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Volume 5, No. 10 October, 2024
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ISSN 2723-6927-e ISSN 2723-4339
EVALUATION OF
POLYPHARMACY AND EXCESSIVE POLYPHARMACY
IN GERIATRIC INPATIENTS IN GENERAL HOSPITAL
Erlinda
Surya Lita, Ida Paulina Sormin
Faculty of
Pharmacy, University of August 17, 1945 Jakarta
Email: erlindasuryalita1@gmail.com
, ida.paulina@uta45jakarta.ac.id
ABSTRACT
Polypharmacy is the simultaneous use of drugs with 5-9 drugs. Excessive
polypharmacy is the simultaneous use of drugs with ≥ 10 drugs. Chronic
diseases that are commonly suffered by geriatric patients are prone to causing
a person to receive polypharmacy or excessive polypharmacy. This study aims to
evaluate polypharmacy and excessive polypharmacy in inpatient geriatric
patients, by knowing the factors that may trigger a person to receive
polypharmacy. The research uses a cross-sectional study method, using medical
record data for the period January to December 2023. The part studied was in
the form of sociodemographics, disease history and
treatment of patients, as well as length of stay. From the research conducted,
the results were obtained from 295 patient data samples with 141 patients
(47.8%) and 154 patients (52.5%) were female. The age of patients consisted of 60-74
years old 192 patients (65.1%), 75-90 years old 100 patients (33.9%), and
≥ 90 years 3 patients (1%). The last education of the highest patient
with a high school background was 101 patients (34.2%), the highest marital
status was married as many as 245 patients (83.1%). The diagnosis of the third
disease had the most patients, namely diabetes mellitus as many as 95 patients
(15.5%), anemia as many as 70 patients (11.5%), and hypertension as many as 56
patients (9.2%). The prevalence of polypharmacy in geriatric patients was 115
patients (39%) and excessive polypharmacy was 180 patients (61%). Broadly
speaking, the sociodemographics of patients do not
have a relationship with the occurrence of polypharmacy and excessive
polypharmacy. The patient's clinical condition has a relationship with the
occurrence of polypharmacy and excessive polypharmacy, this is proven by ap
value of 0.000 (<0.05). The length of hospitalization and diagnosis of the
patient's disease is a predictor of polypharmacy and excessive polypharmacy
Keywords : Geriatrics, Polypharmacy, Risk
Factors, Disease Diagnosis, Excessive Polypharmacy
Introduction
Elderly is someone who enters the age of 60 years and above, where
the human age group has entered the final stage of its life phase. According to
the World Health Organization (WHO),
the elderly population in Indonesia is estimated to reach 38 million in 2030
and 61 million in 2050. Globally, the prevalence of excessive polypharmacy in the elderly population has been reported
to vary widely from 7.4% to 43.4% (Cho et al., 2022).
Polypharmacy, which is the use of several medications
simultaneously, is common in people living with chronic pain (Guilot et al.,
2020). Polypharmacy is needed to treat people with multimorbidity, such as the
elderly or people with chronic pain. Rational polypharmacy can provide positive
clinical outcomes by approaching the disease through multiple mechanisms of
action. However, it can also pose potential problems, such as increased risk of
drug-related adverse events, as well as drug interactions (Chang et al., 2020).
Polypharmacy is one of the causes of potentially inappropriate medications (PIM), is very common in the
elderly and indicates a significant cost in health care. Elderly people who are
sick or who have weakness, and disabilities, are at high risk of experiencing
adverse events due to PIM (Mohamed et al., 2021).
