Drug optimization in older adults improved outcomes in this retrospective study.
Polypharmacy in older adults has implications for safety and economics, as well as posing clinical risks, and the optimization of drug therapy is one of the cornerstones in geriatrics.
A recent retrospective study examined the effect of drug rationalization on comprehensive geriatric assessment (CGA) parameters, in which a detailed medication review is conducted, as well as the Beers Criteria for Potentially Inappropriate Medication (PIM) Use in Older Adults. The Beers criteria, a tool developed by the American Geriatrics Society, is a list of PIMs that are typically best avoided.
The retrospective and longitudinal study examined the records of patients visiting geriatric outpatient clinics between February 2015 and October 2018 in Turkey. Of 1741 patients seen, 515 were included in the analysis and had been followed for 6 months after a medication review, according to Beers and CGA. Patient mean age [SD] was 74.13 [7.29]; most were female.
Detailed medication history, laboratory findings, comorbidities, socioeconomic characteristics, and CGA parameters were recorded at the first visit, and polypharmacy was defined as the concurrent use of 5 or more drugs. These were then compared with follow-up data.
Drug therapy was individualized by the same geriatrician who assessed patients in the outpatient clinic, and patients whose total drug numbers fell were reevaluated separately after 6 months.
Patients were divided into 2 groups: less than 5 drugs, or 5 or more. Patients in the former group numbered 246 (47.8%) and 269 individuals (52.2%) were in the latter. There was no statistically significant difference between the 2 groups in terms of gender.
The baseline mean number of drugs was 5.11 [3.34], but after prescriptions were optimized by a physician, that number fell to 4.76 [2.72].
The patients whose total drug numbers fell were reevaluated separately after 6 months.
Results showed that the polypharmacy group had a higher rate of geriatric syndromes and lower CGA scores. They were also more likely to be married and suffer from hypertension, depression, and type 2 diabetes.
At the end of 6 months, depression, mobility, and nutritional scores improved for patients who were taking fewer drugs, without a decline in cognition, activities of daily living scores, and gait speed.
However, as the number of drugs increased, mobility and functionality decreased, showing that “medication reviews have key importance in the management of older patients,” the authors noted.
Idil E, Ekrem Aydin A, Bulut EA, Isik, AT. Rationally decreasing the number of drugs seems to be a useful therapeutic approach in older adults: 6-month follow-up study. Arch Gerontol Geriatr. Published online June 30, 2021. doi: 10.1016/j.archger.2021.104472