The prevalence of polypharmacy and hyper-polypharmacy among middle-aged vs . older patients in Saudi Arabia: a cross-sectional study

Abstract

Introduction: Polypharmacy, the use of multiple medications, is a growing concern among middle-aged and older patients, posing potential risks and challenges in healthcare management.

Aim: This study aimed to identify the prevalence of polypharmacy and hyper-polypharmacy among populations of middle-aged vs. older patients and identify its associated common comorbidities and prescribed medications in Qatif Central Hospital (QCH), Saudi Arabia.

Methods: Patients aged 40 years or older who presented to an outpatient medical care clinic at QCH, Saudi Arabia, between 1 January and 31 December 2021 were included, and their comorbidities, prescribed medications, and recent clinical laboratory test results were collected. The Charlson comorbidity index (CCI) score was calculated to predict the risk of mortality. Logistic regression was used to compute the association between the prevalence of polypharmacy and patient characteristics. The results were presented as odds ratios (ORs) and 95% confidence intervals (95% CIs).

Results: A total of 14,081 patients were included; 31% of the cohort comprised older patients, and 66% of the cohort was identified with polypharmacy. The majority of the polymedicated patients were presented to an internal medicine care unit (34%). The prevalence of polypharmacy was positively associated with CCI (OR = 3.4, 95% CI 3.3-3.6), having a disease related to the musculoskeletal system (MSD) (OR = 4.2, 95% CI 3.8-4.7), and alimentary tract and metabolism (ATM) (OR = 3.8, 95% CI 3.4-4.2). Conversely, the prevalence of polypharmacy was negatively associated with age (OR = 0.9, 95% CI 0.89-0.91) and patients with cardiovascular diseases (OR = 0.6, 95% CI 0.5-0.7).

Conclusion: Polypharmacy is still an ongoing concern. Patients, particularly those with diseases related to MSD or ATM, should be considered for reviewing prescriptions by pharmacists to reduce the risk of adverse drug reactions and future consequences of polypharmacy.

Keywords: hyper-polypharmacy; medical care unit; middle-aged patients; older patients; polypharmacy (MeSH).

FIGURE 1

Prevalence of polypharmacy among the cohort. (A) Univariate analysis of the prevalence of polypharmacy among the cohort classified into middle-aged and older patients. (B) ANOVA analysis of polypharmacy prevalence trend among the cohort classified into different age groups. Data are presented as a percentage value of the referenced group. * = p < 0.001.

FIGURE 2

ANOVA analysis to determine the trends pattern of patients’ characteristics over different age groups. (A) Trends of Charlson comorbidity index (CCI), number of prescribed medication (NPM), fall risk increasing drugs (FRIDs), orthostatic hypotension-contributing drug (OD), and hemoglobin (HB). (B) Trends of gender, weight, body mass index (BMI), and creatinine clearance (CrCl). Data presented are the actual value.

FIGURE 3

Trends of common recorded comorbidities over different age groups. Data present the percentage value of the referenced group. (A) presents data for osteoarthritis, ischemic heart diseases, osteoporosis, hypertension and gastroesophageal reflux disease (GORD), (B) represents data for diabetes mellitus, hyperlipidaemia, anemia, heart failure and rheumatoid arthritis.

FIGURE 4

Trends of medications prescribed among the cohort classified based on the age groups. Medications were presented by the first-level order as per the anatomical therapeutic classification. Data present the percentage value of the referenced group.

FIGURE 5

Prescribing trends of commonly prescribed medications over different age groups. Medications were presented based on their therapeutics class. (A) presents data for proton pump inhibitors, non-steroidal anti-inflammatory drugs (NSAIDs), vitamin D3, statins, anti-platelets, (B) represents data for calcium channel blockers (CCBs), beta blockers, anti-coagulants, angiotensin converting enzyme inhibitors (ACEIs), diuretic.