ArticlePDF Available

Prevalence of polypharmacy: Comparing the status of Indian states

Authors:
  • National Health Mission
4 © 2019 Indian Journal of Community and Family Medicine | Published by Wolters Kluwer - Medknow
Prevalence of polypharmacy: Comparing the status of Indian
states
Priya Sharma1, N. L. Gupta2, H. S. Chauhan1
1Centre for Public Health and Healthcare Administraon, Eternal University, 2Department of Psychology, Eternal University, Baru Sahib,
Himachal Pradesh, India
Perspective
Introduction: The word “poly” is Greek and means many or much. However, the term polypharmacy has
been given definitions connected both to the use of more than a certain number of drugs concomitantly
and to the clinical appropriateness of drug use. Polypharmacy is the use of multiple medications by a
patient, generally older adults (those aged 60 or over 65 years). More specifically, it is often defined
as the use of 5 or more regular medications. It sometimes alternatively refers to purportedly excessive
or unnecessary prescriptions. The term polypharmacy lacks a universally consistent definition with an
increasing share of population in this age group, it is natural to expect an increase in the problems
associated with them as well. Health problems are supposed to be the major concern of this section
of the society, and it is reported that use of medications has increased significantly among the elderly
in the last decade.
Objective: The objective of this study is to assess the prevalence of polypharmacy among elderly patients
in different Indian states, to make a comparison, and also to study the patterns of polypharmacy and its
associated aspects.
Materials and Methods: Literature review comprising of original articles, reviews, and case studies was
studied to identify articles which correspond to research done on polypharmacy in various different
ways published between the years 2010 and 2018. As the review focuses on the geriatric population, so
considerable data were searched and collected for the use of medication in geriatrics to assess what makes
them prone to polypharmacy, what pattern of polypharmacy they follow, and how they are affected by the
consequences.
Results: Uttaranchal, Karnataka, and Telangana reported a higher level of polypharmacy with 93.14%, 84.6%,
and 82.8%, respectively, whereas Andaman and Nicobar Islands (2%) and West Bengal (5.82%) showed the
lowest polypharmacy.
Conclusion: Overall comparisons made show that there are more studies needed to assess the level of
polypharmacy and ways and measures should be incorporated by the government in states showing high
polypharmacy.
Keywords: Cascade, elderly, India, polytherapy, states
Abstract
Address for correspondence: Dr. Priya Sharma, Centre for Public Health and Healthcare Administraon, Eternal University, Baru Sahib,
Himachal Pradesh, India.
E‑mail: priyasharma2022.ps@gmail.com
Access this article online
Quick Response Code:
Website:
http://www.ijcfm.org
DOI:
10.4103/IJCFM.IJCFM_10_19
How to cite this article: Sharma P, Gupta NL, Chauhan HS. Prevalence of
polypharmacy: Comparing the status of Indian states. Indian J Community
Fam Med 2019;5:4-9.
This is an open access journal, and arcles are distributed under the terms of the Creave
Commons Aribuon‑NonCommercial‑ShareAlike 4.0 License, which allows others to
remix, tweak, and build upon the work non‑commercially, as long as appropriate credit
is given and the new creaons are licensed under the idencal terms.
For reprints contact: reprints@medknow.com
[Downloaded free from http://www.ijcfm.org on Saturday, March 26, 2022, IP: 10.232.74.23]
Sharma, et al.: Polypharmacy status in indian states
Indian Journal of Community and Family Medicine | Volume 5 | Issue 1 | January-June 2019 5
INTRODUCTION
Elderly population is increasing worldwide. In India, the
size of elderly population is fast growing; from 5.6% in
1961, it is projected to rise to 12.4% of the population by
the year 2026.[1] India has witnessed a remarkable growth
in the life expectancy in the last century. In the early
1930s, the average life expectancy of an Indian adult was
only 32 years. Against a global average life expectancy of
75 years, currently, the life expectancy in India is about
67 years. The life expectancy in India is expected to reach
75 years by 2025. Further, the United Nations projections
indicate that elderly Indian population will rise to 21.2%
of the total by 2055 (from 7.2% estimated in 2005).
