Polypharmacy in Primary Care Practices among Chronic Elderly Patients in Gaza Strip

Introduction: The increasing number of elderly, and drug use among the elderly, emphasizes the need for continuous monitoring of drug utilization. Chronic diseases are frequent among the older population;the rate of drug related problems and drug-drug interactions (DDIs) with the medical and financial consequences are enormous. Polypharmacy (PP) is defined as the concomitant use of 5 or more medications. We studied PP among chronic elderly patients in Gaza Strip and its distri- bution among primary health care clinics in different areas. Materials and Methods: This study is a descriptive analytical study, analyzing prescription data from general practices during a 3-month time period, to measure the prevalence of PP and medication errors among chronic elderly pa- tients. Data were collected directly from the prescriptions and medical records, which contain per- sonal data for patients like patient age and gender, included the current illness, drug treatment for the current illness, chronic disease/s and drug treatment for chronic disease/s. SPSS software was used to analyze the obtained data. Results: Percent of major PP was the highest among patients aged 60 - 69 years when compared with other ages categories of study population but not reached to be statisticaly significant (0.012). Major PP was higher in female patients than that in male patients but difference wasn’t statistically significant (0.5). The average number of drug per prescription was 3.4 drug;and the minimum value per prescription was 1 meanwhile maximum value was 9 (SD + 1.7). Conclusion: PP (use of five drugs or more) is more prevalent among elderly patients with multiple diseases. Female patients consume more drugs than male do. There were some regional differences in drug utilization not explained by morbidity, suggesting some varia- tions in prescribing behaviors.

More than Half of Patients with Schizophrenia Are Receiving Polypharmacy and Co-Prescription of Anxiolytics in Pakistan —Findings from Research on Asian Prescription Pattern in 2016

Objective: Little is known about the prescription pattern of psychotropic drugs for patients with schizophrenia in Pakistan. The purpose of this study was to evaluate the characteristic features of psychotropic drug prescriptions for patients with schizophrenia in Pakistan. Methods: Three centers in Pakistan participated in a large scale collaborative study known as Research on Asian Prescription Pattern (REAP). The 2016 REAP survey included centers from 15 countries in Asia and used a unified research protocol. The design of the study was quantitative and of descriptive epidemiology. Analysis was made on the data collected from three centers i.e., Lahore, Karachi and Islamabad. The data collected in Pakistan were compared with those from other Asian countries. The details of REAP were presented on the homepage of REAP (http://www.REAP.Asia). Results: From Pakistan, 298 patients were included. Patients with schizophrenia in Pakistan received higher rate of antipsychotic polypharmacy and a higher rate of co-prescription of mood stabilizers and anxiolytics when compared with participants from other South Asian countries (India and Bangladesh). Conclusion: The main findings of the study were that a majority of the patients were prescribed antipsychotic polypharmacy drugs in Pakistan. Insufficient training on the use of psychotropic drugs and a lack of treatment guideline are considered to be the major contributing factors. Further education and training on the proper use of psychotropic drugs are recommended to psychiatrists in Pakistan. The guidelines on pharmacotherapy for patients with schizophrenia should also be developed and promoted in Pakistan.

Polypharmacy in Elderly Patients in a Community Pharmacy

Introduction:The definition of polypharmacy is not consensual,but all authors refer it as the simultaneous use and the chronic way,of several drugs by the same person.Polypharmacy affects mainly the elderly and it is due to the high number of chronic diseases in this population and consequent need to take medications to control them.Aims:Characterization and quantification of polypharmacy in a rural elderly population.Materials and Methods:It carried out an observational,retrospective,transversal and analytical study in Farmácia Popular(Pombal).Total of 230 individuals aged 65 years old or more were surveyed and the data collection was made through a questionnaire prepared for this purpose,in time between February and April 2017.Results:The elderly took,on mean,6.20 drugs daily.The prevalence of Major polypharmacy(≥5 medications)was 70.4%.The most prescribed pharmacotherapeutics groups were cardiovascular and central nervous system.There were statistically significant differences between age and number of medicaments taken,as well between number of drugs and the way to identify the medication,the knowledge of the therapeutics indications,the occurrence of mistakes or take outside advised time,and the self-perception of health state(p≤0.05).Conclusion:In view of the obtained results,it concludes that polypharmacy is very high in Portuguese population in study.It is the persons most aged who consume a greater number of drugs.The elderly with less academic qualifications are those who have more difficulty in identifying medication and respective therapeutics indications.It is necessary to adopt strategies in order to reduce polypharmacy,with the prescriber and the professionals of pharmacy a preponderant role in this task.

