Prevalence and factors associated with excessive polypharmacy in institutionalized older people in southern Brazil

Mascarelo, Andréia; Bortoluzzi, Emanuelly Casal; Hahn, Siomara Regina; Alves, Ana Luisa Sant’Anna; Doring, Marlene; Portella, Marilene Rodrigues

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Revista Brasileira de Geriatria e Gerontologia

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Original Articles • Rev. bras. geriatr. gerontol. 24 (2) • 2021 • https://doi.org/10.1590/1981-22562021024.210027 copy

Prevalence and factors associated with excessive polypharmacy in institutionalized older people in southern Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To verify the prevalence and factors associated with excessive polypharmacy in institutionalized older people.

Method

Cross-sectional study with 478 older people living in long-term care facilities. The dependent variable was excessive polypharmacy which is defined as the concomitant use of ten or more medications. The independent variables included sociodemographic and health information. The Poisson regression with robust variance was used to analyze the effect of the independent variables compared to the outcome.

Results

The prevalence of excessive polypharmacy was 29.3% associated with heart disease (PR=1.40; 95%CI 1.03-1.91), diabetes mellitus (PR=1.52; 95%CI 1.15- 2.01), depression (PR=1.42; 95%CI 1.08-1.87), hospitalization in the last year (PR=1.36; 95%CI 1.02-1.80), and the use of potentially inappropriate medication for older people (PR=2.13; 95%CI 1.60-2.83).

Conclusion

Excessive polypharmacy was frequent among institutionalized older people. The results suggest that prevalent diseases among older people, hospitalization, and the use of potentially inappropriate medications are reasons for the use of excessive polypharmacy by this population. Said findings can guide actions aimed at optimizing the pharmacotherapy prescribed to older people.

Keywords
Polypharmacy; Elderly; Homes for the Aged; Health of the Elderly; Cross-Sectional Studies

Variable	n (%)	95% CI*
Type of LTCF
Philanthropic	273 (57.1)	52.3 - 61.5
Private	205 (42.9)	38.5 - 47.7
Longevity
Non-long-lived	205 (43.0)	38.8 – 47.2
Long-lived	272 (57.0)	52.8 – 61.2
Gender
Male	138 (28.9)	25.1 – 33.3
Female	340 (71.1)	66.7 – 74.9
Family visit
Yes	411 (87.4)	84.7 – 90.6
No	59 (12.6)	9.4 – 15.3
Color
White	424 (89.5)	86.7 – 92.0
Non-white	50 (10.5)	8.0 – 13.3
Marital status
With spouse	30 (6.3)	4.2 – 8.4
Without spouse	445 (93.7)	91.6 – 95.8
Education
Did not attend school	76 (16.5)	13.0 – 19.7
Attended school	386 (83.5)	80.3 – 87.0

Variable	n (%)	CI* 95%
Cognitive status
With decline	349 (73.2)	69.0 - 77.4
Without decline	128 (26.8)	22.6 - 31.0
Heart disease
Yes	84 (17.8)	14.4 – 21.4
No	389 (82.2)	78.6 – 85.6
Arterial hypertension
Yes	259 (54.8)	49.9 – 59.2
No	214 (45.2)	40.8 – 50.1
Cerebrovascular Accident
Yes	103 (21.6)	18.1 – 26.1
No	373 (78.4)	73.9 – 81.9
Diabetes mellitus
Yes	98 (20.6)	17.2 – 24.4
No	378 (79.4)	75.6 – 82.8
Depression
Yes	176 (37.4)	32.9 – 42.5
No	295 (62.6)	57.5 – 67.1
Dementia
Yes	236 (49.8)	44.5 – 54.2
No	238 (50.2)	45.8 – 55.5
Urinary incontinence
Yes	309 (65.2)	61.0 – 69.6
No	165 (34.8)	30.4 – 39.0
Hospitalization
Yes	148 (31.5)	27.0 – 36.4
No	322 (68.5)	63.6 – 73.0
Chronic pain
Yes	167 (36.6)	31.4 – 41.5
No	289 (63.4)	58.5 – 68.6
Insomnia
Yes	156 (33.3)	29.1 – 37.8
No	312 (66.7)	62.2 – 70.9
Potentially Inappropriate Medication
Yes	158 (35.3)	31.1 – 39.4
No	289 (64.7)	60.6 – 68.9
Basic activities of daily living
Independent	69 (15.0)	12.1 – 18.4
Dependent	392 (85.0)	81.6 – 87.9
Excessive polypharmacy
Yes	140 (29.3)	25.3 – 33.7
No	338 (70.7)	66.3 – 74.7
Multimorbidity
Yes	283 (59.6)	55.4 – 64.2
No	192 (40.4)	35.8 – 44.6

Variable	n (%)	p*	RR** (95% CI)	RR***(95% CI)
Gender		0.011		---
Female	111 (32.6)		0.69(0.47 - 1.00)
Male	29 (21.0)		1.00
Type of LTCF		0.069		---
Philanthropic	71 (26.0)		1.21(0.90 - 1.63)
Private	69 (33.7)		1.00
Heart disease		0.001
Yes	37 (44.0)		1.70(1.24 – 2.33)	1.40(1.03 – 1.91)
No	101 (26.0)		1.00	1.00
Arterial hypertension		0.003		---
Yes	90 (34.7)		1.74(1.25 – 2.43)
No	48 (22.4)		1.00
Diabetes mellitus		0.002
Yes	41 (41.8)		1.82(1.35 – 2.46)	1.52(1.15 – 2.01)
No	98 (25.9)		1.00	1.00
Pulmonary disease		0.121		---
Yes	16 (40.0)		1.47(0.96 – 2.24)
No	123 (28.3)		1.00
Depression		0.001
Yes	68 (38.6)		1.53(1.14 – 2.05)	1.42(1.08 – 1.87)
No	71 (24.1)		1.00	1.00
Dementia		0.060		---
Yes	78 (33.1)		1.24(0.92 – 1.67)
No	60 (25.2)		1.00
Urinary incontinence		0.016		---
Yes	102 (33.0)		1.45(1.03 – 2.04)
No	37 (22.4)		1.00
Fecal incontinence		0.063		---
Yes	74 (33.5)		1.22(0.91 – 1.65)
No	65 (25.7)		1.00
Multimorbidity		0.109		---
Yes	90 (31.8)		1.18(0.86 – 1.61)
No	48 (25.0)		1.00
Hospitalization		0.008
Yes	56 (37.8)		1.52(1.13 – 2.05)	1.36(1.02 – 1.80)
No	83 (25.8)		1.00	1.00
PIM		<0.001
Yes	72 (45.6)		2.43(1.81 – 3.27)	2.13(1.60 – 2.83)
No	54 (18.7)		1.00	1.00

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[1] Correspondence Andréia Mascarelo andreiamascarelo@yahoo.com.br

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Prevalence and factors associated with excessive polypharmacy in institutionalized older people in southern Brazil

Abstract

﻿Objective

Method

Results

Conclusion

Objective