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      Prevalence, risk factors and health outcomes associated with polypharmacy among urban community-dwelling older adults in multi-ethnic Malaysia

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          Abstract

          Background

          Polypharmacy has been associated with increased morbidity and mortality in the older population.

          Objectives

          The aim of this study was to determine the prevalence, risk factors and health outcomes associated with polypharmacy in a cohort of urban community-dwelling older adults receiving chronic medications in Malaysia.

          Methods

          This was a baseline study in the Malaysian Elders Longitudinal Research cohort. The inclusion criteria were individuals aged ≥55years and taking at least one medication chronically (≥3 months). Participants were interviewed using a structured questionnaire during home visits where medications taken were reviewed. Health outcomes assessed were frequency of falls, functional disability, potential inappropriate medication use (PIMs), potential drug-drug interactions (PDDIs), healthcare utilisation and quality of life (QoL). Risk factors and health outcomes associated with polypharmacy (≥5 medications including dietary supplements) were determined using multivariate regression models.

          Results

          A total of 1256 participants were included with a median (interquartile range) age of 69(63–74) years. The prevalence of polypharmacy was 45.9% while supplement users made up 56.9% of the cohort. The risk factors associated with increasing medication use were increasing age, Indian ethnicity, male, having a higher number of comorbidities specifically those diagnosed with cardiovascular, endocrine and gastrointestinal disorders, as well as supplement use. Health outcomes significantly associated with polypharmacy were PIMS, PDDIs and increased healthcare utilisation.

          Conclusion

          A significant proportion of older adults on chronic medications were exposed to polypharmacy and use of dietary supplements contributed significantly to this. Medication reviews are warranted to reduce significant polypharmacy related issues in the older population.

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          Most cited references60

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          National health and nutrition examination survey: analytic guidelines, 1999-2010.

          Clifford Johnson, Ryne Paulose-Ram, Cynthia Ogden … (2013)
          Background-Analytic guide lines were first created in 1996 to assist data users in analyzing data from the Third National Health and Nutrition Examination Survey (NHANES III),conducted from 1988 to 1994 by the Centers for Disease Control and Prevention's National Center for Health Statistics. NHANES became a continuous annual survey in 1999, with data released to the public in 2-year intervals. In 2002, 2004, and 2006, guidelines were created and posted on the NHANES website to assist analysts in understanding the key issues related to analyzing data from 1999 onward. This report builds on these previous guidelines and provides the first comprehensive summary of analytic guidelines for the 1999-2010 NHANES data. Objectives-This report provides general guidelines for researchers in analyzing 1999-2010 NHANES publicly released data. Information is presented on key issues related to NHANES data, including sample design, demographic variables, and combining survey cycles. Guidance is also provided on data analysis, including the use of appropriate survey weights, calculating variance estimations, determining the reliability of estimates, age adjustment, and computing population counts.
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            Incidence and preventability of adverse drug events among older persons in the ambulatory setting.

            Jerry Gurwitz (2003)
            Adverse drug events, especially those that may be preventable, are among the most serious concerns about medication use in older persons cared for in the ambulatory clinical setting. To assess the incidence and preventability of adverse drug events among older persons in the ambulatory clinical setting. Cohort study of all Medicare enrollees (30 397 person-years of observation) cared for by a multispecialty group practice during a 12-month study period (July 1, 1999, through June 30, 2000), in which possible drug-related incidents occurring in the ambulatory clinical setting were detected using multiple methods, including reports from health care providers; review of hospital discharge summaries; review of emergency department notes; computer-generated signals; automated free-text review of electronic clinic notes; and review of administrative incident reports concerning medication errors. Number of adverse drug events, severity of the events (classified as significant, serious, life-threatening, or fatal), and whether the events were preventable. There were 1523 identified adverse drug events, of which 27.6% (421) were considered preventable. The overall rate of adverse drug events was 50.1 per 1000 person-years, with a rate of 13.8 preventable adverse drug events per 1000 person-years. Of the adverse drug events, 578 (38.0%) were categorized as serious, life-threatening, or fatal; 244 (42.2%) of these more severe events were deemed preventable compared with 177 (18.7%) of the 945 significant adverse drug events. Errors associated with preventable adverse drug events occurred most often at the stages of prescribing (n = 246, 58.4%) and monitoring (n = 256, 60.8%), and errors involving patient adherence (n = 89, 21.1%) also were common. Cardiovascular medications (24.5%), followed by diuretics (22.1%), nonopioid analgesics (15.4%), hypoglycemics (10.9%), and anticoagulants (10.2%) were the most common medication categories associated with preventable adverse drug events. Electrolyte/renal (26.6%), gastrointestinal tract (21.1%), hemorrhagic (15.9%), metabolic/endocrine (13.8%), and neuropsychiatric (8.6%) events were the most common types of preventable adverse drug events. Adverse drug events are common and often preventable among older persons in the ambulatory clinical setting. More serious adverse drug events are more likely to be preventable. Prevention strategies should target the prescribing and monitoring stages of pharmaceutical care. Interventions focused on improving patient adherence with prescribed regimens and monitoring of prescribed medications also may be beneficial.
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              Health outcomes associated with polypharmacy in community-dwelling older adults: a systematic review.