This increase in life expectancy may be one of the most
signicant achievements of Indian health-care system. At
the same time, it also poses a major public health issue.
With the increase in the aging population, the drug-related
problems have also increased. The health-care needs of
this growing population are based on the presence of
age-related diseases, increase in the chances of hospital
admissions, longer hospital stays, and more extensive drug
therapies.[2] In India, an estimated 50% of elderly people
suffer from at least one chronic disease that requires
lifelong medication.[3] The term “elderly” or “geriatrics”
refers to a population with a chronological age of >65 years
in most of the developed nations, while this does not
adapt very well to the underdeveloped or developing
nations. The United Nations thus recommends no standard
numerical criterion but agreed a cutoff of >60 years as
elderly population. In January 1999, the Government of
India adopted the “National Policy on Older Persons” by
which “senior citizen” or “elderly” is dened as persons
who are of the chronological age of 60 years or above.
Based on the 2011 census, the number of the elderly living
in India is 103.8 million (10.38 crores), which corresponds
to 8.6% of the total population. Polypharmacy as such
has no standard denition but is generally referred as
taking multiple medications together usually 5 or more
per day and/or administration of more medications than
that are clinically warranted, indicating unnecessary or
unwanted drug use. High level of polypharmacy is dened
as intake of 10 or more drugs.[4] Although polypharmacy
is practiced quite often, there is a lack of consensus
denition for polypharmacy. It is also not known as to the
concurrent use of how many medications are considered
as polypharmacy. Different thresholds have been used to
assess polypharmacy. Some of the authors use thresholds
of 3, 4, 5, or 10 medications to evaluate polypharmacy.
This denition is solely based on the count of medications
irrespective of clinical indications and conditions suffered
by the patient.[5]
Rationale
Elderly population constitute nearly 8% of the total
Indian population. However, this segment of population
is neglected in almost all the aspects of life. They are social
sufferers and are major victims of compromised health.
With this review, we will be able to assess the level of
polypharmacy that is prevalent among elderly population
in different states as the comparison will help the respective
states to improve their insights and focus on this segment
of population. The generated data of this study can then
be utilized in various programs to take adequate measures
to reduce adverse effects of polypharmacy. There should
be concern given to the optimal use of medication and to
improve the good communication among elderly patients
and health providers.
MATERIALS AND METHODS
Literature review comprising of original articles, reviews,
and case studies was studied to identify articles which
correspond to research done on polypharmacy in various
different ways published between the years 2010 and
2018 to give priority to the freshness of the article
as the most recent data will provide the best results.
Furthermore, the focus was laid on the work and data
pertaining to research done on this subject in the elderly.
Effort was put in to at least have data of one study from
each state, but some states were found to be having no
work on polypharmacy. Literature review was also done
to understand the general concept of polypharmacy
and the associated causes. Reference lists of the most
relevant articles were separated from the gray literature
and were sorted to identify other relevant articles. The
search strategy was developed in consultation with the
coauthors with a predetermined protocol for methods
to search and select relevant articles. The studies done
specically showing the prevalence of polypharmacy
were chosen and analyzed, and useful material was then
extracted from the collected material according to the
need of this review.
Data extraction
Data items extracted included the definition of
polypharmacy and associated causes and the prevalence
of polypharmacy in different states. The studies conducted
in different states were searched and compiled individually.
Later, these articles were studied and screened, and
then, the most similar articles were considered for nal
inclusion in the review. Once the primary data extraction
was complete, all authors reviewed the content for each
of the extracted studies, and later, the data were further
summarized in Table 1.
