POLYPHARMACY IN ADULTS WITH CHRONIC DISEASE – CHARACTERISTICS AND ASSOCIATION WITH COGNITIVE DISORDERS

Authors

  • Marta Tundzeva Center for Family Medicine, Ss. Cyril and Methodius University in Skopje, Faculty of Medicine in Skopje, Republic of North Macedonia
  • Vesna VelikjStefanovska Institute for Epidemiology and Medical Biostatistics with Medical Informatics, Ss. Cyril and Methodius University in Skopje, Faculty of Medicine in Skopje, Republic of North Macedonia
  • Katerina Kovacevikj Center for Family Medicine, Ss. Cyril and Methodius University in Skopje, Faculty of Medicine in Skopje, Republic of North Macedonia
  • Azra Gicic Center for Family Medicine, Ss. Cyril and Methodius University in Skopje, Faculty of Medicine in Skopje, Republic of North Macedonia
  • Katarina Stavrikj Center for Family Medicine, Ss. Cyril and Methodius University in Skopje, Faculty of Medicine in Skopje, Republic of North Macedonia

Keywords:

Polypharmacy, elderly, cognitive deficit

Abstract

Polypharmacy in the elderly with multimorbidity in particular results in drug interactions and manifestation of cognitive impairments and functional deficits.

To analyze the characteristics of polypharmacy, predictors affecting its variability and its impact on possible cognitive impairment in adults over 60 years of age with a diagnosed chronic disease at risk for dementia.

A national prospective multicenter study started in 2022 in 46 outpatient clinics of family medicine specialists in primary care. Participants older than 60 years of age with a confirmed minimum of one chronic disease and at risk for dementia were included. A general and clinical information questionnaire and 3 standardized questionnaires were used – Mini-cog test, IADL test and Geriatric Depression Scale (GDS).

Eight hundred fifty-eight participants were analyzed, with female predominance (57.69%). Sex and age as independent predictors significantly affected the variability of polypharmacy consistently 0.7% vs. 0.5%.

Elevated cholesterol [OR=1.449 (1.09 – 1.92) 99% CI] and obesity [OR=1.695 (1.30 – 3.30) 99% CI] were associated with female sex. Four hundred ninety-seven participants (57.92%) received ≤2 groups of medications for treatment of chronic diseases. There was no significant association between the obtained Mini-cog test scores and the number of medication groups participants received (p=0.12).

The higher GDS score was significantly associated with polypharmacy (p=0.03). A non-significant negative correlation was found between the IADL score and the number of medication groups used for therapy of chronic diseases (p=0.38).

References

Rahman S, Singh K, Dhingra S, Charan J, Sharma P, Islam S, et al. The Double Burden of the COVID-19 Pandemic and Polypharmacy on Geriatric Population - Public Health Implications. Ther Clin Risk Manag 2020; 16: 1007-1022. doi: 10.2147/TCRM.S272908.

„Северна Македонија во бројки, 2022“ Република Северна Македонија, Државен завод за статистика.

Portela D, Almada M, Midão L, Costa E. Instrumental activities of daily living (IADL) limitations in Europe: An assessment of share data. Int J Environ Res Public Health 2020; 17(20): 1-15. doi: 10.3390/ijerph17207387.

Connolly D, Garvey J, McKee G. Factors associated with ADL/IADL disability in community dwelling older adults in the Irish longitudinal study on ageing (TILDA). Disabil Rehabil 2017; 39(8): 809-816. doi: 10.3109/09638288.2016.1161848.

Dominick KL, Ahern FM, Gold CH, Heller DA. Relationship of health-related quality of life to health care utilization and mortality among older adults. Aging Clin Exp Res 2002; 14: 499-508 doi: 10.1007/BF03327351.

Thompson WW, Zack MM, Krahn GL, Andresen EM, Barile JP. Health-related quality of life among older adults with and without functional limitations. Am J Public Health 2012; 102: 496-502. doi: 10.2105/AJPH.2011.300500.

Jungo KT, Rozsnyai Z, Mantelli S, Floriani C, Löwe AL, Lindemann F, et al. 'Optimising PharmacoTherapy In the multimorbid elderly in primary CAre' (OPTICA) to improve medication appropriateness: study protocol of a cluster randomised controlled trial. BMJ Open 2019; 9(9): e031080. doi: 10.1136/bmjopen-2019-031080.

Prados-Torres A, Cura-González I, Prados-Torres D, López-Rodríguez JA, Fernández FL, Larrañaga AC, et al. Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy: study protocol of a cluster randomized clinical trial (Multi-PAP project). Implement Sci 2017; 12:54. doi: 10.1186/s13012-0170584-x.

Crowley EK, Sallevelt BTGM, Huibers CJA, Murphy KD, Spruit M, Shen Z, et al. Intervention protocol: Optimising therapy to prevent avoidable hospital admission in the multi-morbid elderly (OPERAM): A structured medication review with support of a computerized decision support system. BMC Health Serv Res 2020; 20(1): 1-12. doi: 10.1186/s12913-0205056-3.