PIM includes the use of medications where the risks outweigh the
benefits, especially when there is evidence of alternative therapies that are
safer and equally or more effective. This also includes drug misuse, including
inappropriate dosing and duration. The presence of multiple comorbid conditions
and altered pharmacokinetics and pharmacodynamics make geriatric patients
particularly vulnerable to inappropriate prescribing (Davies et al. , 2020). Polypharmacy can
increase the risk of adverse drug events in geriatric patients. This is due to
three reasons. First, because a higher number of medications is accompanied by
a higher risk of harmful drug-drug interactions (Santanasto et al., 2019). Second, due to the aging process associated with physiological
changes (e.g., weight loss, impaired hepatic and renal excretion, decreased
cardiac output, remodeling of body composition) that make older adults more
susceptible to adverse drug reactions. Third, because of the high prevalence of
chronic multimorbidity in older age leading to an increased risk of
drug-disease interactions.
Despite the potential negative consequences for geriatric patients
receiving polypharmacy, there is increasing acceptance that prescribing
multiple medications can be appropriate, and under certain circumstances. Thus,
polypharmacy can refer to prescribing too many medications (appropriate) or too
many medications (inappropriate). Patients receiving polypharmacy are at higher
risk for medication-related problems than those taking fewer medications (Almodóvar & Nahata, 2019).
Research on polypharmacy, especially excessive polypharmacy, is important to do. This is because
polypharmacy and excessive polypharmacy
are associated with increased potentially inappropriate medications, medication
errors, side effects, ADRs ( Adverse Drug
Reactions ), hospitalizations, increased health care costs, and death (Whitney et al., 2021).
Excessive polypharmacy is the most dangerous form, with the highest impact
on patient outcomes. Excessive polypharmacy
is the simultaneous use of 10 or more medications in a patient. However, no
studies have been reported focusing on excessive
polypharmacy in Indonesia. Given the higher risk of adverse health outcomes
in geriatric patients using 10 or more medications, it is important to
investigate the factors contributing to excessive
polypharmacy (Soejono & Rizka, 2021).
Most studies on polypharmacy were conducted in developed
countries, while data from developing countries, including Indonesia, are still
rare. Therefore, this study aims to determine the evaluation of polypharmacy
and excessive polypharmacy in
geriatric inpatients at general hospitals.
The purpose of this study is: 1. To determine the sociodemographic description of geriatric
patients who receive polypharmacy or excessive
polypharmacy. 2. To evaluate the prevalence of polypharmacy and excessive polypharmacy in hospitalized
patients. 3. To determine the description of the treatment of geriatric
patients who receive polypharmacy or excessive
polypharmacy. 4. To evaluate the triggering factors so that patients
receive polypharmacy and excessive polypharmacy.
5. Evaluate the correlation between demographic characteristics and patient
diseases with polypharmacy and excessive polypharmacy.
The research conducted is expected to: 1. Provide an overview of
the prevalence of polypharmacy and excessive
polypharmacy in hospitalized geriatric patients. 2. As a study material for
stakeholders in improving health
services for geriatric patients to avoid inappropriate drug administration. 3.
As a concern for the Indonesian government in providing knowledge related to
polypharmacy and excessive polypharmacy
to geriatric patients, considering the large number of elderly people in
Indonesia.
According to the World
Health Organization (WHO), the elderly are categorized into several age
ranges, namely middle age between the
ages of 45 and 59 years, elderly between
the ages of 60 and 74 years, old age between the ages of 75 and 90 years,
and very old age over the age of 90
years (Setiati et al., 2019).
The aging process is a cycle marked by stages of declining organ
function, making the body susceptible to various diseases that can lead to
death.
Aging factors are divided into two parts. These factors are
genetic factors, which involve DNA repair, stress response, and antioxidant
defense, and environmental factors, which include chemicals. Both factors can
affect cell metabolic activity, causing oxidative stress to the aging process (Alqahtani et al., 2022).
Research methods
The study was conducted using a retrospective cross-sectional study method involving inpatient geriatric patients
at Sumber Waras Hospital, West Jakarta.
The research population used was all inpatient geriatric patients
at Sumber Waras Hospital, West Jakarta.
The study was conducted by recording the medical records of
inpatient geriatric patients taken at Sumber Waras
Hospital from January to December 2023. The study was conducted during
April-June 2024.
