June 24, 2024 from Medscape
As the global population ages, managing multiple medications in elderly patients—commonly referred to as polypharmacy—has become an increasing concern. Polypharmacy, defined as the use of five or more medications, is often necessary to treat multiple chronic conditions but comes with significant risks. This is particularly true when potentially inappropriate medications (PIMs) are prescribed, increasing the likelihood of adverse events, morbidity, and mortality.
A recent retrospective cohort study conducted across six European countries aimed to assess the prevalence and risks of polypharmacy in patients aged 65 and older. Using databases from IQVIA, researchers analyzed electronic medical records from hundreds of thousands of elderly patients under the care of general practitioners in 2018. The study focused on identifying the frequency of polypharmacy and the presence of PIMs, such as opioids, antipsychotics, benzodiazepines, and proton pump inhibitors (PPIs).
Prevalence of Polypharmacy Across Europe
The study found significant variation in polypharmacy rates between the six countries. In the United Kingdom, the prevalence of polypharmacy was 22.8%, while in Germany, it was as high as 58.3%. France reported a polypharmacy prevalence of 58%, closely mirroring Germany’s rate. The prescription of 10 or more medications also varied widely, ranging from 11.3% in the UK to 28.5% in Germany.
Despite these differences, the demographic profile of patients remained consistent, with the average age being 75-76 years and 54%-56% of participants being women. This suggests that other factors, such as healthcare system structure or general practitioner practices, may influence polypharmacy rates.
Risks of Potentially Inappropriate Medications
One of the key concerns with polypharmacy is the prescription of PIMs, which can significantly increase the risk of adverse health outcomes. The study highlighted PPIs as the most commonly inappropriately prescribed medication, with rates ranging from 42.3% to 65.5%, including 48.4% in France. Benzodiazepines were also frequently misused, affecting 20.7% of French patients and up to 34.9% in other countries. Opioids and antipsychotics, though prescribed less often, also showed concerning rates of inappropriate use.
“The differences and similarities in country health systems and general practitioner documentation practices…do not provide an obvious explanation for our findings,” noted the authors, calling for further comparative studies to better understand the factors influencing these disparities.
The Impact of Comorbidities
The study also examined the link between polypharmacy and comorbidities, with diabetes and chronic respiratory diseases being the most common conditions among patients taking multiple medications. Gastrointestinal and cardiovascular drugs, such as antiulcer and antithrombotic agents, were among the most frequently prescribed medications.
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