[Downloaded free from http://www.ijcfm.org on Saturday, March 26, 2022, IP: 10.232.74.23]
Sharma, et al.: Polypharmacy status in indian states
6 Indian Journal of Community and Family Medicine | Volume 5 | Issue 1 | January-June 2019
Causes of polypharmacy
An aging population with comorbidities requiring
several different medications and an increasing
availability of newer medications
Patients self-medicating with over-the-counter
medications and herbal preparations without a clear
understanding of the adverse reactions and interactive
effects
A “prescribing cascade” which occurs when patients take a
medication and exhibit side effects that are misinterpreted
by the health-care practitioner as symptoms of a disease
and requiring additional medication
The patient sees several physicians and lls prescriptions
at different pharmacies, but there is a failure to keep
all parties informed about each other’s actions
Ineffective communication and coordination between
health-care practitioners result in redundancy.[18]
RESULTS
The data above in the tabulation form shows the prevalence
of polypharmacy in various Indian states. It reveals the
range of medicines taken by the individuals mostly above
four which further goes upto the range of ten and in some
states even more than 10.
DISCUSSION
Although it is stated in literature that the use of even one
medicine which is not indicated by a practitioner is also
considered polypharmacy, most of the studies have taken
the use of >5 medicines as polypharmacy. Thus, this
review takes into account the use of 5 or more medications
as the base for dening polypharmacy. However, the
criteria for polypharmacy differed in all the studies with
respect to demographic variables. There was a considerable
amount of difference in prevalence rates depending on the
type of study, institution-based study, or community-based
study, but to maintain homogeneity of this review, the
most matching relevant available material was included
to understand the general prevalence and trend of
polypharmacy in Indian states. It was understood from the
literature that maximum studies related to the prevalence
of polypharmacy were done in southern states of India.
Thus, in states such as Bihar, Chhattisgarh, Haryana,
Meghalaya, Mizoram, Nagaland, Orissa, Rajasthan, Sikkim,
Jharkhand, Chandigarh, Dadra and Nagar Haveli, Daman
and Diu, and Delhi, Lakshadweep showed no relevant
data in relation to the prevalence of polypharmacy in the
literature studied.
The study done by Pandey and Saharan shows that the
prevalence of polypharmacy is 4.2% among the elderly
in India. Saldanha et al. revealed that the prevalence of
polypharmacy was 84.6% and the prevalence of high-level
polypharmacy was 11.1%.[12,25]
The study done by Kumar et al., 2015, revealed that
the prevalence of polypharmacy was 73.93%; among
this, minor polypharmacy (2–4 drugs) accounted
for 81.15% and major polypharmacy (≥5 drugs) for
18.85%. Mean (±standard deviation SD) number of
medication taken was 2.57 (±1.47), while the study done
by Dhanapal et al. revealed that out of 502 prescriptions,
61 (11.73%) prescriptions were minor polypharmacy and
457 (88.26%) prescriptions were major polypharmacy.
Furthermore, Radhika et al. revealed that polypharmacy
was observed in 82.8% and 5–8 drugs were prescribed
for most of the patients (42.6), followed by >8
drugs (40.2%). These studies showed dissimilarity to the
study conducted by Mohammad et al. which shows that
of 1003 prescriptions, 403 (40.18%) prescriptions were
found to be of minor polypharmacy and 600 (59.82%)
prescriptions were of major polypharmacy.[3,4,18,26]
Table 1: Comparison among the states in reference to
polypharmacy prevalence
State Region Study done by Prevalence (%)
Andhra Pradesh Kadapa Srikanth and
Sireesha, 2012[6]
40.77
Assam Guwahati Borah et al., 2017[7] 78
Goa GMC, Goa Khandeparkar and
Rataboli, 2017[8]
13.85
