74.3-76.6) were exposed to polypharmacy. Females were 1.18 times more likely to have polypharmacy compared to males (95% CI: 1.03-1.34). The multivariate analysis identified having hypertension (AOR 1.71; 95% CI: 1.38-2.13), diabetes (AOR 2.38; 95% CI: 1.97-2.87), dyslipidemia (AOR 1.29; 95% CI: 1.06-1.56), cardiovascular disease (AOR 1.56; 95% CI: 1.25-1.95) and asthma (AOR 1.39; 95% CI: 1.13-1.72) to be independent parameters associated with polypharmacy. Also, the Body Mass Index (BMI) and number of NCDs were found to be significant independent parameters associated with polypharmacy. CONCLUSIONS The prevalence of polypharmacy among Qatari elderly attending PHC Centers is very high. Our findings confirm the strong relationship between polypharmacy and BMI, and certain NCDs. Healthcare professionals should be educated about the magnitude of polypharmacy, its negative effects, and its associated factors. Best practice guidelines should be developed for improved medical practice in the prescription of medications for such a vulnerable population.
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The impact of an in-department pharmacist on the prevention of drug iatrogenesis in a rheumatology department. Clin Rheumatol 2020; 40:359-368. [PMID: 32519050 DOI: 10.1007/s10067-020-05138-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 04/17/2020] [Accepted: 05/01/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION/OBJECTIVES The primary objective was to evaluate the impact of an in-department pharmacist on the prevention of drug iatrogenesis in a rheumatology department. Secondary objectives were to determine (i) if medication history discrepancies were detected more frequently in the elderly or not, and (ii) if the mean number of treatments at admission had an impact on the number of medication history discrepancies. METHODS Implementation of a clinical-pharmacy program based on medication reconciliation and medication review of prescription for all patients admitted to a rheumatology department between January and June 2017. The analytical approach was mainly descriptive and data were expressed as mean ± standard deviation (i.e., number of treatments at admission, number of medication reconciliations) and as proportions (i.e., acceptance rate, impact). Chi-squared tests and Student's test were performed to determine if there was a significant difference in outcomes. RESULTS Three hundred twelve patients were included in the study, 517 medication history discrepancies in 243 (77.8%) patients and 196 pharmaceutical interventions in 133 (42.6%) patients. A significant difference was found in the number of medication history discrepancies and pharmaceutical interventions between the two age groups and in the mean number of treatments at admission between patients with or without medication history discrepancies. 15.4% of study patients had major medication history discrepancies and major pharmaceutical interventions. All patients and practitioners reported the usefulness of an in-department pharmacist. CONCLUSION This program was found effective in terms of safety and improvement in the continuity of care. Key Points • This clinical-pharmacy program with an in-department pharmacist had a positive impact on the prevention of drug iatrogenesis in one rheumatology department. • 15.4% (n = 48) of study patients had major medication history discrepancies and major pharmaceutical interventions. • All practitioners and patients were satisfied with this clinical-pharmacy program.
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Aldea-Perona AM, García Saiz MDM, Fernandez Quintana E, Rodriguez C, García Sánchez M, Boada C, Gonzalez-Colaço Harmand M. [Usefulness of the summary of product characteristics as a tool to improve prescription in elderly patients]. Rev Esp Geriatr Gerontol 2020; 55:156-159. [PMID: 32063402 DOI: 10.1016/j.regg.2020.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 12/03/2019] [Accepted: 01/14/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND AND OBJECTIVE The Drug Technical Data Sheet should contribute to a safe and effective use of medications in the elderly, providing accurate information on the prescription, on the possible benefits or risks of the medications, or failing that, communicating the lack of information on their use in this group. The aim of this article was to quantify the specific information for people over 65 years of age included in the data sheets of the drugs available in Spain, and enables an adequate prescription in this population. MATERIALS AND METHODS A multidisciplinary group reviewed all the Technical Data Sheets of drugs approved by the Spanish Agency for Medicines and Health Devices (AEMPS). The quality of the information was classified into 4 categories: information specifically referring to the population over 65 years old; information specifically referring to the population over 80 years old; recommendations not specific to the elderly; and specific information for the elderly. RESULTS A total of 1,462 Technical Sheets were reviewed, of which 48% had information regarding prescription in the elderly. Information on the use in patients over 80 years old was present in 1.23% of the sheets. Only 6.83% of all the sheets reviewed included specific recommendations for the elderly. CONCLUSIONS There is little specific information regarding prescription in the elderly in the technical data sheets of drugs prescribed/sold in Spain. To improve knowledge in this field, data must be provided in the sheets that are based on the scientific literature, clinical trials for the elderly, or pharmacovigilance studies focused on this population.