Bahat G, Tufan F, Bahat Z, Aydin Y, Tufan A, Akpinar TS, et al. Assessments of functional status, comorbidities, polypharmacy, nutritional status and sarcopenia in Turkish community-dwelling male elderly. Aging Male 2013; 16(2): 67-72. doi: 10.3109/13685538.2013.771329.

Hovstadius, B, Petersson G. Factors leading to excessive polypharmacy. Clin Geriatr Med. 2012; 28(2): 159-172. doi: 10.1016/j.cger.2012.01.001.

Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B. Epidemiology of multimorbidity and implications for health care, research, and medical education: A cross-sectional study. Lancet 2012; 380(9836): 37-43. doi: 10.1016/S01406736 (12)60240-2.

Moriarty F, Hardy C, Bennett K, Smith SM, Fahey T. Trends and interaction of polypharmacy and potentially inappropriate prescribing in primary care over 15 years in Ireland: A repeated cross-sectional study. BMJ Open 2015; 5(9): 1-7. doi: 10.1136/bmjopen-2015-008656.

Scottish Government Polypharmacy Model of Care Group. Polypharmacy Guidance, Realistic Prescribing 3 rd Edition, 2018. Scottish Government.

Rochon PA. Drug prescribing for older adults. Section Editor: Schmader KE, Deputy Editor: Sokol HN. UpToDate. Last updated November 2012. Available from: http://www. uptodate.com/contents/drug-prescribing-for-older-adults.

Kallumpuram S, Sudhir Kumar CT, Khan B, Gavins V, Khan A, Iliffe S. Targeted case finding for dementia in primary care: Surrey Downs dementia diagnosis project. BMJ Qual Improv Rep 2015; 4(1): u209827.w4086. doi: 10.1136/bmjquality.u209827. w4086. PMID: 26893884; PMCID: PMC4752712.

den Ouden ME, Schuurmans MJ, Mueller-Schotte S. Y. V. D. Schouw. Identification of high-risk individuals for the development of disability in activities of daily living.A ten-year follow-up study. Experimental Gerontology 2013; 48: 437-443. doi: 10.1016/j. exger.2013.02.002

Lunsky Y, Modi M. Predictors of psychotropic polypharmacy among outpatients with psychiatric disorders and intellectual disability. Psychiatr Serv 2018; 69(2): 242-246. doi: 10.1176/appi.ps.201700032.

Agostini J V, Han L, Tinetti ME. The relationship between number of medications and weight loss or impaired balance in older adults. J Am Geriatr Soc 2004; 52(10): 1719-1723. doi:10.1111/j.1532-5415.2004.52467.x.

Fried TR, O’Leary J, Towle V, Goldstein MK, Trentalange M, Martin DK. Health outcomes associated with polypharmacy in community-dwelling older adults: A systematic review. J Am Geriatr Soc 2014; 62(12): 2261-2272. doi: 10.1111/jgs.13153.

Wimmer BC, Cross AJ, Jokanovic N, Wiese MD, George J, Johnell K, et al. Clinical Outcomes Associated with Medication Regimen Complexity in Older People: A Systematic Review. J Am Geriatr Soc 2017; 65(4): 747-753. doi: 10.1111/jgs.14682.

Rieckert A, Trampisch US, Klaaßen-Mielke R, Drewelow E, Esmail A, Johansson T, et al. Polypharmacy in older patients with chronic diseases: A cross-sectional analysis of factors associated with excessive polypharmacy. BMC FamPract 2018; 19(1): 1-9. doi: 10.1186/s12875-018-0795-5.

Prescriptions dispensed in community statistics for 1989–1999: England. Statistical Bulletin. Department of Health. Available from: http://www.dh.gov.uk/prod_consum_ dh/groups/dh_digitalas sets/@dh/@en/documents/digitalasset/dh_4021990.pdf [last accessed Feb 2013.

Tinetti ME, BogardusJr ST, Agostini JV. Potential pitfalls of disease-specific guidelines for patients with multiple conditions. N Engl J Med 2004; 351: 2870-2874. doi: 10.1056/NEJMsb042458

Bjerrum L, Søgaard J, Hallas J, Kragstrup J. Polypharmacy: Correlations with sex, age and drug regimen. Eur J Clin Pharmacol 1998; 54(3): 197-202. doi: 10.1007/ s002280050445.

Blyth FM, Rochat S, Cumming RG, Creasey H, Handelsman DJ, Couteur DGL, et al. Pain, frailty and comorbidity on older men: the CHAMP study. Pain 2008; 140: 224-230. doi: 10.1016/j.pain.2008.08.011.

Jyrkkä J, Hannes E, Korhonen MJ, Sulkava R, Hartikainen S. Patterns of Drug Use and Factors Associated with Polypharmacy and Excessive Polypharmacy in Elderly Persons. Drugs Aging 2009; 26(6): 493-503. https://doi.org/10.2165/00002512-200926060-00006.

Hajjar RE, Cafiero CA, Hanlon TJ. Polypharmacy in Elderly Patients. Am J Geriatr Pharmacother. 2007; 5(4): 345-351. doi: 10.1016/j.amjopharm. 2007.12.002.

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Published

2023-03-31

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Original Articles