Gujarat Anand Shah et al., 2012[9] 52
Himachal
Pradesh
Kangra Priya et al., 2018[10] 33.7
J&K Jammu Gupta et al.,
2018 [11]
53.13
Karnataka Bangalore Saldanha et al.,
2 017 [12]
84.6
Kerala Kochi Rajeev et al.,
2018 [13]
22.9
Madhya
Pradesh
Bhopal Rambhade et al.,
2 012 [14]
8.73
Maharashtra Wardha Agrawal and
Nagpure, 2018[15]
26
Punjab SAS Nagar Kashyap et al.,
2 016 [16]
5 7. 9
Tamil Nadu Elayampalayam Tamilselvan et al.,
2018 [17]
43
Telangana Mahbubnagar Radhika et al.,
2018 [18]
82.8
Tripura Agartala Chakraborty et al.,
2 017 [19]
6.81
Uttaranchal Dehradun Singh et al., 2017[20] 93.14
Uttar Pradesh Bareilly Shalini and Joshi,
2 012 [21]
25.20
West Bengal Kolkata Indu et al., 2018[22] 5.82
Andaman and
Nicobar Islands
Andaman and
Nicobar
Vardhan et al.,
2 017 [23]
2
Pondicherry Pondicherry Kanagasanthosh
et al., 2015[24]
16.5
[Downloaded free from http://www.ijcfm.org on Saturday, March 26, 2022, IP: 10.232.74.23]
Sharma, et al.: Polypharmacy status in indian states
Indian Journal of Community and Family Medicine | Volume 5 | Issue 1 | January-June 2019 7
The study done by Raut et al., 2013, revealed that
polypharmacy was observed in almost all cases, wherein
45% were prescribed 11–15 drugs and 32% patients were
with 6–10 drugs per prescription. Romana et al. study
showed that 18% of the patients received six drugs, 24%
of the patients received seven drugs, 20% of the patients
received eight drugs, and 38% of the patients received nine
drugs or >9 drugs.[27,28]
Battula et al. concluded that polypharmacy was observed
based on the number of drugs prescribed in each
participant and found that the average number of drugs
for prescription was found to be 9.92 ± 0.53 (95%
confidence interval). Polypharmacy was categorized
into four types (no polypharmacy [0–2 drugs], minor
polypharmacy [3–5 drugs], major polypharmacy [6–9
drugs], and excessive polypharmacy [≥10 days]). It was
found that 48% (n = 101) of participants had excessive
polypharmacy, 42% (n = 89%) had major polypharmacy,
and 10% (n = 21) had minor polypharmacy. This showed
similarity to the studies conducted by Harugeri et al.
and Joy et al. which revealed that polypharmacy and
high-level polypharmacy were prescribed in 366 (45.0%)
and 370 (45.5%) patients and the prevalence of poly
pharmacy and potentially inappropriate medication use
was 41% (n = 51) and 51% (n = 63), respectively. Shah
et al. revealed that polypharmacy and high polypharmacy
were prevalent in 52% and 23.25% of patients, respectively.
This showed similarity to the studies of Kashyap et al.
and Gupta et al., with 57.9% and 53.13% of geriatrics,
respectively.[9,11,16,29-31]
Another study done by Agrawal and Nagpure revealed
that ≤4 number of drugs were prescribed to 74%
population, 5–9 number of drugs were prescribed to 25%
population, and 10–14 number of drugs were prescribed
to 1% population.[15]
Manjaly et al. revealed that 73.3% of patients were subject
to polypharmacy. The mean number of medications
consumed per day by the patients in the study group was
6.7 ± 3.1. This showed similarity to the study conducted
by Rathnakar et al. in which polypharmacy of 4 or more
drugs was found in 71.77% of prescriptions. Rakesh
et al. revealed that around 66.19% of patients were
receiving polypharmacy. A signicant number of patients
were receiving drugs which are to be avoided as well as
overprescribed and underprescribed.[32-34]
The study done by Kanagasanthosh et al. revealed that a total
of 1769 drugs were prescribed, giving an average of 2.98
drugs per person (range: 1–9). Polypharmacy (≥5 drugs)
was observed in 99 patients. Sehgal et al. revealed that a
total of 312 patients were on polypharmacy (5 or more
medications at the time of admission). The study done by
Khandeparkar and Rataboli revealed that the total number
of drugs per prescription ranged from minimum of 5 to
maximum of 16 drugs, with an average of 7.96 ± 1.75.
