Could polypharmacy put older patients at increased risk of hospitalization, falls, and all-cause mortality?
Polypharmacy can be associated with many side effects, especially in elderly and debilitated patients.
The risk of hypoglycemia, adherence to treatment, drug interactions, impaired quality of life, increased risk of hospitalization, mortality, and health costs are all associated with polypharmacy. However, no data are available to examine all patient outcomes for polypharmacy. In this article, we wanted to summarize the existing literature that discusses polypharmacy and various adverse health outcomes in elderly patients with type 2 diabetes.
This article has served as a systematic review and meta-analysis. They examined observational studies, including crossover studies, cohort studies, case series, case-control studies, and intervention studies, which included randomized controlled trials and quasi-experimental studies. Only articles written in English were included in the analysis. Patients were 65 years of age or older with a diagnosis of type 2 diabetes. Primary outcomes included all-cause mortality, glycemic control (functionally independent (HbA1c 7.0-7.5%), fragile subcategory (A) (HbA1c ≤ 8.5 (B) Functionally dependent (HbA1c 7.0-8.0%), subcategory (B) dementia (HbA1c ≤ 8.5%)), macrovascular complications (coronary artery disease, heart failure, cerebrovascular disease and stroke) , hospitalization or readmission. Secondary outcomes included an association between polypharmacy and inappropriate treatment, drug interactions, and falls or risk of falls. The odds ratio has been used to link polypharmacy with adverse health effects. Meta-analysis was used when two or more studies with the same design gave the same result using a random-effects model. Inhomogeneity was assessed using the I2test.
Get FREE access to the documentary here
After searching electronic databases and applying exclusion criteria
16 studies were included in the systematic review and three studies in the meta-analysis. This review included 1,205,821 patients. About 50% of these patients were women and 97% were elderly. The definition of polypharmacy included the use of five or more drugs in 50% of the studies, and the prevalence ranged from 6.25 to 93.4%. This review found that almost 28% of elderly patients with type 2 diabetes had an HbA1c of 8% to ≥ 8.5%, although they were intensively treated with antidiabetic drugs. According to research, there was no association between HbA1c use and polypharmacy. According to BEER criteria, the prevalence of potentially inappropriate drugs ranged from 22.7% to 79%. Using the STOPP criteria, the majority was 48%. The most commonly used drugs were metformin in patients aged 85 and over, benzodiazepines, tricyclic antidepressants, aspirin, nonsteroidal anti-inflammatory drugs, and beta-blockers. A drug interaction associated with polypharmacy was between sulfonylurea and cotrimoxazole antibiotics, causing severe hypoglycemia. Other interactions included oral hypoglycemic agents with hydrochlorothiazide, furosemide, angiotensin-converting enzyme inhibitors, simvastatin, and prednisone. No association was found between falling or falling risk with polypharmacy. Polypharmacy was significantly associated with all-cause mortality in 2 cohorts (pooled OR 1.622; 95% CI 1.606 to 1.637, P <0.001, I² = 0%). However, when a cross-sectional study was included, it ceased to be statistically significant, I² = 92%. The association between myocardial infarction and polypharmacy was significant in 2 cohorts (pooled OR, 1.962; 95% CI 1.942–1.982, P <0.001, I² = 0%) and remained significant after cross-sectional study inclusion, I² = 94%. There was no significant association between polypharmacy and hospitalization, I² = 57%.
The results of this analysis were mixed. In some studies, polypharmacy was associated with adverse outcomes, while in others it was not. The limitations of this meta-analysis included the limitations of the studies it evaluated. The limitation is the variable definition of polypharmacy. Another limitation was the participation of older people in clinical trials. Polypharmacy can lead to inappropriate drug use, which increases the risk of adverse health effects in older patients with type 2 diabetes. Therefore, monitoring parameters such as laboratory tests and patient education should be limited and set to monitor these adverse events.
Pearl Practice:
Polypharmacy was significantly associated with myocardial infarction but was not associated with hospitalization, falls, or risk of falls
ไม่มีความคิดเห็น:
แสดงความคิดเห็น