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. 2024 Feb 4:15:20420986241228129.
doi: 10.1177/20420986241228129. eCollection 2024.

Short-term prognosis of polypharmacy in elderly patients treated in emergency departments: results from the EDEN project

Jesus Ruiz Ramos  1 , Aitor Alquézar-Arbé  2 , Ana Juanes Borrego  3 , Guillermo Burillo Putze  4 , Sira Aguiló  5 , Javier Jacob  6 , Cesáreo Fernández  7 , Pere Llorens  8 , Francisco de Borja Quero Espinosa  9 , Susana Gordo Remartinez  10 , Rocio Hernando González  11 , Miguel Moreno Martín  12 , Sara Sánchez Aroca  13 , Alicia Sara Knabe  14 , Rebeca González González  15 , Marina Carrión Fernández  16 , Alberto Artieda Larrañaga  17 , Maria Adroher Muñoz  18 , Jeong-Uh Hong Cho  19 , María Teresa Escolar Martínez Berganza  20 , Sara Gayoso Martín  21 , Goretti Sánchez Sindín  22 , Martina Silva Penas  23 , Bárbara Gómez Y Gómez  24 , Roser Arenos Sambro  25 , Juan González Del Castillo  7 , Òscar Miró  5
Affiliations

Short-term prognosis of polypharmacy in elderly patients treated in emergency departments: results from the EDEN project

Jesus Ruiz Ramos et al. Ther Adv Drug Saf. .

Abstract

Background: Polypharmacy is a growing phenomenon among elderly individuals. However, there is little information about the frequency of polypharmacy among the elderly population treated in emergency departments (EDs) and its prognostic effect. This study aims to determine the prevalence and short-term prognostic effect of polypharmacy in elderly patients treated in EDs.

Methods: A retrospective analysis of the Emergency Department Elderly in Needs (EDEN) project's cohort was performed. This registry included all elderly patients who attended 52 Spanish EDs for any condition. Mild and severe polypharmacy was defined as the use of 5-9 drugs and ⩾10 drugs, respectively. The assessed outcomes were ED revisits, hospital readmissions, and mortality 30 days after discharge. Crude and adjusted logistic regression analyses, including the patient's comorbidities, were performed.

Results: A total of 25,557 patients were evaluated [mean age: 78 (IQR: 71-84) years]; 10,534 (41.2%) and 5678 (22.2%) patients presented with mild and severe polypharmacy, respectively. In the adjusted analysis, mild polypharmacy and severe polypharmacy were associated with an increase in ED revisits [odds ratio (OR) 1.13 (95% confidence interval (CI): 1.04-1.23) and 1.38 (95% CI: 1.24-1.51)] and hospital readmissions [OR 1.18 (95% CI: 1.04-1.35) and 1.36 (95% CI: 1.16-1.60)], respectively, compared to non-polypharmacy. Mild and severe polypharmacy were not associated with increased 30-day mortality [OR 1.05 (95% CI: 0.89-2.26) and OR 0.89 (95% CI: 0.72-1.12)], respectively.

Conclusion: Polypharmacy was common among the elderly treated in EDs and associated with increased risks of ED revisits and hospital readmissions ⩽30 days but not with an increased risk of 30-day mortality. Patients with polypharmacy had a higher risk of ED revisits and hospital readmissions ⩽30 days after discharge.

Keywords: emergency department; frailty; geriatrics; polypharmacy.

Plain language summary

Short-term prognosis of polypharmacy in elderly patients treated in emergency departments: results from the EDEN project Management elderly patients with polypharmacy is becoming a major challenge to the emergency services. The progressive aging of the population is producing a progressive increase in the number of patients treated with multiple comorbidities and chronic medications. It’s well known that polypharmacy is associated with an increase in hospital admissions and health care system costs. However, the impact of polypharmacy over the risk of new visits to the emergency rooms is not well defined. Understanding the impact of polypharmacy on the frequency of new visits to the emergency room and on patient mortality is the first step to establish prevention measures for new visits, proposing improvements in chronic treatment at discharge. This study aimed to determine the prevalence and effect on short-term prognosis of polypharmacy in elderly patients treated in Emergency departments. The authors used a retrospective multipurpose registry in 52 hospitals in Spain. This study includes 25,557 patients with a mean age of 78 years. On admission, the median number of drugs was 6 (IQR: 3–9), with 10,534 (41.2%) patients taking 5–9 drugs and 5,678 (22.2%) taking ⩾10 drugs. In these patients comorbidities were associated with an increase in the number of drugs. In the patients with severe polypharmacy (⩾10 drugs), diuretics were the most frequently drugs prescribed, followed by antihypertensives and statins. The results obtained indicate that polypharmacy is a frequent phenomenon among the elderly population treated in Emergency departments, being antihypertensives the most frequently used drugs in this population. Those patients who takes ⩾10 drugs have a higher risk of new visits to the emergency room and hospital readmissions in short term period.

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Conflict of interest statement

The authors declare that there is no conflict of interest.

Figures

Figure 1.
Figure 1.
Flow chart for patient inclusion in the EDEN-32 study. EDEN, Emergency Department and Elderly Needs.
Figure 2.
Figure 2.
Therapeutic groups included in the usual treatment of the patients analyzed. RAASi, Renin–angiotensin–aldosterone system inhibitors.
Figure 3.
Figure 3.
Associations between polypharmacy and 30-day mortality, 30-day emergency department revisits, and 30-day hospital readmissions.
See this image and copyright information in PMC

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