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Affiliation(s)
- Ana María Aldea-Perona
- Institut Hospital Mar d'Investigacions Mèdiques (IMIM), Barcelona, España; Secció Farmacología Clínica, Hospital del Mar, Barcelona, España; Universitat Autònoma de Barcelona, Barcelona, España
| | | | | | - Consuelo Rodriguez
- Servicio de Farmacología Clínica, Hospital Universitario de Canarias, Santa Cruz de Tenerife, España
| | - Marcelino García Sánchez
- Centro de Farmacovigilancia e Información Terapéutica de Canarias, Santa Cruz de Tenerife, España
| | - Carlos Boada
- Servicio de Farmacología Clínica, Hospital Universitario de Canarias, Santa Cruz de Tenerife, España
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Suzuki T, Iwagami M, Hamada S, Matsuda T, Tamiya N. Number of consulting medical institutions and risk of polypharmacy in community-dwelling older people under a healthcare system with free access: a cross-sectional study in Japan. BMC Health Serv Res 2020; 20:359. [PMID: 32336271 PMCID: PMC7183655 DOI: 10.1186/s12913-020-05205-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 04/12/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Under the Japanese free access healthcare system, patients are allowed to consult multiple medical institutions (including clinics and hospitals for general or specialist consultation) without primary care referral. This potentially increases the risk of polypharmacy. We examined the association between the number of consulting medical institutions and polypharmacy under a healthcare system with free access. METHODS Via a self-administered questionnaire, we identified people aged ≥65 years with ≥1 disease and ≥1 consulting medical institution in a Japanese city in 2016. The exposure of interest was the number of consulting medical institutions (1, 2, or ≥3) and the outcome was polypharmacy (use of ≥6 types of drugs). We performed a multivariate logistic regression analysis, adjusting for age, sex, household economy, and the number and type of comorbidities. To minimize confounding effects, we also performed propensity-score-matched analysis, categorizing patients into two groups: 1 and ≥2 consulting medical institutions. RESULTS Of 993 eligible individuals (mean (standard deviation) age: 75.1 (6.5) years, men: 52.6%), 15.7% (156/993) showed polypharmacy. Proportions of polypharmacy were 9.7% (50/516), 16.6% (55/332), and 35.2% (51/145) for people who consulted 1, 2, and ≥3 medical institutions, respectively. Relative to people who consulted 1 medical institution, adjusted odds ratios (95% confidence intervals) for polypharmacy were 1.50 (0.94-2.37) and 3.34 (1.98-5.65) for those who consulted 2 and ≥3 medical institutions, respectively. In propensity score matching, of 516 and 477 patients who consulted 1 and ≥2 medical institutions, 307 pairs were generated. The proportion of polypharmacy was 10.8% (33/307) and 17.3% (53/307), respectively (P = 0.020). The odds ratio for polypharmacy (≥2 vs. 1 consulting medical institution) was 1.73 (95% confidence interval 1.09-2.76). CONCLUSIONS Patients who consulted more medical institutions were more likely to show polypharmacy. The results could encourage physicians and pharmacists to collect medication information more actively and conduct appropriate medication reviews. Strengthening primary care is needed to address the polypharmacy issue, especially in countries with healthcare systems with free access.
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Affiliation(s)
- Toshiki Suzuki
- School of Medicine, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki, 305-8575, Japan.,Department of Health Services Research, Faculty of Medicine, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Masao Iwagami
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki, 305-8575, Japan. .,Health Services Research and Development Center, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki, 305-8575, Japan.
