ICIUM 2011
Tehran University of
Medical Sciences
Polypharmacy Among Older
Adults in Tehran
Tehran University of Medical Sciences,
School of Public Health,
Islamic Republic of Iran
Ahmadi, Batoul, Pharm D., M. P. H., Ph.D, Dpt. Health Management & Economics
Alimohamadian, Masoumeh, M.S., Dpt. Ecology;
Mahmoodi, Mahmood, Ph.D, Dpt. Epidemiology and biostatistics
Problem Statement
• The older adults usually suffer from chronic conditions and
have multiple medical problems, requiring prescription drugs
to treat diseases and to prevent the arising complications.
• Moreover complex medical conditions are frequent and often
involve multiple drug therapy.
• The elderly people consume about four times as many daily
doses as the rest of the populations .
• The older population in Iran is increasing and they likely use
more drugs than any other age groups.
• The figure for population more than 60 years old in Iran is
estimated to be 6.6%, more than 4 millions, and is estimated
to reach up to 10 millions in 2020.
Problem Statement
• Multiple concurrent illnesses that may benefit from drug
treatment are the rule, not the exception, in this group.
• Multiple drug use is frequently considered to be hazardous for
older people, because of their grater vulnerability to the
complications.
• The likelihood of adverse drug reactions increases markedly as
the number of concurrently administered drugs increases.
• This combined with the age-related decline in physiological
functions (decreased cardiac reserve, decreased
immunological response, decreased renal function) that in
younger patients may be protective from severity of an
adverse drug reaction make the older patient particularly at
risk for polypharmacy related adverse drug reaction.
Polypharmacy
• The term polypharmacy refers to the group of medications
one person may be taking. It is generally used when that one
person is taking too many medications, or when the drugs
have been prescribed by many doctors, and may not have
been coordinated well.
• Also, it's possible that new symptoms will occur based on one
drug, and be treated by taking another drug instead of
exploring the root cause for the symptoms - the original drug.
Over time patients may be prescribed many drugs that just
compound problematic symptoms, masking the roots of their
original medical problem.
Problem Statement
• Polypharmacy is the unwanted duplication of drugs and often
results when patients visit multiple physicians or purchase
prescription and nonprescription medicines from pharmacies.
• Polypharmacy is problematic for older persons. It causes drug
interaction, reduced compliance, adverse drug reactions,
emergency room visits and hospitalizations.
Objectives
• The purpose of this study was to determine the
prevalence of polypharmacy in older adults in Tehran
and to assess the relative medical and demographic
characteristics of patients.
Design and Setting
• In a cross-sectional descriptive study, the selective
patients were interviewed to answer a questionnaire
at home and their current using drugs were observed.
• The Information on all medications used was collected.
• The questionnaire also contained questions regarding
personal, social, and medical factors.
• Polypharmacy was defined as daily intake of three or
more drugs.
Study Population:
• Four hundred cases of patients aged 55 and older by
cluster sampling were randomly selected from
community residents in Tehran.
Results
Cases personal characteristics:
• 54% of cases were female,
• 58.2% aged 55 to 64 years old,
• 71% were retired
• 50% were housewife
• Mostly (67%) belonged to the middle class
income of the society.
• More than 80% of cases had kinds of insurance
coverage.
Results
• Mediam number of drugs used was 3.4 ± 1.9 in studied
cases and 39.6% of cases were exposed to
polypharmacy.
• The prevalence of physician prescribed drugs was
observed to be increased by increasing number of total
used drugs in each case (P<0.002).
• The most commonly used drugs were:
– acetylsalicylic acid
– atenolol
– propranolol
• These drugs were prescribed by physician in over 90%
of cases.
Results
Most frequently used drug categories :
• Cardio vascular (35.3%)
• Central nervous system (25%)
• Hormones (9.2%)
• Vitamins (8.4%)
• Gastrointestinal (7.9%)
They mostly were prescribed by physicians.
Results:
• In this study 39.6% of cases were exposed to
polypharmacy, of which 60% were female.
• The median number of daily drug usage for age
groups was:
– 3.2 for 55-64 years
– 3.6 for 65-74 years
– 3.5 for 75 years and older
Results:
• It was observed that as the number of daily drug usage
was increased the prescribed drugs usage was also
increased (p<0.002)
• Polypharmacy was more prevalent in:
– the age group of 65–75 years (P<0.04)
– lower levels of education (P<0.004)
• Polypharmacy was less prevalent in the group with
moderate income (P<0.001).
• There were positive correlations between
polypharmacy and:
– visiting multiple physicians (OR=1.96, CI 95%, 1.28- 2.98)
(P<0.002)
– reported adverse drug reactions (OR=2.44, CI 95%, 1.474.05) (P<0.001)
The correlation between polypharmacy and sociodemographic characteristics
Results
• patient’s sources of information about drugs:
– physicians as the most common source of drug information for
all cases (86%),
– family and friends (27%),
– media (22%),
– pharmacists (11%)
– drug brochures (10%) had a less important role;
• There were no meaningful relation with the patient's
characteristics.
• In polypharmacy group the figures were:
– 54% for physicians,
– 10% for pharmacists,
– 6% for drug brochures.
• There was correlation between polypharmacy and patient’s
source of information only for pharmacists (p<0.005).
Polypharmacy relation with Visiting Multiple Physicians
(VMP), and Adverse Drug Reactions (ADR) in patients
Polypharmacy prevalence for prescribed drugs
(PD) and non prescribed drugs (NPD)
Conclusion
• Polypharmacy is common among adults aged55 years and
older in Tehran and is affected by age, education level, and
economic status.
• Physicians have played an essential role in providing needed
information and explanation on drug consumption, and
pharmacists have had a poor performance in this regard
• Polypharmacy should be reduced as it has many potential
adverse effects.
Lessons learned
• The use of prescribed drugs and the mean number of
medications being used is growing among older adults.
• This study finding indicates that the pattern of drug
consumption among the older adults living in Tehran
was not satisfactory. That means polypharmacy is
common among community old people and is affected
by age, educational level, and economic status.
• Considering the fact that physicians have played an
essential role in providing needed information and
explanation on drug consumption, and pharmacists
have had a poor performance in this regard; it seems
that more attention should be paid to this issue .
Policy Implications and Conclusion:
• Factors such as longer life, multiple health problems, chronic
conditions, long term medical treatment, increased use of health
services, visiting multiple physicians, and development of new
medications contribute to this problem
• It seems that more attention should be paid to this issue by taking
the following strategies:
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Adequate training and education programmes for physicians and
pharmacists; paying more attention to their prescribing role and
skills in improving the pattern of drug consumption among the
elderly.
Establishing appropriate relations to convey the required information
between physicians and pharmacists, and with the elderly patients.
Improving technical and diagnostic skills of Physicians to prevent
symptom therapy.
Paying more attention by physicians to being informed about the
number of drugs given to the elderly and prescribing the minimum
required drugs. An appropriate diagnosis should be recorded for
each medication prescribed.
Policy Implications and Conclusion:
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Electronic patient’s record and physicians computer systems
can be helpful in reviewing prescriptions and avoiding
duplication of drug in patient at higher risk of medication
errors.
Regular medication review by physician or nurses in each visit
for elderly patients.
Repeat prescribing systems need improvement, emphasizing
on more attention by pharmacists to repeated prescriptions
and possible interactions of prescribed drugs for the elderly.
Regulatory intervention, assessments and closer monitoring
on drug prescriptions and controlling drug orders of Physicians
by health authorities.
Patient consultation and education especially for the elderly
and their family in this regard through health care services and
health education programs.
Thank you