Background
Methods
Ethical approval
Demographic and medical details
Medications and possible medication related adverse events
Blood results
Data analysis
Results
All Participants | Participants with Polypharmacy | ||
---|---|---|---|
Most commonly used medicine classes (n = 636 total different medicines used among 411 participants) | Most commonly used medicine classes (n = 289 total different medicines used among 63 participants with polypharmacy) | ||
Drug Class | n (%) | Drug Class | n (%) |
Antihypertensive agents | 133 (20.9) | Antihypertensive agents | 72 (24.9) |
Diuretics | 92 (14.5) | Diuretics | 48 (16.6) |
Non-steroidal anti-inflammatory agents | 51 (8.0) | Non-steroidal anti-inflammatory agents | 17 (5.9) |
B group vitamins and minerals. | 35 (5.5) | B group vitamins and minerals | 16 (5.5) |
General well-being, multiple use preparations like herbs, others | 31 (4.9) | Beta-adrenergic blocking agents | 13 (4.5) |
Antidepressants | 30 (4.7) | Hyperacidity, reflux and ulcers | 12 (4.2) |
Hyperacidity, reflux and ulcers | 28 (4.4) | General well-being, multiple use preparations like herbs, others | 10 (3.5) |
Beta-adrenergic blocking agents | 27 (4.3) | Antidepressants | 9 (3.1) |
Simple analgesics and antipyretics | 24 (3.8) | Hypoglycaemic agents | 9 (3.1) |
Hypoglycaemic agents | 16 (2.5) | Simple analgesics and antipyretics | 8 (2.8) |
Characteristic | Polypharmacy n (%) | No Polypharmacy n (%) | Unadjusted prevalence ratio (95% CI) |
---|---|---|---|
Sex | |||
Male | 17 (10) | 155 (90) | 1 |
Female | 46 (19) | 193 (81) | 1.9 (1.2–3.3) |
Age (years) | |||
50–54 | 22 (13) | 148 (87) | 1 |
55–59 | 12 (9) | 116 (91) | 0.7 (0.4–1.4) |
60–64 | 11 (18) | 49 (82) | 1.4 (0.7–2.7) |
≥ 65 | 18 (34) | 35 (66) | 2.6 (1.5–4.5) |
Residence | |||
Own | 50 (18) | 223 (82) | 1 |
Rented | 5 (6) | 73 (94) | 0.4 (0.1–0.8) |
Other | 8 (13) | 52 (87) | 0.7 (0.4–1.5) |
Approximate distance from clinic (km) | |||
0–4.9 | 5 (12%) | 36 (88%) | 1 |
5–9.9 | 13 (22%) | 46 (78%) | 1.8 (0.7–4.7) |
10–14.9 | 7 (9%) | 72 (91%) | 0.7 (0.3–2.2) |
≥ 15 | 38 (16%) | 194 (84%) | 1.3 (0.6–3.2) |
Marital status | |||
Married | 20 (13%) | 129 (87%) | 1 |
Widowed | 29 (19%) | 123 (81%) | 1.5 (0.9–2.5) |
Divorced | 14 (14%) | 87 (86%) | 1.1 (0.6–2.1) |
Single | 0 (0%) | 8 (100%) | Not applicable |
Living arrangements | |||
Lives alone | 8 (15) | 46 (85) | 1 |
Lives with others | 55 (15) | 302 (85) | 1.0 (0.5–1.9) |
Education level | |||
Illiterate | 5 (16) | 26 (84) | 1 |
Primary | 30 (16) | 163 (84) | 1.0 (0.4–2.3) |
Secondary | 16 (14) | 99 (86) | 0.9 (0.3–2.2) |
Tertiary | 12 (17) | 60 (83) | 1.0 (0.4–2.7) |
Source of income | |||
Active | 48 (15) | 280 (85) | 1 |
Passive | 15 (18) | 68 (82) | 0.8 (0.5–1.4) |
Hospitalisations in previous year | |||
