Prevalence of polypharmacy in elderly patients with chronic diseases in Arar City, Kingdom of Saudi Arabia

Authors

Abstract

Aim Polypharmacy refers to the simultaneous consumption of numerous medications by a person. The most frequently cited description of polypharmacy involves taking five or more medications daily. Polypharmacy is becoming an increasing worry on a global scale, especially among individuals with long-term health conditions.
Materials and Methods A retrospective cross-sectional study design was employed to investigate the prevalence of polypharmacy among elderly patients with chronic diseases aged > 60 visiting Price Abdulaziz Bin Moussaid Hospital in Arar City. Data was collected from the hospital electronic health records for 6 months between January and June 2022. Descriptive statistics were used to calculate the prevalence of polypharmacy among the study population. Chi-square and logistic regression analyses were performed to identify factors associated with polypharmacy.
Results The overall prevalence of polypharmacy was found to be 39.3%, a result that is consistent with the global finding of analogous populations.
Discussion Our study stated a considerable prevalence of polypharmacy among elderly people with chronic diseases in Arar City in Saudi Arabia, specifically among individuals with diabetes, and those treated in home care settings. Targeted interventions and policy measures are crucially needed to optimize medication utilization to reduce polypharmacy rates and adverse drug events in high-risk subgroups.

Keywords

Introduction

Polypharmacy refers to the simultaneous consumption of numerous medications by a person. The most frequently cited description of polypharmacy involves taking five or more medications on a daily basis [1].
Polypharmacy is becoming an increasing worry on a global scale, especially among individuals with long-term health conditions. This is amplified by changing demographics, a rising number of older patients, and the substantial risks, including mortality, linked to this practice [2]. Polypharmacy heightens the potential for experiencing adverse drug reactions (ADRs), encountering drug interactions, and facing issues with adhering to medication schedules [3]. Unintended and harmful effects caused by medications are known as adverse drug reactions (ADRs), which tend to be more prevalent in older adults due to physiological and metabolic changes associated with aging [4]. Drug interactions occur when two or more medications, when taken together, interact in ways that weren’t anticipated, potentially resulting in adverse or harmful effects on the body. These interactions can interfere with the intended actions of one or both medications, leading to altered effectiveness or increased risks for side effects [5]. Medication non-adherence signifies the lack of adherence to prescribed medication instructions, which often leads to suboptimal health outcomes or complications due to not taking medications as recommended by healthcare providers. This behavior can encompass skipping doses, not completing the full course of medication, or not taking medicines at the prescribed times, ultimately impacting the effectiveness of treatment and potentially worsening health conditions [6].
Polypharmacy has connections to higher healthcare costs, diminished quality of life, and an increased likelihood of mortality [7]. Adults who take multiple medications are more prone to hospitalization, Encounter instances of falls, and face challenges in managing their daily activities [8–10].
Polypharmacy’s prevalence in outpatient settings can reach up to 37%, while it can be nearly 92% among hospitalized individuals [11]. Around 60% of older individuals in the United States take five or more medications, while approximately 20% take ten or more medications [12]. In Saudi Arabia, approximately 54% of individuals were reported to take up to four prescription drugs, while around 46% take five or more prescription medications. Surprisingly, the occurrence of polypharmacy use was twice as high in adults with hypertension compared to those without hypertension. Similarly, adults with diabetes were found to have twice the prevalence of polypharmacy use compared to those without diabetes [13]. Another study conducted in Saudi Arabia revealed that 89% of the investigated records displayed instances of polypharmacy [14]. In Arar City, the prevalence and patterns of polypharmacy remain poorly understood. This research aims to assess the prevalence and associated factors of polypharmacy among elderly patients with chronic diseases visiting Price Abdulaziz Bin Moussaid Hospital in Arar City, to provide valuable insights for improving healthcare management and patient outcomes. With specific objectives to determine the prevalence of polypharmacy among elderly patients with chronic diseases visiting Price Abdulaziz Bin Moussaid Hospital in Arar City Arar City, explore factors associated with polypharmacy, including age, gender, socioeconomic status, and the number and types of chronic diseases, and to propose recommendations and interventions to optimize medication use and minimize polypharmacy-related risks and burden.

