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Polypharmacy and excessive polypharmacy in octogenarians and older acutely hospitalized patients

Polypharmazie und exzessive Polypharmazie bei akut hospitalisierten hochbetagten Patienten

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Summary

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.

Zusammenfassung

Ziel

Das Ziel dieser Studie war es, das Auftreten von Polypharmazie und exzessiver Polypharmazie in Abhängigkeit von Co-Morbiditäten bei hochbetagen hospitalisierten Patienten zu erfassen.

Methodik

Die Entlassungsdokumentationen von allen Patienten (80 Jahre oder älter), die 2010 im durchführenden Zentrum aufgenommen wurden, wurden analysiert. Basierend auf dem Charlson Co-Morbiditätsindex wurde ein multiples logistisches Regressionsmodell mit schrittweiser Rückwärtselimination durchgeführt. Die Patienten wurden des weiteren in 4 Altersgruppen und nach Geschlecht stratifiziert und die Änderung der Medikationen während des stationären Aufenthalts analysiert.

Ergebnisse

Chronische Lungenerkrankung (Odds ratio (OR) 2,40), Diabetes mellitus mit (OR 4,65) oder ohne (OR 1,65) mikrovaskulären Komplikationen, Herzinsuffizienz (OR 2,37), Kollagenose (OR 3,02) and periphere Gefäßerkrankung (OR 2,30) waren statistisch signifikant mit Polypharmazie assoziiert, während einige von diesen Erkrankungen auch mit exzessiver Polypharmazie zusammenhingen. Die Anzahl der eingenommenen Medikamente zeigte einen zunehmenden Abfall mit dem Alter, was mit einer gleichsinnigen Abnahme des Charlson Scores verbunden war. „Aufnahme wegen Myokardinfarkt“ war mit einer Zunahme an einzunehmenden Medikamenten verbunden, während Demenz oder ein metastasiertes Malignom einen protektiven Effekt auf eine Zunahme der Medikamente während des stationären Aufenthaltes hatte.

Schlussfolgerungen

Verschiedene Begleiterkrankungen begünstigen bei sehr betagten Patienten das Auftreten von Polypharmazie. Wenige Co-Morbitidäten scheinen eine Voraussetzung zu sein, um sehr hohes Alter zu erreichen, woraus reduzierter Medikamentenverbrauch resultiert.

Behandelnde Ärzte sollten besonders bei den identifizierten Risikopatienten auf Polypharmazie achten, da dies zu unerwünschtes Ereignissen und unnötiger Hospitalisierung führen kann.

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Ethical standards

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008.

Informed consent was not applicable, as this was a retrospective analysis. The protocol for data acquisition and analysis was approved by the Viennese ethics committee (“Ethikkommission der Stadt Wien,” approval number: EK-12-219-VK).

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Authors and Affiliations

  1. 5th Medical Department,, Wilhelminenspital, Montleartstr. 37, 1160, Vienna, Austria

    Christoph Strehblow MD, Michael Smeikal MD & Peter Fasching MD

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  1. Christoph Strehblow MD
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  2. Michael Smeikal MD
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  3. Peter Fasching MD
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Correspondence to Christoph Strehblow MD.

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Strehblow, C., Smeikal, M. & Fasching, P. Polypharmacy and excessive polypharmacy in octogenarians and older acutely hospitalized patients. Wien Klin Wochenschr 126, 195–200 (2014). https://doi.org/10.1007/s00508-013-0485-1

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  • DOI: https://doi.org/10.1007/s00508-013-0485-1

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