The following is a summary of “Effect of polypharmacy on healthcare services utilization in older adults with comorbidities: a retrospective cohort study,” published in the May 2023 issue of Primary Care by Doumat et al.

As individuals age, they often experience more comorbidities and are more likely to be prescribed multiple medications, a phenomenon known as polypharmacy. Polypharmacy is associated with inappropriate prescribing and an increased risk of adverse effects. For a study, researchers sought to investigate the impact of polypharmacy in older adults on healthcare services utilization (HSU). Additionally, they explored the effects of different drug classes involved in polypharmacy, including psychotropic, antihypertensive, and antidiabetic medications, on HSU outcomes.

The retrospective cohort study focused on community-dwelling older adults aged 65 years and above. The study participants were selected from the primary care patient cohort database of the ambulatory clinics at the Department of Family Medicine, American University of Beirut Medical Center. Polypharmacy was defined as the concurrent use of five or more prescription medications. The researchers collected demographic data, Charlson Comorbidity Index (CCI) scores, and various HSU outcomes, such as the rate of all-cause emergency department (ED) visits, all-cause hospitalizations, ED visits, hospitalizations specifically for pneumonia, and mortality. Binomial logistic regression models were utilized to predict the rates of HSU outcomes.

The analysis included a total of 496 patients. All patients had comorbidities, with 22.8% (113) exhibiting mild to moderate comorbidity and 77.2% (383) having severe comorbidity. Patients with polypharmacy were more likely to have severe comorbidity than those without polypharmacy (72.3% vs. 27.7%, P = 0.001). Patients with polypharmacy were more likely to visit the ED for all causes than those without polypharmacy (40.6% vs. 31.4%, P = 0.05). They had a significantly increased rate of all-cause hospitalization (adjusted odds ratio [aOR] 1.66, 95% CI = 1.08–2.56, P = 0.022). Patients with psychotropic polypharmacy showed a higher likelihood of hospitalization due to pneumonia (crude odds ratio [cOR] 2.37, 95% CI = 1.03–5.46, P = 0.043) and ED visits for pneumonia (cOR 2.31, 95% CI = 1.00–5.31, P = 0.049). However, these associations lost significance after adjustment.

The increasing prevalence of polypharmacy in older adults with comorbidities was associated with higher rates of HSU outcomes. Therefore, a comprehensive, multidisciplinary approach that includes frequent medication reviews was crucial to address the issue.

Source: bmcprimcare.biomedcentral.com/articles/10.1186/s12875-023-02070-0