A descriptive-comparative study of medications used by older people prior to and following admission to a continuing care facility

Medications are beneficial for curing or managing acute and chronic illnesses. Medications typically have positive outcomes, although older people are prone to drug-related problems. Community-dwelling seniors are at particularly high risk of polypharmacy, as they tend to receive many prescriptions over time and from different care providers. Continuing-care facility admission presents an excellent opportunity for a comprehensive medication review. A research study was conducted to describe and compare medications taken by community-dwelling seniors prior to and following admission to a continuing-care facility. This pilot project involved data being gathered from the charts of deceased residents, as required by a University Health Research Ethics Board, who had been cared for at one large local continuing-care facility. The facility administrators also approved this study, in part to evaluate their policy to conduct a medication review for all new residents within six weeks of entry. This study revealed a slight but statistically significant reduction in the number of medications following this review. Other issues such as medication interactions and required dosage changes were addressed by this medication review. Although this study was confined to one continuing-care facility and a small number of residents, the findings suggest medication reviews would be beneficial upon admission to all continuing-care facilities, and annually perhaps through other means for older persons living in the community.

Possibility of Drug-Drug Interaction in Prescription Dispensed by Community and Hospital Pharmacy

Objective: To analyze the use of all subsidized prescription drugs including their use of drug combination generally accepted as carrying a risk of severe interactions. Methodology: In a cross sectional study, we analyzed all prescriptions (n = 1014) involving two or more drugs dispensed to the population (age range 4-85 years) from all pharmacies, clinics and hospitals. Data were stratified by age and sex, and frequency of common interacting drugs. Potential drug interactions were classified according to clinical relevance as significance of severity (types A: major, B: moderate, and C: minor) and documented evidence (types 1, 2, 3, and 4). Result and Discussion: The growing use of pharmacological agents means that drug interactions are of increasing interest for public health. Monitoring of potential drug interactions may improve the quality of drug prescribing and dispensing, and it might form a basis for education focused on appropriate prescribing. To make the manifestation of adverse interaction subside, management strategies must be exercised if two interacting drugs have to be taken with each other, involving: adjusting the dose of the object drug;spacing dosing times to avoid the interaction. The pharmacist, along with the prescriber has a duty to ensure that patients are aware of the risk of side effects and a suitable course of action they should take. Conclusion: It is unrealistic to expect clinicians to memorize the thousands of drug-drug interactions and their clinical significance, especially considering the rate of introduction of novel drugs and the escalating appreciation of the importance of pharmacogenomics. Reliable regularly updated decision support systems and information technology are necessary to help avert dangerous drug combinations.

Frailty Prevalence and Characteristics in Older Patients with Type 2 Diabetes

Background: Older diabetic patients are more likely to be frail than those who do not have diabetes. Frailty is an important risk factor for both mortality and disability in older patients with type 2 diabetes. However, the mechanism of frailty in diabetes mellitus is not fully understood. Aims: The aim of this study was to identify the prevalence of frailty and associated factors in older patients with type 2 diabetes in Japan. Methods: A cross-sectional study was conducted with a total of 178 outpatients who were over 65 years old with type 2 diabetes. We used the Obu Study Health Promotion for the Elderly definition of frailty to divided subjects into a non-frail and a frail group. We investigated the association between frailty and various patient characteristics. Results: In the study, 21.4% of the older patients with type 2 diabetes were considered frail. There were no significant differences in the duration of diabetes, BMI, proportion of microvascular complications, or HbA1c values between the frail and non-frail group. However, serum albumin and IGF-1 levels were lower in the frail group than the non-frail group as were the Mini-Mental State Examination scores. The frail group had a higher number of medications than the non-frail group. In a multivariable analysis, frailty was positively associated with the number of medications and, lower levels of both serum albumin and IGF-1. Conclusion: Our study suggests that diabetes accelerates the aging process and frailty is associated with low albumin, polypharmacy and low levels of IGF-1.

