Polypharmacy and Inappropriate Drug Prescription in Community-dwelling Elderly

BACKGROUND: Due to rapidly growing elderly population, there are increasing numbers of older persons with multiple chronic disorders and geriatric problems arising from polypharmacy. In this study we tried to find out the state of polypharmacy and inappropriate drug prescription and their related factors in community-dwelling elderly by review of drugs taken by older persons visiting a day health center. METHODS: From April 2007 to July 2007, 80 subjects of 65 year-old or over with chronic illness who visited a elderly-wellness and health care center were randomly sampled. All of them were surveyed by structured questionnaires, medical records review, pill counts about all medications they are taking and experience of adverse drug reactions. And all the prescribed medications were reviewed or their drug prescription's appropriateness for each elderly according to Beers criteria. Data results were evaluated by frequency and correlation analyses. RESULTS: The average counts of drugs taken by elderly with chronic disorders were 7.23, minimum 1 to maximum 27 drugs a day. Patients experienced more adverse effects significantly when more prescribed medications were taken (P=0.005), and patients with lack of information about their drugs had taken increased number of medications (P<0.001). Referred to Beers criteria, inappropriate cases of prescription were observed in 26 persons. Those drugs were NSAIDs including aspirin in 17 subjects (21%), amitrityline in 3 (4%), short-acting benzodiazepines in 3 (4%), long acting benzodiazepines in 2 (3%), and anticholinergic antihistamine in 1 (1%). CONCLUSION: Polypharmacy is very common in community-dwelling elderly with chronic disorders. More medications were related to more adverse drug reactions and lack of information about their drugs related to increased number of drug taking. High proportion of inappropriate drug prescriptions was observed in the elderly, which may have resulted from poor education concerning geriatric care of the medical personnels.

Results of 'Short-Form Comprehensive Geriatric Assessment' Application to Elderly Outpatients

BACKGROUND: The importance of comprehensive geriatric assessment(CGA) for the frail elderly can not be overemphasized. Recently, with increasing elderly population and patients, there are increasing need for simplified CGA tool for evaluation of general health and functional status during the limited time in outpatient clinic. This study was conducted to estimate the effectiveness of the 'Short-form Comprehensive Geriatric Assessment' for detecting hidden medical problems beside preexisting diseases. METHODS: 78 outpatients aged 65 or more who revisited to outpatient clinic in a Social Welfare Center answered questionnaires and were examined of the 'Short-form Comprehensive Geriatric Assessment. This screening tool included vision, hearing, arm and leg function, urinary incontinence, nutrition, mental status, depression, ADL, IADL and social support. These results were compared with patients' previous medical records. RESULTS: Among the total 78 subjects, visual difficulty was detected in 63(80.8%)(Rt. eye)/67(85.9%)(Lt. eye). Right hearing difficulty was shown in 8(10.3%) subjects and left hearing difficulty was shown in 4(5.1 %) subjects. There were 2(2.6%) upper extremities dysfunctions and 25(32.1%) lower extremities dysfunctions. 24(30.8%) subjects had depression. The geriatric depression and age and number of disease showed positive correlations. These problems found by assessment tool were not identified on previous medical records. CONCLUSION: Using the 'Short-form Comprehensive Geriatric Assessmen', we could find the new medical problems besides preexisting disease. These findings stress effectiveness and importance of routine application of screening 'Short-form Comprehensive Geriatric Assessment' on daily outpatient clinical practice to improve quality of medical care for the elderly patients.