Polypharmacy and excessive polypharmacy in octogenarians and older acutely hospitalized patients

Wien Klin Wochenschr. 2014 Apr;126(7-8):195-200. doi: 10.1007/s00508-013-0485-1. Epub 2014 Jan 21.

Abstract

Aim: The aim of this study was to assess the occurrence of polypharmacy and excessive polypharmacy in very old hospitalized patients based on their comorbidities.

Methods: The documentation of patients aged 80 years or older admitted to our department in the year 2010 was analyzed. Based on the Charlson index of comorbidity, a multiple logistic regression model with stepwise backward elimination was performed. Patients were stratified by gender and four age-groups, and factors of a change in the number of medications during the hospital stay were assessed.

Results: Chronic pulmonary disease [odds ratio (OR): 2.40], diabetes mellitus with (OR: 4.65) or without (OR: 1.65) microvascular complications, congestive heart failure (OR: 2.37), connective tissue disease (OR: 3.02), and peripheral vascular disease (OR: 2.30) were statistically significantly associated with polypharmacy, while some of these diseases were also associated with excessive polypharmacy. The number of medications showed a gradual decrease with age, which was concordant with a decrease in total Charlson index score. "Admission for myocardial infarction" was associated with an increase in pharmaceuticals during hospital stay, whereas a known diagnosis of dementia or metastatic malignant disease was protective against a further increase in medications.

Conclusions: Several medical conditions seem to predispose to polypharmacy in very old patients. To attain old age seems to be associated with few comorbidities, which reduces the need for a high number of pharmaceuticals. Physicians should pay attention to the identified predictors in very old patients, as polypharmacy may lead to adverse events and unnecessary hospitalization.

MeSH terms

  • Acute Disease
  • Age Distribution
  • Aged, 80 and over
  • Austria / epidemiology
  • Cardiovascular Diseases / drug therapy*
  • Cardiovascular Diseases / epidemiology
  • Chronic Disease
  • Comorbidity
  • Diabetes Mellitus / drug therapy*
  • Diabetes Mellitus / epidemiology
  • Drug Prescriptions / statistics & numerical data*
  • Drug Utilization Review
  • Female
  • Humans
  • Inappropriate Prescribing / statistics & numerical data*
  • Incidence
  • Length of Stay / statistics & numerical data*
  • Lung Diseases / drug therapy*
  • Lung Diseases / epidemiology
  • Male
  • Polypharmacy*
  • Risk Factors
  • Sex Distribution