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Polypharmacy among nonagenarians/centenarians in rural China J. Lu,1 M. Yang,2 L. Luo,2 Q. Hao2 and B. Dong2 1

Department of Pharmacy, West China Hospital, Sichuan University and 2The Center of Gerontology and Geriatrics, Chengdu, Sichuan, China

Key words centenarian, chronic disease, epidemiology, nonagenarian, polypharmacy. Correspondence Birong Dong, The Center of Gerontology and Geriatrics, West China Hospital of Sichuan University, 37 Guoxue Lane, Chengdu, China. Email: [email protected] Received 23 April 2014; accepted 28 June 2014. doi:10.1111/imj.12534

Abstract Background: Little is known about the prevalence and relevant factors of polypharmacy in nonagenarian and centenarians. Aim: The aim of this study is to examine the prevalence and associated factors of polypharmacy in a sample of nonagenarians and centenarians living in a rural area of China. Methods: The data were from the ‘Project of Longevity and Aging in Dujiangyan’ study. Medication use and relevant covariates were obtained by face-to-face interviews. Minor polypharmacy was defined as the concomitant use of two to four medications, whereas major polypharmacy referred to the concomitant use of five or more medications. Results: We included 859 participants with mean age of 93.7 ± 3.3 years. The number of chronic diseases was 1.4 ± 1.2 per subject, whereas the number of drugs was 0.8 ± 1.4 per subject. The prevalence of minor polypharmacy and major polypharmacy was 16.5% and 3.7% respectively. Illiteracy (odds ratio (OR) 2.93, 95% confidence interval (CI) 1.52 to 5.66), cognitive impairment (OR 3.15, 95% CI 1.44 to 6.88), hypertension (OR 2.88, 95% CI 1.46 to 5.67), respiratory disease (OR 2.22, 95% CI 1.08 to 4.58), osteoarthritis (OR 1.24, 95% CI 1.01 to 1.51), and cancer (OR 10.70, 95% CI 1.90 to 126.80) were positively associated with minor polypharmacy. Illiteracy (OR 4.24, 95% CI 1.53 to 11.81), hypertension (OR 3.40, 95% CI 1.22 to 9.49) and cancer (OR 3.40, 95% CI 1.14 to 10.12) were also positively associated with major polypharmacy. Conclusions: Although most subjects suffer from some chronic diseases, minor polypharmacy and major polypharmacy are not common among nonagenarians/ centenarians in rural China.

Introduction With increasing life expectancy, non-transmissible chronic diseases such as cardiovascular diseases and diabetes have become the leading health problems among older people in developed countries and several developing countries, including China.1,2 Many older adults suffer from more than one non-transmissable chronic disease, and most treatment guidelines for these nontransmissable chronic disease recommend combined drug regimens. As a result, the prevalence of multiple drug use, known as ‘polypharmacy’, increases.3 Polypharmacy refers to the concomitant use of multiple medications or the unnecessary overuse of drugs.2,4

Funding: This work was supported by the project of Science and technology Bureau of Sichuan Province (2006Z09-006-4). The sponsor has no role in the design, methods, data collection, analysis and preparation of this paper. Conflict of interest: None. © 2014 The Authors Internal Medicine Journal © 2014 Royal Australasian College of Physicians

There is no consensus on the actual number of concomitant medications defining polypharmacy. The commonly used definitions ranged from two to six or more.3,5 Polypharmacy is very common in older people. A recent systematic review has estimated that the prevalence of polypharmacy is approximately 20–40% in people aged 65 years and older.6 There is evidence that the prevalence of polypharmacy has considerably increased over past decades.7 Polypharmacy is the most important risk factor for adverse drug reactions, especially in the older population.8 It is associated with an increased risk of cognitive impairment, urinary incontinence, falls, hip fractures, hypoglycaemia, impaired mobility, malnutrition and death.7,8 Polypharmacy has been reported to increase the risk of hospitalisations and healthcare costs9 and has become a worldwide health concern in older adults. The prevalence of polypharmacy is increasing with advancing age.10 Previous studies found that sociodemographic factors (e.g. age, gender, income and education),11 1193

Lu et al.

diseases (e.g. hypertension),4,12 symptoms (e.g. breathlessness)4 and healthcare factors (e.g. the accessibility of medications)6 are associated with polypharmacy in older people. However, this information comes from people aged

centenarians in rural China.

Little is known about the prevalence and relevant factors of polypharmacy in nonagenarian and centenarians...
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