A large number of 596 prescriptions contained 6–9
drugs per prescription. Chakraborty et al. revealed that
90.9% of patients were on <6 medications, while 6.81%
and 2.27% of the patients were on 6–10 medications
and >10 medications, respectively. Vardhan et al. revealed
that the most number of prescriptions were containing 3
drugs accounting for 2360 (61%) prescriptions, followed
by 1120 (29%) prescriptions with 4 drugs, followed by
300 (8%) prescriptions with 2 drugs and the least number
were of prescriptions containing >4 drugs with 72 (2%)
prescriptions, and all these prescriptions were containing
at least 1.[8,18,23,24,35]
Nandagopal et al. revealed polypharmacy in geriatric
patients, with an average number of drugs per prescription
being 7.02. This deviates from the WHO standards of
1.6–4.8. Polypharmacy unfortunately is very common
in India and some other countries. It results in increased
cost of treatment, which may lead to nonadherence by
patients as they have more medicines than they can cope
with. It also increases the risk of signicant adverse drug
interaction.[36]
CONCLUSION
Polytherapy is often mandatory in the management of most
of the common ailments affecting geriatric patients. Drug
prescription in the elderly is a serious challenge as there
is an increased possibility of drug interaction resulting in
toxicity, treatment failure, or loss of drug effect. Duplicative
prescribing within the same drug class often occurs, and
unrecognized drug side effects are treated with more
drugs. To minimize polytherapy, periodic evaluation of
patients’ drug regimen is necessary. Prescribers need to
know what other prescriptions patient is taking including
herbs and teas. The small number of drugs in low doses
with a simple regimen is good for drug therapy in the
elderly. A signicant proportion of hospitalized geriatric
patients are exposed to substantial polypharmacy. Further
researches are required to identify the risk of adverse
drug effects following multiple drug administration and
specific potential drug–drug interaction. It would be
pertinent to develop country-specic list of medications
inappropriate for the elderly and include this list in national
drug formularies so as to reduce their prescription and use
in this age group.[37,38]
[Downloaded free from http://www.ijcfm.org on Saturday, March 26, 2022, IP: 10.232.74.23]
Sharma, et al.: Polypharmacy status in indian states
8 Indian Journal of Community and Family Medicine | Volume 5 | Issue 1 | January-June 2019
Recommendations
There are few studies in the predictors of polypharmacy
among the elderly in India. With this review, the gross idea
of the level of polypharmacy that is prevalent among the
elderly population in India is assessed. The generated data
of this review can be utilized in various programs to take
adequate measures to reduce its adverse effects and misery
to the elderly. There should be concern given to the optimal
use of medication and to improve the good communication
among elderly patients and health providers. Findings of the
review will be helpful for the programs and policymakers,
researchers, academician, and social workers who are
working in the eld of health and geriatrics.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conicts of interest.
REFERENCES
1. Jose J. Promoting drug safety in elderly – Needs a proactive approach.
Indian J Med Res 2012;136:362-4.
2. Mandavi, D’Cruz S, Sachdev A, Tiwari P. Adverse drug reactions and
their risk factors among Indian ambulatory elderly patients. Indian J
Med Res 2012;136:404-10.
3. Dhanapal CK. Prevalence of polypharmacy in geriatric patients in
rural teaching hospital. Am J Phytomed Clin Ther 2014;2:413-9.
4. Kumar KN, Holyachi S, Reddy K, Nayak P, Byahatti N. Prevalence
of polypharmacy and potentially inappropriate medication use among
elderly people in the rural eld practice area of a medical college in
Karnataka. Int J Med Sci Public Health 2015;4:1071-5.
5. Grover S. Polypharmacy among elderly: Need for awareness and
caution. J Geriatr Ment Health 2017;4:1.
6. Srikanth BA, Sireesha G. Assessment on the prevalence of
polypharmacy in urban population. Congestive Heart Fail
2012;3:2-91.
