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. 2021 Jun 8:12:686990.
doi: 10.3389/fphar.2021.686990. eCollection 2021.

High Prevalence of Multimorbidity and Polypharmacy in Elderly Patients With Chronic Pain Receiving Home Care are Associated With Multiple Medication-Related Problems

Juliana Schneider  1 , Engi Abd Elhady Algharably  1 , Andrea Budnick  2 , Arlett Wenzel  2 , Dagmar Dräger  2 , Reinhold Kreutz  1
Affiliations

High Prevalence of Multimorbidity and Polypharmacy in Elderly Patients With Chronic Pain Receiving Home Care are Associated With Multiple Medication-Related Problems

Juliana Schneider et al. Front Pharmacol. .

Abstract

Aim: To measure the extent of polypharmacy, multimorbidity and potential medication-related problems in elderly patients with chronic pain receiving home care. Methods: Data of 355 patients aged ≥65 years affected by chronic pain in home care who were enrolled in the ACHE study in Berlin, Germany, were analyzed. History of chronic diseases, diagnoses, medications including self-medication were collected for all patients. Multimorbidity was defined as the presence of ≥2 chronic conditions and levels were classified by the Charlson-Comorbidity-Index. Polypharmacy was defined as the concomitant intake of ≥5 medications. Potentially clinically relevant drug interactions were identified and evaluated; underuse of potentially useful medications as well as overprescription were also assessed. Results: More than half of the patients (55.4%) had moderate to severe comorbidity levels. The median number of prescribed drugs was 9 (range 0-25) and polypharmacy was detected in 89.5% of the patients. Almost half of them (49.3%) were affected by excessive polypharmacy (≥10 prescribed drugs). Polypharmacy and excessive polypharmacy occurred at all levels of comorbidity. We detected 184 potentially relevant drug interactions in 120/353 (34.0%) patients and rated 57 (31.0%) of them as severe. Underprescription of oral anticoagulants was detected in 32.3% of patients with atrial fibrillation whereas potential overprescription of loop diuretics was observed in 15.5% of patients. Conclusion: Multimorbidity and polypharmacy are highly prevalent in elderly outpatients with chronic pain receiving home care. Medication-related problems that could impair safety of drug treatment in this population are resulting from potentially relevant drug interactions, overprescribing as well as underuse.

Keywords: chronic pain; comorbidity; drug-drug interactions; elderly; medication-related problems; multimorbidity; outpatient; polypharmacy.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Flow-diagram showing medication screening and selection process. aAll drugs were non-prescription drugs. bDifferent patients may use the same drug.
FIGURE 2
FIGURE 2
Classification of comorbidities according to the Charlson-Comorbidity-Index (N = 334).
FIGURE 3
FIGURE 3
Number of prescribed medications among elderly receiving home care (N = 353).
FIGURE 4
FIGURE 4
Boxplot diagram: Number of prescribed drugs grouped by different comorbidity levels.*p < 0.05 vs. no comorbidity; **p < 0.01 vs. low comorbidity; ***p < 0.001 vs. low comorbidity; ***p < 0.001 vs. no comorbidity.
FIGURE 5
FIGURE 5
Drug-drug interactions of prescribed medication in one patient.
See this image and copyright information in PMC

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