Medication Use Among Ethnically Diverse Older Adults in the United States

Are there socioeconomic inequalities in polypharmacy among older people? A systematic review and meta-analysis

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.

Polypharmacy among community-dwelling elderly in Singapore: Prevalence, risk factors and association with medication non-adherence

Background:

Polypharmacy, given its link with drug interactions, potentially inappropriate medications and medication non-adherence, may pose a significant health risk, especially among the elderly. A comprehensive understanding of the epidemiology of polypharmacy is essential for countries facing population ageing and growing chronic disease burden, like Singapore.

Objectives:

We assessed the prevalence and risk factors of polypharmacy (⩾5 prescription medications) among community-dwelling elderly in Singapore and established the association of polypharmacy with medication non-adherence.

Methods:

We used data from a national sample of 1499 community-dwelling elderly aged ⩾66 years. Using logistic regression, we assessed the association of socio-demographic, health and healthcare use variables with polypharmacy, and polypharmacy with medication non-adherence.

Results:

The weighted prevalence of polypharmacy was 14.5%. In multivariable analysis, elderly who were men (versus women), with ⩾2 (versus 0–1) chronic diseases, aged ⩾85 (versus 66–69) years, and of Malay and Indian (versus Chinese) ethnicity were significantly more likely to have polypharmacy; healthcare use variables were not associated. Polypharmacy was significantly correlated with medication non-adherence.

Conclusions:

The prevalence of polypharmacy among community-dwelling elderly in Singapore is lower than that reported in other countries; however, polypharmacy is associated with medication non-adherence. Elderly subgroups, defined by gender, health status, age and ethnicity, who are at a higher risk of polypharmacy will benefit from medication review and de-prescribing services.