Variables
Independent Variable
The independent variables in the study were the sociodemographics of geriatric patients, medical history,
and length of hospital stay (LOS ).
Dependent
Variable
The dependent variables in the study were polypharmacy (the number
of drugs given to patients was 5-9 drugs) and excessive polypharmacy (the number of drugs given to patients was
10 or more drugs).
Operational
Definition of Variables
|
No. |
Variables |
Operational Definition |
Category |
Scale |
|
||||
|
1 |
Age |
Age of patient at the time of hospitalization |
60 - 74 years 75-90 years > 90 years |
Ordinal |
|
||||
|
2 |
Gender |
Gender of inpatient geriatric patients |
Male Female |
Nominal |
|
||||
|
3 |
Marital status |
Marital status of
inpatient geriatric patients |
Single Married Divorced |
Nominal |
|
||||
|
4 |
Level of education |
educational status of
inpatient geriatric patients |
Elementary School Middle School High School College Not School |
Ordinal |
|
||||
|
5 |
Medical History |
Diseases that cause patients to receive excessive polypharmacy |
Diagnosis of myocardial infarction, chronic heart
failure, peripheral vascular disease, COPD, diabetes mellitus, kidney
disease, liver disease, cancer, neurological and other conditions when the patient enters |
Nominal |
|
||||
|
6 |
Length Of Stay (LOS) |
Time required during hospitalization |
< 3 Days ≥ 3 Days |
Nominal |
|
||||
|
7 |
Polypharmacy |
Administration of 5-9 drugs to patients |
≥ 5 drugs |
Nominal |
|||||
|
8 |
Excessive Polypharmacy |
Treatment of administering 10 or more drugs to a
patient |
≥ 10 drugs |
Nominal |
|||||
Descriptive
Analysis
The results of the screened medical records were analyzed to
obtain a description of the characteristics of inpatient geriatric patients by
displaying percentages based on the criteria.
Statistical
Analysis
The following statistical analysis uses the Chi-Square test .
The Chi-Square test is a form of
statistical test used to determine whether or not there is a relationship
between categorical variables. The Chi-Square
test can also help to determine whether the difference between two
variables is caused by chance or a relationship between the two. In this case,
the researcher wants to analyze the relationship between two variables which
include a comparison of sociodemographic variables and patient disease diagnoses
with polypharmacy and excessive polypharmacy.
Results and Discussion
The research data were taken from medical record data of geriatric
inpatients at Sumber Waras Hospital, with various
complaints of illness and treatment received. Screening was carried out on
medical record data, which met the inclusion criteria. The number of patient
data taken in this study was 295 patient data samples.
Table 1 Sociodemographic Characteristics of Geriatric Patients
|
Category |
Characteristics |
Polypharmacy |
Percentage (%) |
Excessive Polypharmacy |
Percentage (%) |
P-value |
|
Age |
60-74 years old 75-90 years old >90 years old |
82 30 3 |
71,3 26,1 2,6 |
110 70 0 |
61,1 38,9 0 |
0.007 |
|
Gender |
Man Woman |
58 57 |
50,4 49,6 |
83 97 |
46,1 53,9 |
0.468 |
|
Last Education |
Not school Elementary School Junior High School Senior High School College |
4 34 27 38 12 |
3,5 29,6 23,5 33 10,4 |
5 48 40 63 24 |
2,8 26,7 22,2 35 13,3 |
0.919 |
|
Wedding Status |
Unmarried Married Divorce |
2 94 19 |
1,7 81,8 16,5 |
6 151 23 |
3,3 83,9 12,8 |
0.533 |
Based on the data in table 1, the sociodemographic data of
inpatient geriatric patients receiving polypharmacy and excessive polypharmacy were obtained with a total of 295 patient
data. In patients aged 60-74 years, there were 192 patients with 82
polypharmacy patients (71.3%) and 110 excessive
polypharmacy patients (61.1%), in the age range of 75-90 years, there were
100 patients with 30 polypharmacy patients (26.1%) and 70 excessive polypharmacy patients (38.9%), and in the age range
>90 years, there were 3 patients receiving polypharmacy (2.6%). In addition,
a P-value of 0.007 was obtained,
which stated that there was a significant difference in the age of those
receiving polypharmacy with excessive polypharmacy.
