PREVALENCE AND PREDICTORS OF POLYPHARMACY AND ITS LONGITUDINAL ASSOCIATION WITH ADVERSE HEALTH OUTCOMES AMONG GERIATRIC POPULATION IN PAKISTAN AND
Medication use in the elderly is a global health concern as they have a higher prevalence of multiple drug use, known as polypharmacy. The current study aimed to investigate the prevalence of risk factors and adverse outcomes associated with polypharmacy in Pakistan and Indonesia. The study was conducted in three steps. Firstly, the study translated and validated the Lubben Social Network Scale and De Jong Gierveld Loneliness Scale for measuring social isolation and loneliness, respectively, through a cross-sectional study. Secondly, a retrospective study of the patient’s medical record profile for the prevalence and risk factors of polypharmacy was conducted. Lastly, a prospective cohort study was performed to measure the longitudinal association of polypharmacy with adverse health outcomes. The data was analysed using IBM SPSS version 26 and IBM AMOS version 22. The validation results showed that the translated version of both scales showed the same factor structure as the original versions, and the confirmatory factor analysis showed acceptable fit indices. The study found a high prevalence of polypharmacy, up to 55.8% in both countries, and increasing age, comorbidity, increased LOS, and disorders of circulatory, respiratory, endocrine, nutrition, metabolic, and genitourinary systems were among the predominant risk factors (OR > 2) associated with polypharmacy. The prevalence of potential drug-drug interactions (pDDIs) ranged from 26.5% to 49.5%, while the prevalence of potentially inappropriate medications (PIMs) ranged from 49.1% to 63.5% in both countries. Polypharmacy was the independent risk factor associated with pDDIs and PIMs. Furthermore, the study found a significant association between polypharmacy and length of hospital stay. The study did not find a significant association of polypharmacy with revisits and readmissions in Pakistan; however, in Indonesia, polypharmacy was among the risk factors associated with revisits and readmission after discharge in the crude model. Moreover, the study revealed that polypharmacy patients have a lower quality of life and have more problems with the severity of some domains of EQ-5D-5L. In addition, a significant negative association between medications and adherence was noted. The polypharmacy group patients in Pakistan were more exposed to isolation and loneliness as compared to the Indonesians, and polypharmacy, up to a certain extent, was associated with adverse social outcomes. The study concluded that almost every 2nd or 3rd elderly patients were exposed to polypharmacy, and polypharmacy was a predominant risk factor for adverse health outcomes. There is a need for sound strategies and interventional approaches to minimise the use of polypharmacy and prevent the risk of adverse health outcomes in the most vulnerable groups.
Keywords: Polypharmacy, Elderly Patients, Risk Factors, Adverse Outcomes