| | - Shota Hamada
- Health Services Research and Development Center, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki, 305-8575, Japan.,Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, No.11 Toyo-Kaiji Bldg, 1-5-11 Nishi-Shimbashi, Minato-ku, Tokyo, 105-0003, Japan
| | - Tomoyuki Matsuda
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki, 305-8575, Japan.,Health Services Research and Development Center, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki, 305-8575, Japan.,Department of Physical Therapy, School of Medical Health, Ibaraki Prefectural University of Health Sciences, 4669-2 Ami, Amimachi, Inashikigun, Ibaraki, 300-0394, Japan
| | - Nanako Tamiya
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki, 305-8575, Japan.,Health Services Research and Development Center, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki, 305-8575, Japan
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Lopes LBDC, Pereira RR, Andrade PM, Carneiro FM, Mediano MFF, Kilgore SIL, Hasslocher-Moreno AM, Sousa ASD, Oliveira MME, Saraiva RM, Holanda MTD, Silva GMSD. Adverse drug events and the associated factors in patients with chronic Chagas disease. Rev Soc Bras Med Trop 2020; 53:e20190443. [PMID: 32321092 PMCID: PMC7182287 DOI: 10.1590/0037-8682-0443-2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 01/28/2020] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION: Herein, we aimed to identify the factors associated with adverse drug events (ADEs) in chronic Chagas disease (CD) patients. METHODS: We analyzed 320 medical notes from 295 patients. The Naranjo algorithm was applied to determine the cause of ADEs. Mixed effects logistic regression was performed to evaluate the factors associated with ADEs. RESULTS: ADEs were described in 102 medical notes (31.9%). Captopril was most frequently associated with ADEs. Age (RR 0.96; 95%CI 0.94-0.99) and cardiac C/D stages (RR 3.24; 95%CI 1.30-4.58) were the most important clinical factors associated with ADEs. CONCLUSIONS: Close follow-up is warranted for CD patients.
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Affiliation(s)
- Luiza Braz da Cunha Lopes
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brasil
| | - Raquel Rodrigues Pereira
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brasil
| | - Patricia Mello Andrade
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brasil
| | - Fernanda Martins Carneiro
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brasil
| | | | | | | | - Andréa Silvestre de Sousa
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brasil
| | | | - Roberto Magalhães Saraiva
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brasil
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Gbeasor-Komlanvi FA, Zida-Compaore WIC, Dare IH, Diallo A, Darre TP, Potchoo Y, Belo M, Ekouevi DK. Medication Consumption Patterns and Polypharmacy among Community-Dwelling Elderly in Lomé (Togo) in 2017. Curr Gerontol Geriatr Res 2020; 2020:4346035. [PMID: 32351556 PMCID: PMC7178761 DOI: 10.1155/2020/4346035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 08/05/2019] [Accepted: 09/17/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND In the sub-Saharan African, region of the world with a fast growing aging population and where the use of herbal products is very common, there is a paucity of data on medication consumption patterns among elderly people. The objective of this study was to assess the prevalence of polypharmacy and its associated factors among community-dwelling elderly in Lomé, Togo, in 2017. METHODS A cross-sectional study was conducted from March to June 2017 in Lomé, Togo among people aged 60 years and older. The Respondent Driven Sampling method was used to recruit participants. Data on socio-demographic characteristics and medication consumption patterns, including the use of medicinal plants and dietary supplements, were collected using a standardized questionnaire during a face-to-face interview at participants' home. Descriptive and binary logistic regression analyses were performed. RESULTS A total of 370 participants with median age 65 years, (IQR: 62-71) were enrolled in the study. Almost three elderly in five (57.6%) were multimorbid (had two or more chronic diseases). Conventional drugs (78.4%), medicinal plants (14.3%) and other dietary supplements (9.5%) were used by participants. The prevalence of polypharmacy was 22.7% (95% CI: 18.5-27.3%). Concurrent use of conventional drugs and medicinal plants or other dietary supplements was observed among 17.0% of participants and 67.3% reported self-medication. Multimorbidity (aOR = 4.55; 95% CI: [2.42-8.54]) and female sex (aOR = 1.86; 95% CI: [1.00-3.47]) were associated with polypharmacy. CONCLUSION One elderly in five uses five or more medications in Togo. Further studies are needed to assess drug-drug interactions and herb-drug interactions among this population.
