Characteristics Of Polypharmacy In The Elderly During Hospitalization Based On Comprehensive Geriatric Assessment

Background Polypharmacy is a common and serious phenomenon in the elderly, which easily leads to adverse outcomes, and causes relational significant morbidity and mortality. Factors of geriatric pharmacotherapy are confounding, older individuals suffer from multiple co-morbidities, which often result in polypharmacy, potentially inappropriate medication(PIM) and potential prescribing omission(PPO).Aims The aim of this study was to assess the characteristics of prescribed medication in a hospital based on comprehensive geriatric assessment(CGA), to estimate the prevalence of polypharmacy and PIM among geriatric inpatients.Methods A cross-sectional study of 817 geriatric inpatients(aged ≥60 years) was conducted from March 2011 to June 2014. Inclusion criteria included(1) aged 60 years or older,(2) patients been in stable condition and were willing to participate with CGA(comprehensive geriatric assessment). Exclusion criteria included(1) patients with emergency or medically unstable status,(2) patients refused to participate in the investigatory. Written informed consent, witnessed oral consent, or kin written consent was obtained from all study participants or their family members. This study was approved by the Ethical Committee of The First Affiliated Hospital of Chongqing Medical University on human research. Data were collected through CGA, medical record and electronic prescription system. The multidimensional investigation included the demographic characteristics(gender, age, occupation, residence, income, and education), the characteristics of the type of disease and the number of suffering, characteristics of the kind and quantity of drugs and statistical analysis of adverse drug reaction. Beers’ criteria and Screening Tool to Alert doctors to Right(START) were used to identify PIM and PPO.Results Statistical analysis of 817 cases of hospitalized elderly patients(mean age 77.3 years), of which women accounted for 51.6%, men accounted for 48.8%. 78.3% of the patients suffering from 4-8 diseases(average 5.5). The commonly used drugs were antihypertensive drugs, antiplatelet drugs, statins, calcium, antibiotic and insulin. The ranges of prescribed drugs were 1-19(mean7.5), polypharmacy(5drugs) was observed in 68.5% and hyperpolypharmacy(≥9drugs) in 34.8% of patients.In addition, 57.0% of the elderly took 1-3 types of Chinese traditional medicines. From age 60 to 89, the number of drugs use gradually increased with age(P<0.05), and elderly in age group 80-89 used more drugs than other age groups. The factors contributing to polypharmacy included age, economic condition, number of diseases and occupation(P<0.001). The prevalence rate of PPOs was 47.8% using START tool, the prevalence of residents with at least one PIM was 50.1?% and 77 of patients had drug-disease or drug-disease symptom interactions using Beers’ criteria.Conclusion Our study indicates that polypharmacy, PIM and PPO are highly prevalent among older inpatients in Chongqing. Age, economic condition, comorbid conditions occupation and morbidities contributed to polypharmacy. The elderly with polypharmacy may proper when multimorbidity. Beers’ criteria and STOPP/START criteria are useful tools to assist prescription to identify and reduce PIMs and PPOs.