Polypharmacy in older patients with chronic diseases: a cross-sectional analysis of factors associated with excessive polypharmacy

Abstract

Table 1 Demographic and clinical characteristics of the population Characteristics All subjects (n = 3904) Polypharmacy 7–10 substancesb (n = 1644) Excessive Polypharmacy ≥10 substances (n = 2260) n n n Sociodemographic data Age 3904  75-85c (n, %) 3036 77.8 1270 77.3 1766 78.1 ≥ 85 (n, %) 868 22.2 374 22.7 494 21.9 mean ± SD (years) 3904 81.5 ± 4.4 1644 81.6 ± 4.4 2260 81.5 ± 4.4 Sex 3904 Female, n (%) 2240 57.4 913 55.5 1327 58.7 Male, n (%) 1664 42.6 731 44.5 933 41.3 Educational level, n (%) 3578a Low 1536 39.3 669 40.7 867 38.4 Medium 1465 37.5 583 35.5 882 39.0 High 577 14.8 239 14.5 338 15.0 Health-related factors 3736a Smokers, n (%) 154 3.9 72 4.4 82 3.6 BMI, n (%) 3904 BMI < 18.5 34 0.9 15 0.9 19 0.8 BMI 18.5–24 957 24.5 435 26.5 522 23.1 BMI 25–29 1606 41.1 710 43.2 896 39.7 BMI ≥30 1307 33.5 484 29.4 823 36.4 Frailty level, n (%) 3781a Managing well 1643 42.1 804 48.9 839 37.1 Vulnerable 868 22.2 358 21.8 510 22.6 Mildly frail 660 16.9 237 14.4 423 18.7 Moderately frail 505 13.0 153 9.3 352 15.6 Severely frail 97 2.5 32 2.0 65 2.9 Very severely frail 8 0.2 2 0.1 6 0.2 Physical health composite score, median (range) 3484a 36.6 (10–68) 1454 39.4 (12–68) 2030 34.7 (10–63) Mental health composite score, median (range) 3483a 48.7 (12–76) 1454 50.3 (14–76) 2029 47.4 (12–74) Study centre, n (%) 3904 Austria 587 15.0 259 15.8 328 14.5 Germany 1 981 25.1 351 21.3 630 27.9 Germany 2 742 19.0 334 20.3 408 18.1 Italy 901 23.4 439 26.7 462 20.4 UK 693 17.8 261 15.9 432 19.1 Substances, n (mean ± SD) 3904 10.5 ± 2.4 1644 8.5 ± 0.6 2260 12.0 ± 2.2 Diagnoses, n (mean ± SD) 3898a 9.5 ± 4.9 1644 8.2 ± 4.2 2260 10.5 ± 5.2 aAs n differs from 3904, the rest of the patients have missing data regarding the variable b7 patients took < 7 substances c5 patients were < 75 years old Legend: BMI body mass index, Germany 1 Rostock, Germany 2 = Witten, SD Standard deviation Table 2 Percentage of the population using substances (ATC level 4) according to polypharmacy status Substances All subjects Polypharmacy < 10 substances Excessive polypharmacy ≥10 substances n (%) n (%) n (%) C10AA HMG CoA reductase inhibitors 2479 63.5 999 60.8 1480 65.5 A02BC Proton pump inhibitors 2328 59.6 837 50.9 1491 66.0 C07AB Beta blocking agents, selective 2240 57.4 909 55.3 1331 58.9 B01AC Platelet aggregation inhibitors excl. Heparin 1952 50.0 762 46.4 1190 52.7 C09AA ACE Inhibitors, plain 1751 44.9 792 48.2 959 42.4 C03CA Sulfonamides, plain 1715 43.9 569 34.6 1146 50.7 C08CA Dihydropyridine derivates 1611 41.3 658 40.0 953 42.2 C09CA Angiotensin II antagonists, plain 1355 34.7 505 30.7 850 37.6 C03AA Thiazides, plain 1354 34.7 555 33.8 799 35.4 A11CC Vitamin D and analogues 1120 28.7 345 21.0 775 34.3 Table 3 Most common diagnoses of the population according to polypharmacy status Diagnoses All subjects Polypharmacy < 10 substances Excessive polypharmacy ≥10 substances n (%) n (%) n (%) I10 Essential (primary) hypertension 3428 87.8 1426 86.7 2002 88.6 E78 Disorders of lipoprotein metabolism and other lipidaemias 2078 53.2 814 49.5 1264 55.9 E11 Type 2 diabetes mellitus 1850 47.4 686 41.7 1164 51.5 M19 Osteoarthritis 1752 44.9 683 41.6 1069 47.3 I25 Chronic ischaemic heart disease 1473 37.7 566 34.4 907 40.1 M54 Dorsalgia 1442 36.9 499 30.4 943 41.7 I48 Atrial fibrillation and flutter 1172 30.0 471 28.7 701 31.0 I50 Heart failure 1142 29.3 412 25.1 730 32.3 K21 Gastro-oesophageal reflux disease 982 25.2 369 22.5 613 27.1 F32 Depressive episode 853 21.9 292 17.8 561 24.8 Factors associated with excessive polypharmacy Table 4 reports the results of the multivariable analysis. Table 4 Factors associated with excessive polypharmacy (≥10 substances); results from the multivariable generalized linear mixed model Univariable Multivariable Factors OR (95% CI) p OR (95% CI) p Sex (female vs male) 1.18 (1.03–1.35) 0.0189 1.03 (0.89–1.19) 0.6718 Age group (≥85 vs < 85) 0.96 (0.82–1.13) 0.6388 0.83 (0.70–0.99) 0.0328 Educational level (low vs medium/high/missing) 0.94 (0.81–1.10) 0.4440 0.95 (0.80–1.13) 0.5506 Frailty (frail/terminally ill vs managing well/vulnerable/missing) 1.83 (1.57–2.13) <.0001 1.45 (1.22–1.71) <.0001 BMI (≥30 vs < 30) 1.34 (1.16–1.54) <.0001 1.18 (1.02–1.38) 0.0303 Smoker (smoker vs non-smoker/ex-smoker/missing) 0.83 (0.59–1.16) 0.2763 0.85 (0.60–1.21) 0.3579 Research centre (Austria vs Germany 1) 0.69 (0.52–0.93) 0.0139 0.97 (0.72–1.31) 0.8519 Research centre (Italy vs Germany 1) 0.58 (0.44–0.75) <.0001 0.90 (0.67–1.21) 0.4950 Research centre (UK vs Germany 1) 0.92 (0.70–1.22) 0.5561 1.71 (1.27–2.30) 0.0004 Research centre (Germany 2 vs Germany1) 0.71 (0.54–0.94) 0.0150 0.74 (0.56–0.97) 0.0303 Number of diagnoses (> 8 vs ≤8) 2.70 (2.32–3.14) <.0001 2.64 (2.24–3.11) <.0001 Physical health composite score (≤36.635 vs > 36.636) 1.83 (1.58–2.11) <.0001 1.47 (1.26–1.72) <.0001 Mental health composite score (≤48.7 vs > 48.8) 1.53 (1.33–1.76) <.0001 1.36 (1.17–1.59) <.0001 Legend: Germany 1 = Rostock, Germany 2 = Witten Discussion This cross-sectional study is based on a large sample of older patients with polypharmacy recruited for the European randomised controlled multicentre trial PRIMA-eDS. [...]these factors increase the likelihood of excessive polypharmacy regardless of age [33, 50, 51]. [...]the positive effect of high age may become more apparent when adjusting for these factors.