Materials and Methods

A retrospective cross-sectional study design was employed to collect data on the prevalence of polypharmacy among elderly patients with chronic diseases aged > 60 visiting Price Abdulaziz Bin Moussaid Hospital in Arar City. The study population consists of adult patients (aged 60 years and above) diagnosed with at least one chronic disease, such as diabetes, hypertension, cardiovascular diseases, respiratory diseases, or mental health disorders, visiting Price Abdulaziz Bin Moussaid Hospital in Arar City. Data was collected from the hospital electronic health records for a period of 6 months between January and June 2022. Descriptive statistics were used to calculate the prevalence of polypharmacy among the study population. Chi-square and logistic regression analyses were performed to identify factors associated with polypharmacy.
AI Usage
The authors acknowledge the use of AI-assisted tools in the preparation of this manuscript. ChatGPT (OpenAI) was employed to support language refinement, idea structuring, and enhancement of clarity in scientific expression. Additionally, SciSpace (Typeset) was utilized to assist with literature insights. These tools were used under the authors’ supervision and did not influence the scientific content, data interpretation, or conclusions drawn.
Ethical Approval
This study was approved by the Ethics Committee of Northern Border University HAP-09-A-043 (Date: 2023-12- 27, No: 122/23/H). And approved by the Ethics Committee of Institutional Review Board in Arar HAP-09-A-051 (Date: 2024- 07-30, No: NIC-IRB-024-07-19).

Results

The study sample comprised 135 participants with a mean age of 71.9 years (SD = 8.9). Of the sample, 56.3% were female and 43.7% were male. Additionally, 88.1% of the participants were Saudi nationals. Regarding medical diagnoses, 65.2% were diagnosed with essential hypertension, 20.7% with type 2 diabetes mellitus, 13.3% with asthma, and approximately 1% with heart failure. In terms of clinic location, 48.9% of the participants were seen in the cardiology clinic, 23% in home care, 19.3% in the emergency department, and fewer than 10% in other types of clinics (Table 1) The prevalence of polypharmacy is found to be 39.3%, with a 95% confidence interval of 30.9% to 47.6% (Table 1).
The Chi-Square test of association between polypharmacy and participants’ characteristics revealed a statistically significant association with nationality, diagnosis, and location of care. A significantly higher proportion of non-Saudi nationals had polypharmacy (68.8%) compared to Saudi nationals (35.3%) (p-value 0.01). Also, diagnosis type was significantly associated with polypharmacy (p-value = 0.001); 71.4% of participants diagnosed with type 2 diabetes mellitus had polypharmacy, compared to 33.3% of those with asthma and 30.7% of those with essential hypertension. Another significant factor is the location of care (p-value < 0.001), participants treated in home care settings show higher rates of polypharmacy (74.2%) and other locations (58.3%), contrasted to those seen in the cardiology clinic (25.8%) and emergency department (23.1%) (Table 2).
Individual analysis of the association between polypharmacy and patient characteristics is represented in (Table 3). The findings indicate statistically significant associations between polypharmacy and several factors. Regarding diagnosis, patients diagnosed with type 2 diabetes mellitus were five times more likely to have polypharmacy compared to those diagnosed with asthma (UAOR = 5.0; 95% CI: 1.4–17.9; p-value 0.001). Location of care also showed a significant association: patients seen in home care settings were eight times more likely to have polypharmacy (UAOR = 8.0; 95% CI: 3.1–22.0; p-value < 0.001), while those seen in other locations were four times more likely (UAOR = 4.0; 95% CI: 1.1–14.4; p-value < 0.001), compared to those seen in the cardiology clinic.
(Table 3) also presents a multivariable association between polypharmacy and patient characteristics, namely nationality and location, when considered collectively. The analysis revealed statistically significant associations with both factors. Non-Saudi patients were 6.6 times more likely to experience polypharmacy compared to Saudi patients (AOR = 6.6; 95% CI: 2.0–22.2; p-value = 0.002), after adjusting for location. In terms of location, patients who received care in home care settings were 11.5 times more likely to have polypharmacy compared to those seen in the cardiology clinic (AOR = 11.5; 95% CI: 4.1– 32.0; p-value < 0.001).