From the following data, it can be seen that the majority of inpatient
geriatric patients were aged 60-74 years.
On category type sex, patient shared become two that is man And Woman. Amount patient various sex man as much as 141 patient with 58 patient polypharmacy (50.4%) and 83 patients with excessive polypharmacy (46.1%), and patients with the type female gender as many as 154 patients with 57 polypharmacy patients (49.6%) and 97 patient excessive polypharmacy (53.9%). Besides That, obtained mark P-value as big as 0.468 Which stated that there was no significant difference in gender. receiving polypharmacy or excessive polypharmacy. From the following data it can also be seen that patient geriatrics take care stay most various sex Woman.
In the last education category, the last education of patients was
grouped into five categories, namely the category of no school, elementary
school, junior high school, high school, and college. Based on the data of the
last education category, there were 9 patients with a background of no school
with 4 polypharmacy patients (3.5%) and 5 excessive
polypharmacy patients (2.8%), 82 patients with an elementary school
background with 34 polypharmacy patients (29.6%) and 48 excessive polypharmacy patients (26.7%), 67 patients with a junior
high school background with 27 polypharmacy patients (23.5%) and 40 excessive polypharmacy patients (22.2%),
101 patients with a high school background
with 38 polypharmacy patients (33.0%) and 63 excessive polypharmacy patients (35%), and 36 patients with a
college background with 12 polypharmacy patients (10.4%) and 24 excessive polypharmacy patients (13.3%).
In addition, a P-value of 0.919 was
obtained, which stated that there was no significant difference in the last
education of those who received polypharmacy or excessive polypharmacy. From the following data, it can be seen
that the majority of inpatient geriatric patients had a high school education.
In the marital status category, it is divided into three categories, namely
unmarried, married, and divorced. Based on the following categories, data was
obtained for 8 unmarried patients with 2 polypharmacy patients (1.7%) and 6 excessive polypharmacy patients (3.3%),
245 married patients with 94 polypharmacy patients (81.8%)
and 151 patients with
excessive polypharmacy (83.9%), and 42 patients were divorced with 19
polypharmacy patients (16.5%) and 23 excessive
polypharmacy patients (12.8%). In addition, a P-value of 0.533 was obtained, which stated that there was no
significant difference in the marital status of those receiving polypharmacy or
excessive polypharmacy. From these
data, it can also be seen that the majority of inpatient geriatric patients
were married.
Prevalence
of Polypharmacy and Excessive Polypharmacy
in Hospitalized Geriatric Patients
Table 2 Prevalence of polypharmacy and excessive polypharmacy
|
Category |
Age |
Frequency |
Percentage
(%) |
p-value |
|
Polypharmacy |
60-74 year 75-90 year >90 year |
82 30 3 |
71,3 26,1 2,6 |
0.897 |
|
Excessive Polypharmacy |
60-74 year 75-90 year >90 year |
110 70 0 |
61,1 38,9 0 |
0.873 |
Table 2 shows the prevalence of polypharmacy and excessive polypharmacy in hospitalized
geriatric patients. Based on the data obtained, patients with the most therapy
given with excessive polypharmacy
compared to polypharmacy. The prevalence of polypharmacy obtained was 115
patients (39%) and excessive polypharmacy
obtained was 180 patients (61%). From the data obtained, at Sumber
Waras Hospital, more patients received excessive
polypharmacy treatment (≥ 10 drugs) compared to polypharmacy (5-9
drugs).
