No abstract available.
Anticonvulsants* ; Drug Therapy* ; Polypharmacy*

Background: Polypharmacy has been linked to multiple undesirable effects notably medication, non-compliance and adverse drug reactions. Objective: This case-control study aimed to determine the association between polypharmacy and dementia among Filipino elderly patients in a tertiary care hospital in Metro Manila, Philippines. Methods: The average daily use of medications was compared between cases and controls composed of admitted Filipino elderly patients with and without dementia, respectively, while controlling for co-morbidities and sociodemographic factors. Data collection was accomplished by obtaining relevant information from medical records. These underwent descriptive statistical analysis, chi-square test, and logistic regression. The odds ratio between dementia and polypharmacy was ultimately determined, among other variables. Results: The incidence of polypharmacy is 12.6% greater in those with diagnosed dementia vis-à-vis those without. Although multivariate logistic regression analysis showed that the odds ratio of dementia was 1.474 (95% CI 0.834–2.604) for those considered to experience polypharmacy compared to patients using four or less drugs, none of the variables identified, including polypharmacy, have p-values of less than 0.05. Conclusion The risk of developing dementia does not have a statistically significant association with the number of regularly administered medications in the Filipino elderly. Other variables also revealed no significant correlation on both bivariate and multivariate analyses. This may be the first study to report such an absence of association, particularly in the Philippines, and thus calls for further research and investigation on this subject.
Polypharmacy ; Dementia ; Case-Control Studies

OBJECTIVE: Patterns of clinical use of antipsychotics have changed greatly in the past decade. The authors' goal was to examine these patterns in an inpatient unit at a university hospital between 1997, 2003-2004, and 2009-2010. METHODS: We evaluated medication use in inpatients treated with antipsychotic drugs during 2009-2010 (n=379) and compared the results with inpatients treated with antipsychotics in 2003-2004 (n=379) and inpatients treated with antipsychotics in 1997 (n=165). RESULTS: The distribution of psychiatric diagnoses in 2009-2010 was different from that in 2003-2004 and 1997. The proportion of patients with schizophrenia spectrum disorders was higher in 2009-2010 (p=0.013, p<0.001). An atypical agent was prescribed for 98.7% (n=374) of patients in 2009-2010. This represents a significant proportional increase over both 2003-2004 (93.7%, n=355; p<0.001) and 1997 (57.6%, n=95; p<0.001). In 2009-2010 the number of patients receiving prescriptions of two or more antipsychotics in combination was 16.1% (n=61), which represents a significant proportional increase over 2003-2004 (9.0%, n=34; p=0.007) and 1997 (4.8%, n=8; p=0.001). CONCLUSION: The present study demonstrates that atypical antipsychotic medications have replaced typical antipsychotic medications. Polypharmacy increased markedly despite limited empirical evidence of cost-risk-benefit relationships.
Antipsychotic Agents ; Humans ; Inpatients ; Polypharmacy ; Prescriptions ; Schizophrenia

Background: Quality of Life (QoL) is an indicator of an elderly patient’s health status in achieving optimum care. However, no available local studies focused on QoL in elderly patients with polypharmacy. Better knowledge on this may help healthcare practitioners design and modify interventions that will suit elderly patients’ needs to improve both care and well-being. This study examined the QoL of elderly patients with polypharmacy and evaluated its relationship with demographic and clinical profile. Methods: A descriptive cross-sectional study was done among 333 elderly patients with polypharmacy seen at Region 1 Medical Center-Family and Community Medicine Out-Patient Department (R1MC-FCM OPD) from January to June 2019 using a self-administered EuroQoL-5 Dimension 5-Level (EQ-5D-5L) questionnaire to elicit the domains of QoL. The following statistical tests were utilized: Frequency count and percentage for analyzing gathered data; Spearman’s rank correlation for determining correlation between ordinal and continuous variables; and Mann-Whitney U and Kruskal-Wallis H tests for comparison of mean ranks. All analyses were performed using SPSS version 25. Results: Majority of the respondents were 60-69 years old (59.5%), female (55.3%), married (65.5%), attained at least elementary level education (38%), diagnosed with two illnesses (53%), taking four medications (65.5%) with an average monthly income below Php 10,000.00 (82.6%). Most of the respondents reported “no problems” in all five dimensions of EQ-5D-5L; however, decrease in usual activities (49.8%), pain (49.5%), and mobility (39%) were noted to be the common problems. Lower EQ-5D index and EQ-Visual Analogue Scale (EQ-VAS) scores were observed among respondents aged 80-90 years old, attained at least elementary level education, with three diagnosed illnesses, taking more than four medications, suffering mild cognitive impairment, partially dependent on activities in daily living, and mildly depressed (p <0.05). Conclusion The quality of life was reduced in the ageing population with low educational attainment, polypharmacy, multimorbidity, functional incapacity, cognitive impairment, and emotional problem.
Quality of Life ; Polypharmacy ; Outpatients ; Tertiary Care Centers