Patients Aged 80 Years or Older are Encountered More Potentially Inappropriate Medication Use

Background： Polyphamlacy and potentially inappropriate medications （PIMs） are prominent prescribing issties in elderly patients. This study was to investigate the different prevalence of PIM use in elderly inpatients between 65-70 years of age and 80 years or older, who were discharged from Geriatric Depamnent in West China Hospital. Methods： A large-scale cohort of 1796 inpatients aged 65 years or over was recruited. Respectively. 618 patients were 65 79 years and 1178 patients were 80 years or older. Updated 2012 Beers Criteria by the Anaerican Geriatric Society was applied to assess the use of PIM among the investigated samples. Results： A review of the prescribed medications identified 686 patients aged 80 years or older constimed at least one PIM giving a rate of 58.2%. Conversely, 268 （43.4%） patients aged 65-79 years consumed at least one PIM （x^2=40.18, P 〈 0.001）. Patients aged 80 years or older had higher hospitalization expenses, length of stay, co-morbidities, medical prescription, and mortality than patients aged 65-79 years （all with P 〈 0.001 ）. Patients aged 80 years or older were prescribed with more benzodiazepines, drugs with strong anticholmergic properties, megestrol, antipsychotics, theophylline, and aspirin. In multiple regression analysis, PIM use was significantly associated with female gender, age, number of diagnostic disease, and number of prescribed medication. Conclusions： The finding from this study revealed that inpatients aged 80 years or older encountered more PIM use than those aged 65-79 years. Anticholinergic properties, megestrol. antipsychotics, theophylline, and aspirin are medications that often prescribed to inpatients aged 80 years or older. Doctors should carefully choose drugs for the elderly, especially the elderly aged 80 years or older.

Age-specific differences in non-cardiac comorbidities among elderly patients hospitalized with heart failure: a special focus on young-old, old-old, and oldest-old

Background:Despite the growing epidemic of heart failure(HF),there is limited data available to systematically compare noncardiac comorbidities in the young-old,old-old,and oldest-old patients hospitalized for HF.The precise differences will add valuable information for better management of HF in elderly patients.Methods:A total of 1053 patients aged 65 years or older hospitalized with HF were included in this study.Patients were compared among three age groups:(1)young-old:65 to 74 years,(2)old-old:75 to 84 years,and(3)oldest-old:≥85 years.Clinical details of presentation,comorbidities,and prescribed medications were recorded.Results:The mean age was 76.7 years and 12.7%were 85 years or older.Most elderly patients with HF(97.5%)had at least one of the non-cardiac comorbidities.The patterns of common non-cardiac comorbidities were different between the young-old and oldestold group.The three most common non-cardiac comorbidities were anemia(53.6%),hyperlipidemia(45.9%),and diabetes(42.4%)in the young-old group,while anemia(73.1%),infection(58.2%),and chronic kidney disease(44.0%)in the oldest-old group.Polypharmacy was observed in 93.0%elderly patients with HF.Additionally,29.2%patients were diagnosed with infection,and 67.0%patients were prescribed antibiotics.However,60.4%patients were diagnosed with anemia with only 8.9%of them receiving iron repletion.Conclusions:Non-cardiac comorbidities are nearly universal in three groups but obviously differ by age,and inappropriate medications are very common in elderly patients with HF.Further treatment strategies should be focused on providing optimal medications for age-specific non-cardiac conditions.

Fabrication of Electrospun Levodopa-Carbidopa Fixed-Dose Combinations

Introduction Parkinson’s disease(PD)is a disabling disorder that signifi-cantly affects a patient’s quality of life[1].Treatments are available,but only 10%of PD patients fully adhere to their treatment regimens[2].Non-adherence is a serious problem linked to worsening symptoms and increased motor fluc-tuations[3-5].Levodopa(LD)remains the most effective treatment for PD[6].However,a single dosing treatment is only effective in the early phase of the disease.In the severe phase,4-5 years after diagnosis,the therapeutic window of dopamine becomes narrow,and due to its short half-life of between 0.7 and 1.4 h dosing of LD will be required every 2 h[7-9].One way to ameliorate this issue is to co-admin-ister LD with carbidopa(CD),which can increase LD’s oral bioavailability to 40-70%[10].