Iris Publishers - Current Trends in Clinical & Medical Sciences (CTCMS)

Satisfaction and Knowledge of Elderly Patients Towards Their Multiple Medications Usage

Authored by SM Alqallaf


Although multiple drug use or polypharmacy might be considered appropriate as in cases of concomitant diseases or in complex medical conditions, the inappropriate polypharmacy or major polypharmacy is a very common problem around the globe [1-4]. An example of that is a German study which reported the use of more than 5 medications in 26.7% of elderly patients and this doubles (54%) when including over the counter medications [1]. Nevertheless, the number of medications that constitutes polypharmacy is not fully agreed. However, WHO (2004) defined Polypharmacy as “the administration of many drugs at the same time or the administration of an excessive number of drugs “WHO 2004. Hence, polypharmacy term has been used to describe a patient’s use of multiple drugs and is used also more generally to describe unnecessary drug prescription [3,5].

The main reason for the problem of inappropriate polypharmacy is the growing elderly population with its accompanying pathophysiological changes and the advancement in healthcare services [6-8]. Age-related changes involves all body organs / systems and necessitates special considerations in drug prescribing in the elderly [9]. These changes might affect drugs’ pharmacokinetics parameters and might result in potential drugdrug interactions [9,10]. Other causes for the polypharmacy include visiting multiple physicians, the use of complex drug treatment and the occurrence of drugs’ side effects which might be interpreted as a newly existing disease [6,11,12]. Another genuine reason is the psychosocial factor such as the use of traditional remedies or herbs which was reported in 30 % of German adults [6,8].

 

he evidence for the negative impact of polypharmacy on the patients’ health is well established, even with the intake of as few as four medications at any given time [5,13]. One main complication is the exposure to potentially inappropriate medications with what it carries of an increase in the incidence of serious adverse drug reactions and interactions [2,6,13-16]. In Sweden, fatal adverse drug reactions represented approximately 3 % of all deaths in elderly patients [15]. Non-fatal adverse drug reactions secondary to polypharmacy represents a significant cause of emergency department visits and hospital admission in the elderly [7,14-16]. A study indicated that 12 % of hospital admissions in elderly are related to adverse drug reactions [14]. These patients were found to be at increased risk of rehospitalization [17]. Another complication of polypharmacy is the under-prescribing of recommended drugs; which is known as ‘‘treatment risk paradox’’ [6]. Polypharmacy is also associated with an increase in the risk of geriatric syndromes such as delirium, falls, incontinence and behavioral disturbances [14-16]. Other consequences of polypharmacy are higher mortality rate, greater health-care cost and increased medication errors [6, 14-18]. Additionally, multiple medication use carries the risk of poor adherence which is a multi-factorial problem [14]. Factors that might worsen the problem of poor adherence in patients with multiple medications include dosing schedule confusion, inadequate medication education / counselling, poor patient’s memory, poor hand dexterity with difficult to open packages and it might intentional trying to avoid adverse drug reactions [6].

The aim of this study is to determine the satisfaction and knowledge of elderly patients in Bahrain towards their multiple medication’s usage. Another aim is to discover the prevalence of inappropriate polypharmacy among elderly patients in Bahrain.

Methods

A systematic review of the literature was performed using several medical engines including the National Library of Medicine’s PubMed database, Science Direct and Google Scholars (limited to English language). The terms used in the search were polypharmacy, multiple medication use, polypharmacy and elderly, inappropriate medication frequency, medication errors with polypharmacy. The search profile included comprehensive lists of various clinical studies that were conducted in different world areas for statistically relevant information about polypharmacy. Data of these studies were eventually compared with the analysis of the current study. A cross sectional survey was carried out aiming at exploring the prevalence of the problem of inappropriate polypharmacy. Using a standardized questionnaire, 100 Bahraini patients aged 55 to more than 75 years were interviewed in different. Because of the limited time available for completing the study being part of an educational course, convenience sampling was used and therefore the study may not be sufficiently representative of the entire population. The Inclusion criteria were patients aged more than 55 years. No exclusion criteria were put. Both genders were enrolled, in which fifty-five males and forty-five females were interviewed. Participants answered 14 questions regarding drugs taken, pattern of using each drug and patients’ personal, social and medical history in addition to their satisfaction with their treatment regimen. The survey was pilot tested on 10 subjects to improve questions, clarity and quality of data collection. Full demographic data was collected for all subjects, including age, gender, and education Table 1.

A summary score of percentage correct answers was finally created. The data was analyzed using Microsoft Excel program for statistical analysis. Since the study is cross-sectional, descriptive statistical analysis was conducted. This study was approved by the Pharmacy Program Ethics Committees. Data was collected from participants who provided verbal consent.

Results

Demographic data

Demographical data of the participants are shown in Table 1. The male patients were 55 %, while the rest were female. The majority (49 %) of patients were 55 - 64 years age, 31 % were 65- 75 years and the rest (20%) were more than 75 years. Illiterate patients were 15 %, patients with elementary, intermediate and secondary school certificates were 18%, 16% and 33% respectively, while patients with university degrees were 18%. The results showed that the majority of participants suffered from diabetes (87%), hypertension (84%) and hyperlipidemia (83%). Furthermore, some of the participants suffered from heart disease (38 %), thyroid gland disorders (32%) and other chronic disease such as gout, glaucoma, depression, asthma and rheumatoid arthritis (Figure 1).

To read more about this article: https://irispublishers.com/ctcms/fulltext/satisfaction-and-knowledge-of-elderly-patients-towards-their-multiple-medications-usage.ID.000532.php

Indexing List of Iris Publishers: https://medium.com/@irispublishers/what-is-the-indexing-list-of-iris-publishers-4ace353e4eee

Iris publishers google scholar citations: https://scholar.google.co.in/scholar?hl=en&as_sdt=0%2C5&q=irispublishers&btnG=


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