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ASSESSMENT OF POLYPHARMACY AMONG THE GERIATRIC POULATION IN A TERTIORY CARE HOSPITAL IN KERALA; A PROSPECTIVE STUDY


A.Srinivasan٭1, Dr. N. Senthil Kumar 2, T.Venkatachalam2, G.Sekar3, V.Kishorekumar4, AT.Abdulrahman1
1. Dept of pharmacy practice, JKKMMRF College of pharmacy, Komarapalayam, Namakkal Dist, Tamilnadu
2. Dept of pharmaceutical chemistry,JKKMMRF College of pharmacy, Komarapalayam, Namakkal Dist, Tamilnadu
3. Dept of pharmacology, JKKMMRF College of pharmacy, Komarapalayam, Namakkal Dist, Tamilnadu
4. Dept of pharmacognosy, JKKMMRF College of pharmacy, Komarapalayam, Namakkal Dist, Tamilnadu

ABSTRACT

This study was performed to asses and establishes the prevalence of polypharmacy in geriatric population at Relief Hospital Malppuram, Kerala, on June 2011 to February 2012. Demographic analysis of this prospective study revealed the 508 patients, 290 (57.08%) were male and 218 (42.9%) were female maximum patients were in the  age group of 55-59  (29.72%) range led to a significant increase in the number of medications. the most common diagnoses was  Cardiovascular system disorders in 169 (33.26 %) patients, and Endocrine disorder ( DM Mellitus)  in 132(25.98 %) patients  followed by  Respiratory system disorders in 75 (14.76 %) patients, The Co morbidity Disease which express, 35 patients (6.89%) of the patients suffer by DM , Hypertension with Hyperlipididimia and 33(6.50%) patients were suffer by Hyperlipididimia with Hypertension.

The  number of drugs prescribed on admission 6-10 drugs received by 130 (25.59 %) patients  followed by 82 (16.14%) patients  received 11-15 drugs on admission, The most frequently used drugs on admission is Pantoprazole for 189(37.20%) patients, followed  by  Cefixime+Tazobactam  for 52 (10.23%) patients, Most Commonly Prescribed Drugs on Discharge is Clopidogrel 67(13.18 %)  patients.       Relationship between Polypharmacy and Age shows that polypharmacy occur in 73 (14.37%)) patients in age group of 55-59, followed by 63 (12.40%)) patients in age group 60-64. 19 (3.74%), Patients receiving Unnecessary Drug therapy in our study, possible drug interaction may occur for 63(12.40%) patients and Therapeutic Duplication occur in 50 (9.84%) patients. Polypharmacy can be solved by selection of appropriate medications by following proper therapeutic guidelines.

Keywords; Polypharmacy, Geriatric, DM, Hyperlipididimia

Abbrevation- COPD- Chronic Obstructive Pulmonary Disease, C R F-Chronic Renal Failure, ARF- Acute Renal Failure, UTI-Urinary Tract Infection,CVA- Cerebrovascular Accident,CAD- Coronary arteary disease,DM-Diabetes Mellitus.  

INTRODUCTION

The field of ageing and health has become a dominant area of concern in the 21st century. This is due to an increase in the absolute and relative numbers of older people in both developed and developing countries. Although the term Polypharmacy has evolved over time and is often used to mean many different things in different situations, its basic definition is quite simple more drugs are prescribed or taken than are clinically appropriate 1,2.

Polypharmacy is common occurrence in geriatric patients due to multiple illnesses. Polypharmacy is defined as the practice of prescribing four or more medications to the same person 3, 4. When the number of drugs prescribed totals five or more (major polypharmacy), a significant risk may be present 5,6 .Those the patient receives greater the number of drugs leads to the higher chances of drug interactions. Due to physiological changes in the elderly, the pharmacokinetic and pharmacodynamics of the drug may be altered and may lead to adverse drug reactions, medication errors, longer duration of hospital stay and increased treatment cost 7,8.

The risk of duplication of therapy can be high; multiple agents in the same class are available, in addition to generic and brand name versions of the same medications 9.

MATERIALS AND METHODS

This prospective study was performed in between the months of June 2011 to February 2012 among the 508 patients data (both demographical & pharmacotherapeutic) were collected at Relief Hospital Malappuram, Kerala. Collected data has been compared and analyzed with standard treatment guideline to identify the unnecessary drug therapy, duplication therapy, unwanted reaction and   economically quantify the cost of inappropriate medicine.

Inclusion & Exclusion Criteria

The individual who were aged 55 or above, an individual who has multiple chronic diseases, under reports of symptoms, multiple prescription users and who are using an inappropriate dosage medication. ICU and emergency patients and older patients who were terminally ill were excluded.

RESULTS

Gender Wise Distribution

A total of 508 patients were enrolled in the study. Out of 508 patients, there were 290(57.08%) patients were male and 218(42.9 %) patients are female.

Fig: 1Gender Wise Distribution  

Age Wise Distribution

Among them, Table-1 shows  that   29.72%   patients were  aged  55-59  years,    25.39% patients was  aged  60-64 years, 17.91  % patients was 65-69 years.

Table-1; Age Wise Distribution

S. No. Age (years) Number of Patients Percentage (%)
1 55-59 151 29.72
2 60-64 129 25.39
3 65-69 91 17.91
4 70-74 66 12.99
5 75-79 36 07.08
6 80-84 23 04.52
7 > 85 12 02.36

Disease Wise Distribution

Among the 508 patients the table (2) shows the most common diagnoses were  33.26 % of patients fall in Cardiovascular system disorders, 25.98 % of the patients suffered by Endocrine disorder (DM), 14.76 % of the patients were in  fall Respiratory system disorders, 05.31 % of the patients were fall in UTI, , 04.13 % of the patients have Renal system disorder ( ARF&CRF ).  