Discussion

Our current study investigated the prevalence and associated factors of polypharmacy among elderly patients with chronic diseases visiting Price Abdulaziz Bin Moussaid Hospital in Arar City. The overall prevalence of polypharmacy was found to be 39.3%, a result that is consistent with the global finding of analogous populations. In developed healthcare systems such as the United States and Canada, the polypharmacy rates had been documented to range from 30% to 60% among older adults, depending on the healthcare setting and population characteristics [15, 16]. Similarly, a study in a primary care setting generally in Saudi Arabia reported a prevalence rate of 55% among elderly patients, which is comparable to our results [17], and closely aligned with results of a retrospective study at Buriadah Central Hospital, Saudi Arabia [18].
Markedly, our study found a significant statistical association between polypharmacy and patient diagnosis and the medical care location. The type of diagnosis was a significant factor; patients diagnosed with type-2 Diabetes revealed the highest prevalence of polypharmacy (71.4%). This is aligned with reports that the chronic conditions, specifically Diabetes, are strongly correlated with the rates of polypharmacy, because of the need for multiple medications prescribed to manage and control those conditions, and to prevent their long-term complications [19]. In contrast, a lower rate of polypharmacy had been found in the patient diagnosed with asthma and essential hypertension, which may be due to simpler guidelines required to manage those conditions that are not always complicated by comorbidities.
The medical care location was found to be another significant contributing factor. Those receiving medical care in a home setting were 11.5 times more likely to experience polypharmacy compared to those treated in a cardiology clinic (AOR = 11.5; p < 0.001). This result merely reflects the complexity of the treatment of patients joining a home care program, who are most likely suffering from multiple chronic conditions and disabilities, which urge comprehensive pharmacotherapeutic interventions. Comparably, an international study stated close findings, where elderly people treated in home care settings show markedly higher rates of polypharmacy [20, 21]. By contrast, a lower rate of polypharmacy had been found in the Emergency Department and cardiology clinic; this may be due to the specialized nature of care in these settings.
The observed polypharmacy prevalence highlighted the pivotal role of medication evaluation processes, particularly in high-risk groups, patients with diabetes, and those in home care settings. As a result, the effect of pharmacist-led interventions using comprehensive medication reconciliation, including the criteria of the positionally inappropriate medications (PIMs) and the Medication Regimen Complexity Index-Korean (MRCI-K), and the differences in Adverse Drug Reactions (ADEs) have been shown to reduce polypharmacy rates and improve the overall treatment outcomes in elderly people [22, 23].

Limitations

Although the valuable insights of our study, still there are study limitations that have been encountered. The causal inferences significantly affected by the cross-sectional design of the research, and the precision of the nationality-based estimations was affected by a relatively small number of non-Saudi participants. Moreover, the appropriateness and drug-related problems were not assessed, which play an important role in distinguishing between necessary and potentially inappropriate polypharmacy. Future research should be employed to explore longitudinal outcomes associated with polypharmacy and to consider integrating clinical parameters such as medical and medication history, comprehensive system review, cognitive status, and medication compliance.

Conclusion

Our study stated a considerable prevalence of polypharmacy among elderly people with chronic diseases in Arar City in Saudi Arabia, specifically among individuals with diabetes, and those treated in home care settings. Targeted interventions and policy measures are crucially needed to optimize medication utilization to reduce polypharmacy rates and adverse drug events in high-risk subgroups.

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