              Terri R. Fried, John C. O'Leary, Virginia Towle … (2014)
              To summarize evidence regarding the health outcomes associated with polypharmacy, defined as number of prescribed medications, in older community-dwelling persons.
              Article 0 comments Cited 241 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Alessandra Marengoni: Role: Editor
                Journal
                Journal ID (nlm-ta): PLoS One
                Journal ID (iso-abbrev): PLoS ONE
                Journal ID (publisher-id): plos
                Journal ID (pmc): plosone
                Title: PLoS ONE
                Publisher: Public Library of Science (San Francisco, CA USA )
                ISSN (Electronic): 1932-6203
                Publication date (Electronic): 8 March 2017
                Publication date Collection: 2017
                Volume: 12
                Issue: 3
                Electronic Location Identifier: e0173466
                Affiliations
                [1 ]Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
                [2 ]The Malaysian Elders Longitudinal Research (MELOR) Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
                [3 ]Centre of Excellence for Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia
                [4 ]Pharmacy Department, University Malaya Medical Centre, Kuala Lumpur, Malaysia
                [5 ]Faculty of Pharmacy, National University of Malaysia (UKM), Kuala Lumpur, Malaysia
                [6 ]Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
                [7 ]Peter Doherty Institute for Infection and Immunity, Melbourne University, Melbourne, Australia
                University of Brescia, ITALY
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                • Conceptualization: RR SSC SBK.

                • Data curation: LML WWC SAAA SA SBK.

                • Formal analysis: MM NNA LML.

                • Funding acquisition: SBK RR.

                • Investigation: LML WWC.

                • Methodology: SSC RR.

                • Supervision: AK SBK.

                • Writing – original draft: LML RR.

                • Writing – review & editing: SA AK SBK SSC.

                Author information
                http://orcid.org/0000-0003-3756-0629
                Article
                Publisher ID: PONE-D-16-46681
                DOI: 10.1371/journal.pone.0173466
                PMC ID: 5342241
                PubMed ID: 28273128
                SO-VID: 1cadda5a-1e91-410f-8d40-1544c8b45b22
                Copyright © © 2017 Lim et al
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 24 November 2016
                Date accepted : 22 February 2017
                Page count
                Figures: 0, Tables: 3, Pages: 18
                Funding
                Funded by: High Impact Research Grant
                Award ID: UM.C/625/1/HIR/MOHE/ASH/02
                Award Recipient :
                Funded by: University Malaya Research Grant
                Award ID: UMRG RP029-14HTM
                Award Recipient :
                ORCID: http://orcid.org/0000-0003-3756-0629
                This work was supported by the University of Malaya (UM) High Impact Research (HIR) Grant from the Department of Higher Education, Ministry of Education, Malaysia [UM.C/625/1/HIR/MOHE/ASH/02] to SBK and the University Malaya Research Grant from UM [UMRG RP029-14HTM] to RR.
                Categories
                Subject: Research Article
                Subject: Medicine and Health Sciences
                Subject: Geriatrics
                Subject: People and Places
                Subject: Population Groupings
                Subject: Age Groups
                Subject: Elderly
                Subject: Medicine and Health Sciences
                Subject: Cardiology
                Subject: Medicine and Health Sciences
                Subject: Health Care
                Subject: Quality of Life
                Subject: People and Places
                Subject: Geographical Locations
                Subject: Asia
                Subject: Malaysia
                Subject: Medicine and Health Sciences
                Subject: Pharmacology
                Subject: Drug Interactions
                Subject: Drug-Drug Interactions
                Subject: Medicine and Health Sciences
                Subject: Health Care
                Subject: Health Risk Analysis
                Subject: Medicine and Health Sciences
                Subject: Epidemiology
                Subject: Ethnic Epidemiology
                Custom metadata
                Data Availability All relevant data are within the paper and its Supporting Information files.

                ScienceOpen disciplines: Uncategorized
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                ScienceOpen disciplines: Uncategorized

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