Table-2; Disease Wise Distribution

S. No. Disease Number of Patients Percentage (%)
1 Cardiovascular System Disorders (CAD, Angina pectoris) 169 33.26
2 Endocrine disorder(DM, Pancriatic disorder) 132 25.98
3 Respiratory System Disorders (Asthma,COPD,pneumonia, Tuberculosis) 075 14.76
4 UTI 027 05.31
5 Renal System Disorder (CRF&ARF) 021 04.13
6 Others(Gastric ulcer, Infectious disease, Anaemia, Bed Ridden) 084 16.52

Co Morbidity Disease

Co morbidity Disease which express out of 508 patients. 6.89% of the patients have DM , Hypertension with Hyperlipididimia ,6.50% of the patients have Hyperlipididimia with Hypertension, 5.71% of the patients have DM with Hypertension ,  5.11% of the study  sample have DM with Hyperlipidimia ,4.53% of the patients shave Asthma with DM,4.13% of the patients have COPD with DM,3.54% of the patients have DM with CRF, 3.15% of the patients have DM with Stroke, 2.17% of the patients have DM, Hyperlipididimia  with Bipolar disorder, 1.77% of the patients have DM, Hypertension, Hyperlipididimiia  with asthma, 1.77% of the patients have DM with CVA,CAD, 1.18% of the patients have C R F with Hypertension and 0.78% of the patients have Hypertension with asthma.

 Table-3; Co Morbidity Disease

S. No Disease Number of Patients Percentage (%)
1 DM, Hypertension with Hyperlipididimia 35 6.89
2 Hyperlipididimia with Hypertension 33 6.50
3 DM  with Hypertension 29 5.71
4 DM with Hyperlipidimia 26 5.11
5 DM with Asthma 23 4.53
6 DM with COPD 21 4.13
7 DM with C R F 18 3.54
8 DM with Stroke 16 3.15
9 DM, Hyperlipididimia  with Bipolar disorder 11 2.17
10 DM, Hypertension, Hyperlipididimiia  with asthma  09 1.77
11 DM with CVA,CAD 09 1.77
12 C R F with Hypertension 06 1.18
13 Hypertension with asthma                        04 0.78

Number of Drugs used

The  number of drugs prescribed on admission 6-10 drugs received by 130 (25.59 %)patients   followed by 82 (16.14%) patients  received 11-15 drugs on admission, The most frequently used drugs on admission is Pantoprazole for 189(37.20%) patients, followed  by  Cefixime+Tazobactam  for 52 (10.23%) patients, Most Commonly Prescribed Drugs on Discharge is Clopidogrel 67(13.18 %)  patients.

Relationship between Polypharmacy and Age

Polypharmacy occur in 256 (51.57 %) Patients, from that 73 (14.37%)) patients in age group of 55-59, followed by 63 (12.40%)) patients in age group 60-64. Total number of Patients in age above 80 was 12 patients from this 8 patients (2/3 of populations) receiving polypharmacy. 

Chart-2; Polypharmacy and Age

Age (years) Taking More Than 5 Medication Taking 5or Less Than 5 Medication
Number Percentage (%) Number Percentage (%)
55-59 73 14.37 80 15.74
60-64 63 12.40 68 13.38
65-69 47 9.4 42 8.26
70-74 41 8.2 24 4.72
75-79 18 3.6 17 3.34
80-84 14 2.8 09 1.77
>85 04 0.8 08 1.57
TOTAL 256        51.57 244 48.78

 Unnecessary Drug Therapy

Patients receiving Unnecessary Drug therapy in our study, possible drug interaction may occur for 63(12.40%) patients and Therapeutic Duplication occur in 50 (9.84%) patients, Therapeutic Duplication cost of wastage by Therapeutic Duplication was found to be 4667.90. per patient  provide an average 141.45 Indian rupees.

DISCUSSION

This study was to evaluate and monitor prevalence of polypharmacy in 508 geriatric patients. In this study, Polypharmacy occur in 256 (51.57 %) Patients, from that 73 (14.37%)) patients were in age group of (55-59) and 2/3 of populations from age above 80   receiving polypharmacy, More number of medication has been prescribed to Cardiovascular System Disorders patients and also Polypharmacy occur in patients suffer by multiple diseases like DM, Hypertension with Hyperlipididimia in 35(6.89%) patients, and Hyperlipididimia with Hypertension33 (6.50%) patients. Possible drug interaction may occur in 162(31.89%) patients, Unwanted reaction has been persists in 37(07.28%) patients, Unnecessary Drug therapy has given to 33(6.49 %) geriatric patients.

CONCLUSION

The increasing numbers of medications in geriatric population shows the necessary required to the careful re-evaluation of pharmacotherapy during the stay in hospital. Polypharmacy can be avoided by sharing the decision for making the treatment goals and plan. The medication regimen can be simplified by eliminating pharmacological duplication, drug interaction and regular review of drug regimen.

Avoid using another medication to treat a side effect of another agent. Careful observation need while prescribing antibiotics, anti ulcer and analgesics for prophylaxis purpose, over prescribing of antibiotics may in effective and creating drug tolerance. Polypharmacy can be solved by selection of appropriate medications by following proper therapeutic guidelines and thereby minimizing the number of drugs in geriatric population.

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