None | 51 (13) | 329 (87) | 1 |
One or more | 12 (39) | 19 (61) | 2.9 (1.7–4.8) |
Prescribing cadre | |||
Nurse | 4 (9) | 40 (91) | 1 |
Physician assistant | 25 (12) | 177 (88) | 1.4 (0.5–3.7) |
General medical officer | 28 (19) | 123 (81) | 2.0 (0.8–5.5) |
Internist | 6 (67) | 3 (33) | 7.3 (2.6–20.8) |
Duration since Highly Active Anti – Retroviral Therapy commenced | |||
< 5 years | 18 (12%) | 127 (88%) | 1 |
≥ 5 years | 36 (15%) | 201 (85%) | 1.2 (0.7–2.1) |
Charlson’s weighted comorbidity score | |||
0 | 29 (10%) | 253 (90%) | 1 |
1 | 23 (22%) | 82 (78%) | 2.1 (1.3–3.5) |
≥ 2 | 11 (46%) | 13 (54%) | 4.5 (2.6–7.8) |
Frailty index score | |||
0–2 | 1 (2) | 62 (98) | 1 |
3–4 | 8 (6) | 132 (94) | 3.6 (0.5–28.2) |
5–6 | 22 (19) | 95 (81) | 11.8 (1.6–85.8) |
≥ 7 | 32 (35) | 59 (65) | 22.2 (3.1–157.9) |
Characteristic | Adjusted PR (95% CI) | P value |
---|---|---|
Hospitalisation | ||
None | 1 | |
One or more hospitalisations in last year | 1.8 (1.1–3.1) | 0.02 |
Prescribing cadre | ||
Nurse | 1 | |
Clinical officer | 1.0 (0.4–2.6) | 0.99 |
Medical officer | 1.4 (0.5–3.7) | 0.49 |
Internist | 3.6 (1.3–10.5) | 0.02 |
Frailty score | ||
0–2 | 1 | |
3–4 | 3.3 (0.4–25.6) | 0.25 |
5–6 | 10.6 (1.4–78.0) | 0.02 |
7 or more | 17.4 (2.4–126.5) | 0.005 |
Characteristic | Unadjusted PR (95% CI) | P value | Adjusted PR (95% CI) | P value |
---|---|---|---|---|
≥1 possible side effect due to medication once or more per week | ||||
Polypharmacy | 1.7 (1.2–2.3) | 0.002 | 1.2 (0.8–1.6) | 0.38 |
Protease inhibitor based regimen | 1.7 (1.1–2.4) | 0.01 | 1.6 (1.1–2.3) | 0.01 |
Frailty score | ||||
0–2 | 1 | 1 | ||
3–4 | 2.1 (1.0–4.5) | 0.05 | 2.1 (1.0–4.5) | 0.05 |
5–6 | 2.9 (1.4–6.2) | 0.005 | 2.9 (1.4–6.1) | 0.006 |
7 or more | 4.7 (2.3–9.8) | < 0.001 | 4.4 (2.1–9.4) | < 0.001 |
Moderate or severe distress of ≥1 medication side effect | ||||
Polypharmacy | 1.9 (1.3–2.8) | 0.002 | 1.1 (0.7–1.7) | 0.57 |
Frailty score | ||||
0–2 | 1 | |||
3–4 | 1.4 (0.5–3.6) | 0.54 | 1.3 (0.5–3.5) | 0.55 |
5–6 | 2.8 (1.1–6.9) | 0.03 | 2.7 (1.1–6.8) | 0.03 |
7 or more | 5.7 (2.4–13.6) | < 0.001 | 5.4 (2.2–13.4) | < 0.001 |
≥1 Fall in previous 12 months | ||||
Polypharmacy | 1.6 (0.9–2.9) | 0.09 | 1.0 (0.6–1.6) | 0.90 |
Protease inhibitor based regimen | 1.9 (1.0–3.6) | 0.06 | 1.9 (1.1–3.3) | 0.03 |
Frailty score | ||||
0–2 | 1 | 1 | ||
3–4 | 2.3 (0.5–10.0) | 0.29 | 2.3 (0.5–10.4) | 0.28 |
5–6 | 5.1 (1.2–21.3) | 0.02 | 5.2 (1.2–22.3) | 0.02 |
7 or more | 9.0 (2.2–36.6) | 0.002 | 7.8 (1.9–32.4) | 0.005 |
Cognitive status (using MMSEa) | ||||
Normal cognition | 1 | 1 | ||
Mild cognitive decline | 2.4 (1.2–4.6) | 0.009 | 2.0 (1.1–3.9) | 0.03 |
Moderate cognitive decline | 4.1 (2.4–6.8) | < 0.001 | 3.6 (2.2–5.9) | < 0.001 |
Severe cognitive decline | 1.4 (0.5–4.4) | 0.53 | 1.1 (0.4–3.4) | 0.87 |