Estimating the magnitude of Polypharmacy among the older patients attending the outpatient department of Tertiary Hospital

Summary: Polypharmacy is known to increases risk of adverse drug reactions (ADRs) in older adults. About 30% hospitalizations among elderly patients are attributable to ADRs. Inappropriate medication use and inappropriate use of mediation both contribute to ADRs. Multiple co-morbidities often make it impossible to avoid polypharmacy in the older patients. However, medication management is an important step in managing ADRs and improving quality of care in the elderly who suffer from polypharmacy and associated ADRs. Different reference sources are used in the developed countries, e.g., Beers criteria, for guiding physician in avoiding inappropriate medication use in older patients. Medication use pattern, disease prevalence and use of inappropriate medication may be different in Bangladesh compared to the developed world. Inappropriate prescribing by informal health care providers, e.g., village doctors, Rural Medical Practitioners (RMPs) in Bangladesh polypharmacy was recently growing in Bangladesh. Anecdotal data suggest prescribing inappropriate anti-cholinergic medication (e.g., benzodiazepine, tricyclic amitriptyline, short acting anti-histamines) by physicians to treat sleep problem in their elderly patients (Authors’ observation). There is a gap in knowledge about prevalence of physician prescribed inappropriate medication use in the elderly in Bangladesh; and most of them were used in patients who are already on multiple medications which adds to their risks of ADRs. We propose a cross-sectional study to determine prevalence of polypharmacy and type of medication prescribed in older patients attending the medicine outpatient department in consecutive six months in Kumudini Hospital. A semi-structured questionnaire will be used to collect data on demographics, medication use, personal, family and medical history from participants after obtaining consent. Polypharmacy will be defined by concurrent use of 4 or more medications by the participant. All eligible patients attending general medicine out-patient clinic at the Kumudini Hospital will be approached to participate in the study. Prevalence of polypharmacy and prescription pattern will be reported using descripting statistics and a regression model will report determinants of polypharmacy in the study population.