Overview
of Treatment for Inpatient Geriatric Patients
Table 3 Types of therapy for inpatient geriatric patients
|
Types of Therapy Which Given |
Frequency |
Percentage (%) |
|
Omeprazole |
206 |
69.8 |
|
Ceftriaxone |
154 |
52.2 |
|
Amlodipine |
96 |
32.5 |
|
Paracetamol |
94 |
31.9 |
|
Ondansetron |
91 |
30.8 |
|
Cefixime |
85 |
28.8 |
|
Ranitidine |
78 |
26.4 |
|
Bisoprolol |
71 |
1.0 |
|
Candesartan |
67 |
24.1 |
|
Furosemide |
66 |
22.4 |
|
Atorvastatin |
61 |
20.7 |
|
Clopidogrel |
61 |
20.7 |
|
Ketorolac 3% |
61 |
25.8 |
|
Acetylcysteine |
55 |
18.6 |
|
Simvastatin |
54 |
18.3 |
|
Miniaspi |
54 |
18.3 |
|
Mefenamic
Acid |
50 |
16.9 |
|
KSR 600 |
50 |
16.9 |
|
Lansoprazole |
49 |
16.6 |
|
Bicnat tab |
49 |
16.6 |
|
Levofloxacin |
44 |
14.9 |
|
Metformin |
42 |
14.2 |
|
Sucralfate Syrup |
40 |
13.6 |
|
Isosorbide Dinitrate |
38 |
12.9 |
|
Ramipril |
36 |
12.2 |
|
Curcuma |
34 |
11.5 |
|
Caco3 |
33 |
11.2 |
|
Spironolactone |
32 |
10.8 |
|
Ciprofloxacin |
30 |
10.2 |
|
Tranexamic
Acid |
28 |
9.5 |
Table 3 shows the types of drugs given to inpatient geriatric
patients receiving polypharmacy and excessive
polypharmacy treatment. Based on the data obtained, there are 3 types of
drugs that are most often used, namely omeprazole with a total of 206 patients
(69.8%), ceftriaxone with a total of 154 patients (52.5%), and amlodipine with
a total of 96 patients (32.5%).
Factors
Causing Geriatric Patients to Receive Polypharmacy and Excessive Polypharmacy
Table
4 Factors Causing Geriatric Patients to Receive
Polypharmacy and Excessive Polypharmacy
|
Category |
Polypharmacy |
Percentage
(%) |
Excessive Polypharmacy |
Percentage
(%) |
|
|
Diseases experienced by patients |
DM |
24 |
14,3 |
71 |
16 |
|
Anemia |
18 |
10,7 |
52 |
11,7 |
|
|
Hypertension |
29 |
17,3 |
27 |
6,1 |
|
|
Hypokalemia |
12 |
7,1 |
33 |
7,4 |
|
|
Pneumonia |
11 |
6,5 |
33 |
7,4 |
|
|
CKD |
5 |
3 |
36 |
8,1 |
|
|
Hyponatremia |
12 |
7,1 |
27 |
6,1 |
|
|
CAD |
5 |
3 |
29 |
6,5 |
|
|
Dehydration |
9 |
5,4 |
24 |
5,4 |
|
|
TB |
10 |
6 |
22 |
5 |
|
|
CHF |
5 |
3 |
23 |
5,2 |
|
|
Dyslipidemia |
10 |
6 |
17 |
3,8 |
|
|
PPOK |
8 |
4,8 |
17 |
3,8 |
|
|
Bronchopneumonia |
2 |
1,2 |
12 |
2,7 |
|
|
LOS |
<3 days |
61 |
57,5 |
45 |
42,5 |
|
≥3 days |
54 |
28,6 |
135 |
71,4 |
|
In table 5.4, there is an overview of the factors that allow
geriatric patients to receive polypharmacy and excessive polypharmacy. Based on
the data obtained, there were 3 diseases that were most experienced, namely DM
with 95 patients where polypharmacy was 24 patients (14.3%) and received excess
polypharmacy as many as 71 patients (16%), anemia with 70 patients who received
polypharmacy as many as 18 patients (10.7%) and received excessive polypharmacy
as many as 52 patients (11.7%), and hypertension as many as 56 patients where
received polypharmacy as many as 29 patients (17.3%) and received excessive
polypharmacy as many as 27 patients (6.1%). LOS (Length Of
Stay) data was also obtained for the patients who were hospitalized the most
≥3 days. This is evidenced by the number of patients hospitalized
≥3 days, 189 (64.1%) and <3 days, 106 patients (35.9%).
