POLYPHARMACY AND POTENTIALLY INAPPROPRIATE MEDICATION USE AMONG ELDERLY PATIENTS IN A TERTIARY CARE HOSPITAL IN NORTH INDIA: A CROSS-SECTIONAL OBSERVATIONAL STUDY
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Keywords
Polypharmacy; Potentially Inappropriate Medications; Elderly Patients; Beers Criteria; Geriatric Pharmacotherapy; Prescription Pattern; Drug Utilization
Abstract
Background: Population ageing has led to an increasing prevalence of chronic diseases requiring long-term pharmacotherapy. Elderly patients frequently receive multiple medications, predisposing them to polypharmacy and potentially inappropriate medication (PIM) use. Such prescribing practices are associated with adverse drug reactions, drug interactions, increased healthcare utilization, and poor clinical outcomes. Data regarding the prevalence of polypharmacy and PIM use among elderly patients in tertiary care settings of North India remain limited.
Objectives: To assess the prevalence of polypharmacy and potentially inappropriate medication use among elderly patients attending a tertiary care hospital in North India and to evaluate the association between polypharmacy and PIM use.
Methods: A hospital-based cross-sectional observational study was conducted from September 2023 to December 2023 among 34 elderly patients aged 60 years and above attending the medicine outpatient department or admitted to medical wards of a tertiary care hospital in North India. Data regarding demographic characteristics, comorbidities, and prescribed medications were collected using a structured case record form. Polypharmacy was defined as the concurrent use of five or more medications. Potentially inappropriate medications were identified using the American Geriatrics Society Beers Criteria 2023. Statistical analysis was performed using SPSS version 26.0. Associations between categorical variables were assessed using the Chi-square test, and a p-value <0.05 was considered statistically significant.
Results: The mean age of the participants was 68.7 ± 6.5 years, and 55.9% were male. Most patients had two or more comorbidities, with hypertension (64.7%) and diabetes mellitus (47.1%) being the most common conditions. The mean number of prescribed medications was 6.4 ± 2.1. Polypharmacy was observed in 24 (70.6%) patients. Potentially inappropriate medications were identified in 11 (32.4%) patients, with long-acting benzodiazepines, prolonged proton pump inhibitor use, first-generation antihistamines, and non-steroidal anti-inflammatory drugs being the most frequently encountered PIMs. A significant association was observed between polypharmacy and PIM use (p=0.048), indicating a higher likelihood of inappropriate prescribing among patients receiving multiple medications.
Conclusion: Polypharmacy and potentially inappropriate medication use are common among elderly patients in tertiary care settings. The significant relationship between polypharmacy and PIM use emphasizes the need for regular medication review, application of geriatric prescribing criteria, and multidisciplinary approaches to optimize pharmacotherapy and enhance patient safety in older
adults.
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Dr. Kunal Siddharth Sonawane
Associate Professor, Department of Pharmacology, RAMA Medical College Hospital & Research Centre, Kanpur, Uttar Pradesh, India.
Dr. Deb Pooja Pradip Rina
Associate Professor, Department of Pharmacology, G.S. Medical College & Hospital, Hapur, Uttar Pradesh, India.
Dr. Deshmukh Amol Chandrakant
Associate Professor, Department of Pharmacology, RAMA Medical College Hospital & Research Centre Kanpur, Uttar Pradesh, India.
Dr. Jatin Prajapati
Post Graduate Student, Department of Community Medicine, RNT Medical College, Udaipur, Rajasthan, India.
