Multi-Institutional Drug Use Patterns in Hospitalized Older Patients: Retrospective Cross-Sectional Study

TL;DR

This study examines drug use patterns in hospitalized older patients and proposes a new polypharmacy threshold of 10-19 drugs.

Contribution

A 4-level polypharmacy categorization system is proposed, with a higher threshold for hospitalized older patients.

Findings

The traditional polypharmacy threshold of 5 or more drugs may be too low for hospitalized older patients.

A threshold of 10-19 concurrent drugs (major polypharmacy) is more appropriate for this population.

Antibacterials, anesthetics, and cardiac therapy were frequently prescribed in the major polypharmacy category.

Abstract

A rapidly aging population led to an increase in the number of patients with chronic diseases and polypharmacy. Although investigations on the appropriate number of drugs for older patients have been conducted, there is a shortage of studies on polypharmacy criteria in older inpatients from multiple institutions.

The aim of this study was to examine the patterns of polypharmacy and determine the criteria for the number of drugs defining polypharmacy in the geriatric inpatient population.

Electronic health records of 4 medical institutions for patients aged 65 years and older hospitalized between January 1, 2012, and December 31, 2020, were analyzed for the study. The maximum number of drugs prescribed was obtained for each patient and, along with a literature review, was used to determine the appropriate polypharmacy level for our population.

We suggest a 4-level polypharmacy category system consisting of nonpolypharmacy, polypharmacy, major polypharmacy, and excessive polypharmacy based on a review of international guidelines and polypharmacy literature. Application of this system to our study population showed that the major polypharmacy category (use of 10-19 concurrent drugs) was an appropriate threshold for polypharmacy in hospitalized patients versus the traditional threshold of 5 or more concurrent drugs. The tendency of our study population to have a higher disease and drug count supports this threshold. Frequently prescribed therapeutic subgroups in this category were antibacterials for systemic use, anesthetics, and cardiac therapy.

This study proposes a polypharmacy categorization system for older inpatients, which differs from the common definition of the concomitant prescription of 5 or more drugs. The older population tends to have severe conditions including those requiring major surgeries; therefore, a drug count corresponding to the definition of major polypharmacy is appropriate.

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