Association Between Potential Inappropriate Medication And Chronic Multi-morbidities In Elderly Patients

Objective:To analyze the occurrence of potentially inappropriate medication(potentially inappropriate medication,PIM)and chronic disease Multi-morbidities in elderly patients,and to explore its correlation and influencing factors with chronic disease Multi-morbidities,so as to provide reference for clinical rational medication use.Methods:To determine the presence of PIM among elderly patients aged ≥ 65,who were hospitalized in the Department of Geriatrics of the First Hospital of Qinhuangdao City from January 2018 to December 2020 with complete chronic disease status,sex,tobacco,alcohol and drug treatment were included.,according to Criteria of potentially inappropriate medications for older adults in China(2017 version).Exclusion age<65 years;duration of hospital stay ≤48h;key variable values missing,death,non-medicated elderly.Statistics of 15 kinds of common chronic diseases(diagnosed by secondary and higher medical institutions),including Hypertension,Diabetes(with or without complications),Unstable angina pectoris,Congestive Heart Failure,Myocardial Infarction and other diseases.Then,according to the definition of comorbidity by the World Health Organization in 2008,"two or more chronic diseases co-existing with the patient",the correlation of multimorbidity was analyzed.Finally,the application of SPSS 23.0 statistical software for data processing,Spearman’s-correlation was used to analyze the association of PIM with chronic disease Multi-morbidities,and binary Logistic regression was used to analyze the related influencing factors of PIM.Results:1 The average age of the 841 elderly patients with chronic diseases was(78.97±8.07)years,including 456 males(54.22%)and 385 females(45.78%);the youngest was 65 years old,and the oldest was 103 years old,which could be divided into three groups according to age: 275 cases in the young elderly group(65 ～ <75 years old),332 cases in the middle elderly group(75 ～ <85years old),and 234 cases in the old elderly group(≥85 years old).The CCI scores of 841 elderly patients ranged from 0 to 12 points,with an average of(2.33±1.46)points.The average type of medication was(5.15±2.67);and the patients with polypharmacy(≥5 kinds of drugs)accounted for 54.10%.99 cases(11.77%)had a smoking history,and 123 cases(14.63%)had quit smoking.129 cases(15.34%)had a history of drinking alcohol,and 49 cases(5.83%)had stopped drinking.2 In the aspect of chronic diseases,the elderly patients suffered from multiple chronic diseases on average(3.27±1.45),and the chronic disease with the highest prevalence rate was Hypertension in 584 cases(69.44%).It was followed by 530 cases of Cerebrovascular Disease(63.02%),355 cases of Unstable angina pectoris(42.21%),312 cases of Diabetes(37.10%),and193 cases of Chronic liver disease(22.95%).In terms of chronic disease Multi-morbidities,the most common Multi-morbidities in this study were Hypertension combined with Cerebrovascular Disease(389 cases),followed by Hypertension combined with Unstable angina pectoris(275 cases)and Hypertension combined with Diabetes(247 cases).3 According to the Chinese PIM standard analysis,there were 474 PIM in 333 of 841 elderly patients in this study,with an incidence rate of39.60%;among them,the drug with the highest incidence was Insulin 122times(25.74%),followed by Clopidogrel 88 times(18.57%).Among drug-related PIM,17 kinds of class A warning drugs were involved in 403 cases,and 8 kinds of class B warning drugs were involved in 45 cases.There were 6 high-risk drugs(35 cases)and 19 low-risk drugs(413 cases).A total of 26 cases of PIM were used in the disease state,and only 1 case of Class B warning drug was involved,which was reserpine used in hypertensive state for antihypertensive treatment.The occurrence of PIM is positively correlated with the number of drug combinations(r=0.531,P < 0.001),polypharmacy(r=0.507,P < 0.001),And Unstable angina pectoris(r=0.243,P < 0.001),Diabetes(with or without complications)(r=0.284,P < 0.001),Congestive Heart Failure(r=0.211,P < 0.001),the number of chronic Multi-morbidities(r=0.216,P < 0.001),CCI score(r=0.207,P < 0.001)showed moderate positive correlation.In the correlation of chronic disease Multi-morbidities,Diabetes Mellitus combined with Unstable angina pectoris(r=0.271,P <0.001),Hypertension combined with Diabetes Mellitus(r=0.247,P < 0.001),Unstable angina pectoris combined with Heart Failure(r=0.231,P < 0.001)had a high positive correlation.Binary Logistic regression analysis showed that the number of combined drugs and chronic disease Multi-morbidities,Unstable angina pectoris,Myocardial infarction,Chronic obstructive pulmonary disease,Diabetes and Congestive Heart Failure were the influencing factors of the occurrence of PIM.Conclusion:1 In this study,the incidence of PIM in hospitalized elderly patients is relatively high,and the current situation is not optimistic.The phenomenon of polypharmacy is common.Therefore,single-disease guidelines can no longer meet the current drug treatment needs of elderly patients,and there is an urgent need to implement multi-disease guidelines as an important supplement to the existing single-disease guidelines.Individualize medication use.2 In this study,the most common potentially inappropriate drug was insulin,followed by clopidogrel.Insulin may have the risk of hypoglycemia,and should be carefully increased dose;Clopidogrel may cause adverse drug reactions in the blood system(such as thrombocytopenia,neutropenia,gastrointestinal bleeding,purpura,nose bleeding,eye bleeding,hematuria,intracranial bleeding)and nervous system(headache,dizziness,confusion,hallucinations).Combined with Unstable angina pectoris,Myocardial infarction,Chronic obstructive pulmonary disease,Diabetes,Congestive heart failure and other diseases were related factors for the occurrence of PIM,so in the clinical diagnosis and treatment work,we should be very vigilant about the drug use of elderly patients with such diseases to avoid inappropriate drug use and drug-related adverse reactions;from the results of Logistic regression analysis,it can be seen that the number of combined drugs is also a relevant influencing factor for the occurrence of PIM.In the process of multi-drug combination therapy for elderly patients,we must also be cautious and pay attention to the compatibility and selection of drugs.3 The occurrence of PIM in elderly patients has a high positive correlation with chronic disease comorbidities,among which diabetes with Unstable angina pectoris,hypertension with diabetes,and Unstable angina pectoris with heart failure are particularly prominent.The number of Multi-morbidities is also an independent factor affecting the occurrence of PIM.Therefore,clinicians need to pay enough attention to the rational use of drugs for elderly patients with chronic diseases and weigh the pros and cons.When there is a conflict in medication,it can be discussed with clinical pharmacists and patients to fully guarantee the rational and safe medication of the elderly according to actual needs.