Polypharmacy in Older Patients: A Three-Year Longitudinal Analysis in Primary Care Settings of Aragón, Spain.

BACKGROUND: Challenges of polypharmacy and the impact of coronavirus disease 2019 (COVID-19) pandemic in older patients require further investigation. This retrospective study analyzed the progression of polypharmacy and anticholinergic burden in older patients in a primary care setting before, during, and after the COVID-19 pandemic. METHODS: This 3-year cross-sectional study (2019, 2020, and 2021) comprised a dynamic cohort of individuals aged ≥75 years, who attended the Arrabal Primary Care Center in Zaragoza, Spain. Older patients with polypharmacy (≥5 medications) were identified according to their electronic health records. We collected demographic and clinical data, including medication prescriptions, diagnoses, and anticholinergic risks, and performed descriptive and statistical analyses. RESULTS: This study included a total of 1,928 patients with a mean age of 83.52±0.30 years. Over the 3-year study period, the mean number of medications prescribed increased, from 9.4 in 2019 to 10.4 in 2021. The prevalence of excessive polypharmacy (≥10 medications) increased from 39% in 2019 to 45% in 2021. The most commonly prescribed drugs were anilides, proton pump inhibitors, benzodiazepine derivatives, and platelet aggregation inhibitors. Women had a higher prevalence of illnesses and anticholinergic drug prescriptions than men. CONCLUSION: The results of this study highlighted an upward trend in polypharmacy and excessive polypharmacy among older patients in primary care settings. Future research should focus on optimizing medication management and deprescribing strategies and minimizing the adverse effects of polypharmacy in this population.

One-year follow-up of the effectiveness of a lifestyle modification programme as an adjuvant treatment of depression in primary care: A randomised clinical trial.

BACKGROUND: An estimated 280 million individuals suffer from depression. Brief group interventions in Primary Healthcare Centres (PHCs) are recommended. One goal of these interventions is to educate people about healthy lifestyle habits, as they prevent the development of depression. This study aims to analyse the one-year follow-up results about the effectiveness of a Lifestyle Modification Programme (LMP) and an LMP plus Information and Communication Technologies (LMP + ICTs) when compared to Treatment as Usual (TAU). METHODS: We conducted an open-label, multicentre, pragmatic, randomised clinical trial. A total of 188 individuals that visited a general practitioner and met the inclusion criteria were randomised. LMP consisted of six weekly 90-minute group sessions focusing on lifestyle improvement. LMP + ICTs was a hybrid of the LMP format with the inclusion of a wearable smartwatch. We used linear mixed models (with a random intercept and an unstructured covariance) to evaluate the effectiveness of the interventions, and an intention-to-treat analysis and Multiple Imputation technique for handling missing data. RESULTS: LMP + ICTs showed a statistically significant reduction on depressive symptoms (b = -2.68, 95 % CI = [-4.239, -1.133] p = .001) and sedentarism (b = -37.38, 95 % CI [-62.930, -11.833], p = .004) compared to TAU. LIMITATIONS: Most of the dropouts were due to time restrictions. CONCLUSIONS: In long-term, LMPs plus ICTs administered in PHCs to people suffering from depression were effective in reducing depressive symptomatology and sedentarism comparing to TAU. More research is needed to enhance adherence to lifestyle recommendations. These promising programmes could be easily implemented in PHCs. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov Registry (NCT03951350).