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Affiliation(s)
- Fifonsi A. Gbeasor-Komlanvi
- Faculté des Sciences de la Santé, Université de Lomé, Lomé, BP 1515, Togo
- Centre Africain de Recherche en Epidémiologie et en Santé Publique, Lomé, BP 4089, Togo
| | | | - Ikpindi H. Dare
- Faculté des Sciences de la Santé, Université de Lomé, Lomé, BP 1515, Togo
| | | | - Tchin P. Darre
- Faculté des Sciences de la Santé, Université de Lomé, Lomé, BP 1515, Togo
| | - Yao Potchoo
- Faculté des Sciences de la Santé, Université de Lomé, Lomé, BP 1515, Togo
| | - Mofou Belo
- Faculté des Sciences de la Santé, Université de Lomé, Lomé, BP 1515, Togo
| | - Didier K. Ekouevi
- Faculté des Sciences de la Santé, Université de Lomé, Lomé, BP 1515, Togo
- Centre Africain de Recherche en Epidémiologie et en Santé Publique, Lomé, BP 4089, Togo
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Badawy NA, Labeeb SA, Alsamdan MF, Alazemi BF. Prevalence and Risk of Polypharmacy among Community-Dwelling, Elderly Kuwaiti Patients. Med Princ Pract 2020; 29:166-173. [PMID: 31509828 PMCID: PMC7098304 DOI: 10.1159/000503298] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 09/11/2019] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES To estimate the prevalence of polypharmacy in community-dwelling, older Kuwaiti patients, describe the number and types of drugs used, and identify risk factors associated with polypharmacy. SUBJECTS AND METHODS This was a descriptive cross-sectional questionnaire-based survey in which we interviewed 500 community-dwelling Kuwaiti adults over 65 years of age. The data collection occurred during a 4-month period from March to July 2017. RESULTS Fifty-two percent (n = 260) of the patients were males, with a mean age of 71.73 ± 5.32 years. The prevalence of polypharmacy (5-8 drugs) and excessive polypharmacy (>8 drugs) was 58.4% (n = 292) and 10.2% (n = 51), respectively. The risk factors associated with an increased number of medicines used were: female gender (p = 0.019), a lower level of education (p = 0.003), a high number of hospital admissions (p = 0.000), clinics visited by the patient (p =0.000), and number of comorbidities (p = 0.000). The most commonly used medications (82.6% of the study population) were blood glucose-lowering agents, excluding insulin. Other commonly used medications were antihypertensive drugs and lipid-modifying agents. CONCLUSION A significant sector of the older Kuwaiti patient population has a high prevalence of polypharmacy and is thus exposed to its potential hazards. The current study highlights the need to revise the drug-dispensing policy among community-dwelling, older Kuwaiti people, as well as to initiate educational programs among healthcare practitioners concerning prescribing issues in older individuals.
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Affiliation(s)
- Nabil Ahmed Badawy
- Department of Biomedical Science, College of Nursing, Public Authority for Applied Education and Training, Al Shuwaikh, Kuwait,
| | - Shokria Adely Labeeb
- Department of Nursing, College of Nursing, Public Authority for Applied Education and Training, Al Shuwaikh, Kuwait
| | - Mawaheb Falah Alsamdan
- Department of Biomedical Science, College of Nursing, Public Authority for Applied Education and Training, Al Shuwaikh, Kuwait
| | - Badria Faleh Alazemi
- Department of Nursing, College of Nursing, Public Authority for Applied Education and Training, Al Shuwaikh, Kuwait
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Gutiérrez-Valencia M, Aldaz Herce P, Lacalle-Fabo E, Contreras Escámez B, Cedeno-Veloz B, Martínez-Velilla N. Prevalencia de polifarmacia y factores asociados en adultos mayores en España: datos de la Encuesta Nacional de Salud 2017. Med Clin (Barc) 2019; 153:141-150. [DOI: 10.1016/j.medcli.2018.12.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 12/11/2018] [Accepted: 12/13/2018] [Indexed: 12/22/2022]
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Ghorbani Z, Mirghafourvand M, Charandabi SMA, Javadzadeh Y. The effect of ginseng on sexual dysfunction in menopausal women: A double-blind, randomized, controlled trial. Complement Ther Med 2019; 45:57-64. [DOI: 10.1016/j.ctim.2019.05.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 04/24/2019] [Accepted: 05/12/2019] [Indexed: 12/30/2022] Open
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Changes in Alcohol Consumption and Associated Variables among Older Adults in Spain: A population-based cohort study. Sci Rep 2019; 9:10401. [PMID: 31320663 PMCID: PMC6639301 DOI: 10.1038/s41598-019-46591-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 06/27/2019] [Indexed: 12/29/2022] Open
Abstract
We examined prospective changes in drinking patterns and their associations with socio-behavioral and health status variables in older adults in Spain using data from a prospective cohort of 2,505 individuals (53.3% women) representative of the non-institutionalized population aged >60 years in Spain. Alcohol consumption was assessed at baseline (2008–10) and at follow-up (2012) with a validated diet history. At risk drinking was defined as consuming >14 g of alcohol/day on average or any binge drinking in the last 30 days; lower amounts were considered light drinking. A total of 26.5% of study participants changed their intake during follow-up. Most participants reduced alcohol intake, but 23.3% of men and 8.9% of women went from light to at risk drinking during the study period. Low social connectivity at baseline was linked to at risk drinking for both sexes. However, the observed associations between changes in social connectivity, morbidity, BMI, or dietary habits and changes in drinking patterns differed by sex. We concluded that since about a quarter of older adults in Spain consume more alcohol than recommended, identifying socio-behavioral factors associated with this behavior is key for designing health campaigns targeting excessive alcohol consumption in this vulnerable population.