Sociodemographic
and Clinical Relationship of Patients with Polypharmacy and Excessive Polypharmacy
Table
5 Sociodemographic and Clinical Relationships with
Polypharmacy and Excessive Polypharmacy
|
Category |
Polypharmacy |
Percentage (%) |
Excessive Polypharmacy |
Percentage (%) |
Frequency |
Percentage (%) |
P-value |
|
Age 60-74 years old 75-90 years old >90 years old |
82 30 3 |
71,3 26,1 2,6 |
110 70 0 |
61,1 38,9 0 |
192 100 3 |
65,1 33,9 1 |
0.007 |
|
Gender Man Woman |
58 57 |
50,4 49,6 |
83 97 |
46,1 53,9 |
141 154 |
47,8 52,2 |
0.468 |
|
Last Education Not School Elementary School Junior High School Senior High School Collage |
4 34 27 38 12 |
3,5 29,6 23,5 33 10,4 |
5 48 40 63 24 |
2,8 26,7 22,2 35 13,3 |
9 82 67 101 36 |
3,1 27,8 22,7 34,2 12,2 |
0.919 |
|
Wedding Status Unmarried Married Divorce |
2 94 19 |
1,7 81,8 16,5 |
6 151 23 |
3,3 83,9 12,8 |
8 245 42 |
2,7 83,1 14,2 |
0.533 |
|
Complications/Comorbidities ≤ 2 diseases > 2 diseases |
29 86 |
25,2 74,8 |
15 165 |
8,3 91,7 |
44 251 |
14,9 85,1 |
0.000 |
|
LOS (Length of
Stay) < 3 days ≥ 3 days |
61 54 |
57,5 28,6 |
45 135 |
42,5 71,4 |
106 189 |
35,9 64,1 |
0.000 |
Table 5 shows the relationship between sociodemographics
and clinical patients with polypharmacy and excessive
polypharmacy. Based on the data obtained, in general it can be seen that
there is no significant relationship between sociodemographics
and polypharmacy and excessive polypharmacy.
However, there is one category in sociodemographics
that has a relationship with polypharmacy and excessive polypharmacy, namely the age category, where the
significance value obtained is 0.010 (<0.05). The diagnosis of the disease
experienced by the patient (clinical condition) has a relationship with
polypharmacy and excessive polypharmacy.
This is obtained from the p value of 0.000 (<0.05). Likewise, the LOS ( Length Of Stay ) category appears to have a
relationship with polypharmacy and excessive polypharmacy, which is stated with
a significance value ( p-value ) of
0.000 (<0.05)
Sociodemographic Overview of Hospitalized Geriatric
Patients
Based on sociodemographic data of inpatient geriatric patients
receiving polypharmacy and excessive polypharmacy
with a total of 295 patient data. The majority of inpatient geriatric patients
were aged 60-74 years. This is also supported by research conducted by (Faisal et al., 2023) which states that the majority of patients are in the 60 to 74
year age group. This can be caused because increasing age can increase
functional disorders that can be caused by irregular lifestyles, stress, and so
on. In addition, increasing age of a person is usually always associated with a
decrease in routine sports activities and a decrease in a person's
physiological hormonal activity.