The author reviews general principles and guidelines regarding the drug treatment of geriatric depression. Older depressed patients are more prone to drug adverse reactions and drug-drug interactions than younger patients because of pharmacokinetic and pharmacodynamic changes resulting from age-related physiological changes, physical illnesses, polypharmacy, and various other factors. Therefore, a careful evaluation for physical illnesses and drugs needed to be made before strating antidepressant medication and "start low, go slow" dosing principle should be kept in mind. All classes of antidepressants available for younger depressed patients could be used for the geriatric patients. Choice of specific antidepressant drugs depend on potential adverse reactions and interactions of each agent, subtype or severity of depression, and comorbid diseases, such as stroke, dementia, Parkinson's disease, and heart disease. ECT must be also considered for antidepressant-resistant severe geraitric depression.
Antidepressive Agents ; Dementia ; Depression* ; Heart Diseases ; Humans ; Parkinson Disease ; Polypharmacy ; Stroke

BACKGROUND: This study was to verify the necessity of a control program developed to improve compliance, by conducting a research on the status of medication compliance in the elderly with chronic diseases in rural area and analyzing the related variables. METHODS: The organized questionnaire and pill-count were used to collect information on personal details, physical status, drugs taken in the elderly over 65 years old suffering from more than two chronic diseases in one rural area. RESULTS: The mean age of the subjects was 73.13+/-6.36 (65~93), and the number of the subjects in compliance group was 60 (77.9%) and the accuracy of self-report which was identified by pill-count was 0.86. Polypharmacy and visiting several clinics were the main factors that decided a low- degree of compliance, with OR of 5.92 (95% CI 1.11~31.44, P=0.037), and 4.25 (95% CI 1.03~17.53, P=0.045), respectively. CONCLUSION: Systematic efforts are necessary and plans must be established without delay to increase compliance in the elderly in the rural, expansively to manage chronic diseases in stay-at-home elders.
Aged ; Chronic Disease ; Compliance ; Humans ; Medication Adherence ; Polypharmacy ; Republic of Korea ; Stress, Psychological ; Surveys and Questionnaires

PURPOSE: Patients with epilepsy experience the impairment of Quality of life (QOL). The objective of this study was to investigate the 'Quality of Life' in epileptic patients and the influences of clinical factors upon QOL in epileptic patients. METHODS: Total 138 epileptic patients (male : 77, female : 61) were recruited for the study. The Quality of Life in Epilepsy (QOLIE)-89 was applied to evaluate QOL in epileptic patients. We gathered data about clinical variables (seizure type, frequency, duration of disease, number of antiepileptic drug, and depression) and socio-demographic variables (age, sex, marriage, employment, and education), and compared each variables in use of QOLIE-89 score. RESULTS: Depression influenced negatively the most of all subscales (16 of 20 subscales) and overall score (p<0.01), and was the most significant inverse predictor of QOL in patients with epilepsy. Patients who were seizure-free in the past year reported better QOL than those with seizure-doing (p<0.05). Patients with polypharmacy showed lower scores at overall QOL, health discouragement, language, and overall score than those with monopharmacy (p<0.05). Male showed lower score than female at the scale of sexual relation (p<0.05), but higher scores at scales of health perception, overall health, and physical health (p<0.05). Highly-educated group (> or =16 year) had higher score at overall score and emotional well-being (p<0.05). However, age, marital state, employment, seizure type, and duration of disease did not affect QOL significantly. CONCLUSIONS: Sex, education, number of AEDs, depression, and seizure free state were major socio-clinical factors affecting QOL in patients with epilepsy. It is suggested that physician should recognize these factors and manage appropriately for improving the QOL.
Depression ; Education ; Employment ; Epilepsy ; Female ; Humans ; Male ; Marriage ; Polypharmacy ; Quality of Life* ; Seizures ; Weights and Measures

