Correlation Study Of Multi-morbidity And Polypharmacy In Hospitalized Elder Patients

Objectives:By understanding the distribution characteristics of disease and oral drugs in hospitalized elderly patients with comorbidities,analysis the impact of elderly common chronic diseases on prescription drugs and polypharmacy.So that clinicians on the comorbidity and the resulting multiple-drug-using problems have a deeper understanding of the elderly patients,in order to improve the irrational drug use and reduce the possible adverse drag-related events which may lead to explore new ideas.Methods:During the one year from January 2015 to December 2015,data were collected from elderly patients who were hospitalized at the First Affiliated Hospital of Kunming Medical University.Patients aged 65 and more than 65 were selected to study clinical characteristics from the patient's electronic medical records,including age,sex,length of hospital stay,diseases and oral medication.Patients were divided into 3 groups according to age,65 to 74 years old for the younger group,75 to 84 years old in the middle age group,85 years old or older for the elderly group.Using statistical methods to analyze its clinical features.Results:1.Of the 373 elderly patients,92.5%(345 cases)were patients with Multi-morbidity.The mean age of patients with comorbidities were(81.35 ± 7.185)years.There was a positive correlation between age and hospitalization and hospital days(Spearman rank correlation coefficients were 0.127 and 0.256,and p values were<0.05).The number of co-morbidities was 2-13,averaged(4.99 ± 2.18),73.6%(254 cases)had 4 or more diseases,and the number of drugs was 0-17,with an average of 6.13 ± 3.63,65.2%(225 cases)Of patients taking 5 or more drugs.The most common diseases among patients with comorbidities were hypertension(75.1%),benign prostatic hyperplasia(50.1%),chronic obstructive pulmonary disease(47.5%),type 2 diabetes(33.9%),cerebrovascular disease(28.1%),osteoarthrosis(27.8%),coronary heart disease(24.6%),chronic renal failure(19.7%),respiratory tract infection(18.3%),malignancy(18.3%);Prescription drugs with trimetazidine(108 cases),atorvastatin(97 cases),rosuvastatin(83 cases),amlodipine(77 cases)and other cardiovascular drugs were common.Accounted for 35.7%of patients treated with proprietary Chinese medicine.2.The correlation between age,number of diseases and number of drug use was analyzed by Spearman rank correlation analysis.The results showed that there was a positive correlation between age and number of illnesses and number of drugs(Spearman rank correlation coefficient respectively 0.244 and 0.222,and p valueswere<0.001).The percentage of multiple medication between groups was analyzed by chi-square test,indicating a statistically significant difference(p=0.012<0.05).Analysis of the three age groups,different age groups have different types of illness,There were statistical differences between the elderly group and the middle age group,the middle age group and the low age group about Chronic obstructive pulmonary disease(p<0.05),Chronic renal insufficiency,osteoporosis,and malnutrition.There was a statistically significant difference between middle age group and younger age group(p<0.05).Drug use analysis of three ages,trimetazidine,compound enzymes,enteral nutrition liquid medicine proportion in three age groups were analyzed,results showed that age group and the middle and low age group were positively correlated,statistical differences(p<0.05).Comparative analysis of aspirin in the three age groups showed a negative correlation between the elderly group and the middle and young age group(p<0.05).Calcium carbonate D3 and calcitriol were compared between the three age groups.The results showed that there were statistically significant differences between high and low age and middle and low age(p<0.05).3.From the common combination of chronic diseases,the most common combination of hypertension + chronic obstructive pulmonary disease(35.65%),followed by hypertension + diabetes(29.57%).4.From the types of drug use cases,in coronary heart disease,chronic obstructive pulmonary disease,type 2 diabetes,cerebrovascular disease in the presence of multiple drugs,especially coronary heart disease,chronic obstructive pulmonary disease,cerebrovascular,there were 25 cases(29.4%),20 cases(12.2%)and 18 cases(18.6%)respectively.Conclusions:1.The number of hospitalization,hospital stay,the number of illnesses and the incidence of multiple medication were positively correlated with age.Cardiovascular disease and diabetes prevalence is high;The most common prescription drugs are cardiovascular drugs.2.Disease and drug use of the elderly are different by different age groups,hypertension,diabetes and cerebrovascular are high incidence of disease in three ages.Disease group with hypertension + chronic obstructive pulmonary disease,hypertension + diabetes are more common.The elderly group with chronic renal insufficiency,osteoporosis,malnutrition are more common,drugs to trimetazidine,compound digestive enzymes,enteral nutrition solution are more common.3.From the various types of drug use cases,in the coronary heart disease,chronic obstructive pulmonary disease,cerebrovascular disease treatment there are multiple drugs.4.Through the study of the co-morbidity and medication characteristics of the elderly,in the co-morbidity management,should be carefully considered the patient's age and chronic disease types.In the treatment should establish the overall concept,the elderly medication should be integrated management,and pay close attention to the interaction between the disease and drug interactions.