In the gender category, the most common gender is female with 154
patients with 57 polypharmacy patients (49.6%) and 97 excessive polypharmacy patients (53.9%). This is supported by
research conducted by Clare et al. (2021),
where researchers obtained the most gender data, namely female. Research by Aryaldy and Rose (2019) stated that based on the research
conducted, it was obtained that most patients were male. This difference could
occur because patients at Sumber Waras Hospital are
more often female than male. Psychologically, women tend to think about
something deeply, causing women to experience stress more easily. Biologically,
women are more prone to stress because there are changes in the hormonal system
in the body. Physiological processes in the body occur when receptors receive
stimulation from stressors for the first time. The stimulus is transmitted to
the hypothalamus which causes the hypothalamus to release the hormone corticotrophin-releasing factor (CRF)
which stimulates the anterior pituitary gland to release adenocorticotrophic hormone (ACTH) which then stimulates
the adrenal glands to release the hormones cortisol (hydrocortisone),
adrenaline (adrenaline) and noradrenaline (norephinephrine)
(Styoningsih, R., Amananti, W., & Meliyana, 2020).
In the last education category, most patients have a high school
education background with a total of 101 patients, of which 38 patients have
polypharmacy (33.0%) and 63 patients have
excessive polypharmacy (35%). This may be due to the lack of patients in
terms of economy in financing higher education.
Prevalence of Polypharmacy and Excessive Polypharmacy in Hospitalized Geriatric Patients
Based on the data obtained, patients with the most therapy given
with excessive polypharmacy compared
to polypharmacy. The prevalence of polypharmacy obtained was 115 patients (39%)
and excessive polypharmacy obtained
was 180 patients (61%). This is different from several studies that have been
conducted, where the average study stated that most geriatric patients received
polypharmacy compared to excessive polypharmacy.
According to research by (Pazan & Wehling, 2021), in Scotland the prevalence of polypharmacy in geriatric patients
ranged from 28.6% to 51.8% while excessive
polypharmacy ranged from 7.4% to 18.6%.
According to research by (Faisal et al., 2023), the prevalence of excessive
polypharmacy is 8.67%, and globally the prevalence of excessive polypharmacy also varies from 7.4% to 43.4%. This is also
supported by research by Aryaldi and Rose (2019),
where in Indonesia the prevalence of excessive
polypharmacy (5.17%) is less than polypharmacy (59.9%). Cross-sectional
studies from Ireland, Scotland, and Sweden state that the prevalence of excessive polypharmacy is in the range
of 7.4% to 11.7%. In addition, another study from Italy of 13%, and from Japan
based on national pharmacy claims data reported the prevalence of excessive polypharmacy ranging from
12.3%, 35.8%, and 43.3% among patients aged 50-64, 65-79, and >80 years.
This difference may occur due to differences in population in each
place. In addition, geriatric patients often have to be treated by several
doctors with different specialists. The lack of communication and collaboration
between medical service providers and pharmacists results in the use of too
many drugs simultaneously. This is also supported by research conducted by (Tanzil et al., n.d.) which states that polypharmacy and excessive polypharmacy are the result of a prescribing cascade that
occurs when drug side effects are misinterpreted as new medical problems, so
that more drugs are prescribed to treat symptoms induced by the initial drug.
Patients with polypharmacy and excessive polypharmacy
have an increased risk of mortality with more chronic diseases. In a study from
the UK, the fall rate was 21% higher in geriatrics receiving polypharmacy, 50%
higher in those receiving excessive polypharmacy
than non-polypharmacy (Pazan & Wehling, 2021).
Based on the data obtained, there are 15 types of drugs that are
most often received by patients. The drugs that are often received by patients
are omeprazole, ceftriaxone, amlodipine, paracetamol, ondansetron, cefixime,
ranitidine, bisoprolol, candesartan, furosemide, atorvastatin, clopidogrel,
ketorolac 3%, acetylcysteine, and simvastatin. Drug interactions in amlodipine
and simvastatin must be considered. This is similar to the study conducted by Aryaldi and Rose (2019), where drug therapy data were widely
given to patients, one of which was amlodipine and simvastatin. Amlodipine can
increase the action of simvastatin, which can potentially increase the risk of
myopathy/rhabdomyolysis, which should limit the dose to no more than 20 mg/day
when used simultaneously.