OBJECTIVES: The objective of this study was to investigate the prescription trends for the elderly psychiatric outpatients at a university hospital. METHODS: We performed a retrospective study based on medical records. Data on 146 elderly patients (65 years and older) diagnosed with psychiatric disorders according to ICD-10 from January 2005 to March 2008 were collected. Analyses were performed regarding demographic characteristics, prevalence of polypharmacy, and the doses and types of drugs prescribed. RESULTS: In 146 subjects, the mean age was 76.14+/-5.21. More than five types of drugs were prescribed to 49.5% of the patients in 2008. The percentage of stable users (those without changes in the category of polypharmacy for 3 years) was 69.8%. Each patient received an average of 4.20+/-1.50 kinds of drugs in 2005 and 4.02+/-1.77 in 2008. The average dose of drugs was 6.1+/-3.50 in 2005 and 6.49+/-4.09 in 2008, and the difference was not statistically significant. The average number of types of psychiatric drugs prescribed to the patients decreased from 2.37+/-0.86 in 2005 to 2.17+/-0.87 in 2008 (p<0.05). CONCLUSION: Although practice of polypharmacy showed a slow increase over the 3 years from 2005 to 2008, almost half of the elderly patients we studied received multiple drugs. Since polypharmacy can increase drug-drug interactions and adverse effects in the elderly, appropriate drug monitoring and careful prescription are necessary.
Aged ; Drug Monitoring ; Humans ; International Classification of Diseases ; Medical Records ; Outpatients ; Polypharmacy ; Prescriptions ; Prevalence ; Retrospective Studies

OBJECTIVES: The objective of this study was to investigate the prescription trends for the elderly psychiatric outpatients at a university hospital. METHODS: We performed a retrospective study based on medical records. Data on 146 elderly patients (65 years and older) diagnosed with psychiatric disorders according to ICD-10 from January 2005 to March 2008 were collected. Analyses were performed regarding demographic characteristics, prevalence of polypharmacy, and the doses and types of drugs prescribed. RESULTS: In 146 subjects, the mean age was 76.14+/-5.21. More than five types of drugs were prescribed to 49.5% of the patients in 2008. The percentage of stable users (those without changes in the category of polypharmacy for 3 years) was 69.8%. Each patient received an average of 4.20+/-1.50 kinds of drugs in 2005 and 4.02+/-1.77 in 2008. The average dose of drugs was 6.1+/-3.50 in 2005 and 6.49+/-4.09 in 2008, and the difference was not statistically significant. The average number of types of psychiatric drugs prescribed to the patients decreased from 2.37+/-0.86 in 2005 to 2.17+/-0.87 in 2008 (p<0.05). CONCLUSION: Although practice of polypharmacy showed a slow increase over the 3 years from 2005 to 2008, almost half of the elderly patients we studied received multiple drugs. Since polypharmacy can increase drug-drug interactions and adverse effects in the elderly, appropriate drug monitoring and careful prescription are necessary.
Aged ; Drug Monitoring ; Humans ; International Classification of Diseases ; Medical Records ; Outpatients ; Polypharmacy ; Prescriptions ; Prevalence ; Retrospective Studies

Older persons generally have greater susceptibility to infections than younger adults, probably because of the increased frequency of comorbidities and physiologic changes. There are many factors, both patient-related and treatment-related, which contribute to unique aspects of antimicrobial use in elderly persons that make prescribing complicated. Physiologic and pharmacokinetic changes associated with aging results in a higher risk of an adverse drug event and a harmful drug interaction, making antimicrobial dosing difficult. The risk of polypharmacy and more frequent adverse drug reactions in the elderly population justify a thorough consideration of the patient's true need for antimicrobial therapy. Given the increase in the elderly population and in the incidence of adverse drug reaction among elderly persons, further efforts should be made to optimize approach to management of infectious diseases in elderly persons.
Adult ; Aged ; Aging ; Anti-Bacterial Agents ; Communicable Diseases ; Comorbidity ; Drug Interactions ; Drug Toxicity ; Humans ; Incidence ; Polypharmacy