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Li J, Chattopadhyay K, Xu M, Chen Y, Hu F, Wang X, Li L. Prevalence and predictors of polypharmacy prescription among type 2 diabetes patients at a tertiary care department in Ningbo, China: A retrospective database study. PLoS One 2019; 14:e0220047. [PMID: 31314797 PMCID: PMC6636754 DOI: 10.1371/journal.pone.0220047] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 07/08/2019] [Indexed: 12/30/2022] Open
Abstract
Objectives To determine the prevalence of polypharmacy prescription among type 2 diabetes (T2DM) patients at a tertiary care department in Ningbo, China, and to determine factors that independently predict this polypharmacy prescription. Methods A retrospective cross-sectional study was conducted using an existing computerised medical records database. This database was screened from 2012 to 2017 for adult patients with T2DM and parameters like prescribed medicines and socio-demographic, behavioural and other medical information. Polypharmacy prescription was defined as the simultaneous prescription of ≥5 medicines by the clinician at the time of discharge for daily usage by the patient as part of his/her long-term treatment plan. Results The study inclusion criteria were satisfied by 3370 T2DM patients. Over a 5-year period, 72.2% (n = 2432) of T2DM patients were prescribed polypharmacy. On an average, eight medicines were prescribed to them. The odds of polypharmacy prescription increased with patients’ age (18–39 years: 1; 40–59 years: OR 1.86, 95% CI 1.28–2.71; and ≥60 years: 2.42, 1.65–3.55), duration of T2DM (≤1 year: 1; >5–10 years: 1.70, 1.10–2.62; and >10 years: 2.55, 1.68–3.89), and length of hospital stay (≤5 days: 1; >5–10 days: 2.43, 1.86–3.17; and >10 days: 2.99, 2.24–3.99), and were higher in those with poor blood glucose level (2.09, 1.67–2.62) and with comorbidities like other endocrine, nutritional and metabolic diseases (2.24, 1.76–2.85), circulatory system diseases (4.35, 3.62–5.23), skin and subcutaneous tissue diseases (1.64, 1.04–2.59), and musculoskeletal system and connective tissue diseases (1.61, 1.27–2.03). The odds of polypharmacy prescription were lower in those with comorbidities like neoplasms (0.51, 0.36–0.70) and during pregnancy, childbirth and the puerperium (0.06, 0.01–0.49). Conclusions Around three fourth of T2DM patients at the tertiary care department were prescribed polypharmacy, and the predictors were identified. The study findings could be taken into consideration in future interventional studies aimed at supporting medicines optimisation (and deprescribing) among these patients.
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Affiliation(s)
- Jialin Li
- Department of Endocrinology and Metabolism, Ningbo First Hospital, Ningbo, Zhejiang Province, PR China
| | - Kaushik Chattopadhyay
- Division of Epidemiology and Public Health, School of Medicine, The University of Nottingham, Nottingham, United Kingdom
| | - Miao Xu
- Department of Endocrinology and Metabolism, Ningbo First Hospital, Ningbo, Zhejiang Province, PR China
| | - Yanshu Chen
- Department of Endocrinology and Metabolism, Ningbo First Hospital, Ningbo, Zhejiang Province, PR China
| | - Fangfang Hu
- Department of Endocrinology and Metabolism, Ningbo First Hospital, Ningbo, Zhejiang Province, PR China
| | - Xingzhen Wang
- Department of Endocrinology and Metabolism, Ningbo First Hospital, Ningbo, Zhejiang Province, PR China
| | - Li Li
- Department of Endocrinology and Metabolism, Ningbo First Hospital, Ningbo, Zhejiang Province, PR China
- * E-mail:
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