The administration of several drug therapies also needs to be
considered. Simultaneous administration of omeprazole and clopidogrel can
reduce the anti-clotting effect of clopidogrel by omeprazole. Administration of
furosemide and candesartan can lower blood pressure, both systolic and
diastolic blood pressure. This is supported by research by (Angin, M., Saputri, G., & Fahmi, 2023), which states that the use of furosemide and candesartan in three
control times experienced a significant decrease in blood pressure in both
blood pressure, both systolic and diastolic, in hypertensive patients.
Factors
That Allow Geriatric Patients to Receive Polypharmacy or Excessive Polypharmacy
Based on the data obtained, there are several chronic diseases
that are most often suffered, namely diabetes mellitus, anemia, hypertension,
heart disease, kidney failure, lung disease. The acquisition of this data is
supported by research conducted by several previous researchers, namely (Faisal et al., 2023), (Zahlan et al., 2023), and several other studies both in Indonesia and in developed
countries, that the above diseases are often found in patients who receive
polypharmacy or excessive polypharmacy.
This can occur because in geriatric patients, there are various physiological
changes in the organs and body systems that can affect the response to drugs.
Data obtained from geriatric patients at Sumber
Waras Hospital mostly suffer from diabetes mellitus. Diabetes mellitus that is
often experienced by geriatric patients is type 2 diabetes mellitus. Type 2 DM
can be characterized by hyperglycemia and hyperinsulinemia caused by insulin
resistance. Diabetes mellitus can cause stomach disease, one of which is nerve
damage caused by high blood sugar levels. If a patient suffers from diabetes
mellitus accompanied by stomach disease, they will have many complications and
a worse prognosis than patients without diabetes mellitus (Tseng, 2021).
Length of stay (LOS) can also be a predictor of geriatric patients
receiving polypharmacy or excessive polypharmacy.
Inpatients in hospitals for a long time require many drugs simultaneously. The
length of stay can be influenced by several factors including the severity of
the disease, the patient's condition, the risk of therapy received by the
patient, and other medical interventions received by the patient while being
treated in the hospital. The results of this study are in line with research
conducted by (Kurniawan et al., 2020) which showed that the average length of stay for patients was 4-5
days with a discharge status of cured. Patients with a long length of stay are
more likely to have drug interactions than patients with a short LOS.
Sociodemographic
and Clinical Relationship of Patients with Polypharmacy and Excessive Polypharmacy
In general, patient sociodemographics
have no relationship to polypharmacy or excessive
polypharmacy, either from the category of gender, education level, and
marital status. However, there is one category in sociodemographics
that has a relationship to polypharmacy and excessive
polypharmacy, namely the age category. The results of this study are in
line with previous studies, one of which was by (Faisal et al., 2023), which stated that polypharmacy and excessive polypharmacy will increase over time. This can occur due
to the physiological decline of elderly patients. The patient's clinical
condition and LOS have a relationship to the occurrence of polypharmacy and excessive polypharmacy. The more
diseases a patient experiences, the more likely the patient is to receive
polypharmacy or excessive polypharmacy.
The longer a patient is hospitalized, the more likely they are to receive
polypharmacy or excessive polypharmacy
Conclusion
The results of the study obtained can be concluded that the
provision of polypharmacy and excessive polypharmacy
in geriatric patients still occurs a lot, both in Indonesia and in other
developed countries. This is feared to have undesirable effects on patients.
There are also several diseases related to the potential for geriatric patients
to receive polypharmacy and excessive polypharmacy,
including diabetes mellitus, kidney disease, heart disease, and other chronic
diseases. This can be a factor in someone receiving polypharmacy, as well as
the length of hospitalization. The longer a patient is hospitalized, the more
treatment must be received.
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