7. Borah L, Devi D, Debnath PK, Deka D. A study of drug utilization
pattern of the geriatric patients in the department of geriatric medicine
in a tertiary care hospital in Assam, India. Asian J Clin Pharm Res
2017;10:122-6.
8. Khandeparkar A, Rataboli PV. A study of harmful drug-drug
interactions due to polypharmacy in hospitalized patients in Goa
Medical College. Perspect Clin Res 2017;8:180.
9. Shah RB, Gajjar BM, Desai SV. Drug utilization pattern among
geriatric patients assessed with the anatomical therapeutic chemical
classication/dened daily dose system in a rural tertiary care teaching
hospital. Int J Nutr Pharmacol Neurol Dis 2012;2:258.
10. Priya S, Gupta NL, Chauhan HS. Polypharmacy – Prevalence and
risk factors among elderly patients in government medical college,
Tanda, Distt Kangra (HP). Available from: https://gmch.gov.in/
community%20medicine/IPHA_Vol%203_No9.pdf. [Last accessed
on 2019 Jun 13].
11. Gupta R, Malhotra A, Malhotra P. A study on polypharmacy among
elderly medicine in-patients of a tertiary care teaching hospital of
North India. Natl J Physiol Pharm Pharmacol 2018;8:1.
12. Saldanha K, Raj JP, Devi DP, Mohan LN. Patterns, predictors and
outcomes of polypharmacy among elderly perioperative patients in
the general surgical department of a tertiary care teaching hospital.
Indian J Pharm Sci 2017;79:778-84.
13. Rajeev A, Paul G, George S, Vijayakumar P. The study on use of
potentially inappropriate medications in elderly patients presenting
to a tertiary care hospital in Kerala. Int J Sci Res 2018;7:3542-4.
14. Rambhade S, Chakarborty A, Shrivastava A, Patil UK, Rambhade A.
A survey on polypharmacy and use of inappropriate medications.
Toxicol Int 2012;19:68-73.
15. Agrawal RK, Nagpure S. A study on polypharmacy and drug
interactions among elderly hypertensive patients admitted in a tertiary
care hospital. Int J Health Allied Sci 2018;7:222.
16. Kashyap M, D’Cruz S, Sachdev A, Tiwari P. Drug use patterns among
Indian elderly outpatients. J Indian Acad Geriatr 2016;136:404-10.
17. Tamilselvan T, Kumutha T, Priyanka MK, Reeba Bose S, Shabana S,
Sindhuja M. Incidence of polypharmacy and drug related problems
among geriatric patients in a multispecialty hospital. Int J Res Dev
Pharm L Sci 2018;7:3055-9.
18. Radhika AR, Mahammad Juber S, Nousheen N, Atiq-ur R.
Polypharmacy in elderly patients: A research article in teaching hospital.
IOSR J Dent Med Sci 2018;17:16-23.
19. Chakraborty A, Ray D, Ghosh R, Roy N, Bhattacharje S. Pattern
of adverse drug reactions reporting in two medical colleges of
Tripura, India: A cross sectional study. Int J Basic and Clinical Pharm
2017;6:1372.
20. Singh GN, Kumar N, Mathur P. To assess the drug utilization pattern
and to analyze pharmacoeconomics for geriatrics in-patient in
medicine department of tertiary care teaching. Int J Pharm Pharm
Sci 2017;9:276-82.
21. Shalini MD, Joshi MC. Study of polyphar macy and associated problems
among elderly patients. Internet J Med Update 2012;7:35-9.
22. Indu R, Adhikari A, Maisnam I, Basak P, Sur TK, Das AK.
Polypharmacy and comorbidity status in the treatment of type 2
diabetic patients attending a tertiary care hospital: An observational
and questionnaire-based study. Perspect Clin Res 2018;9:139-44.
23. Vardhan A, Dinesh C, Naidu M. A study of the prescribing pattern of
antimicrobial agents in a Tertiary care teaching hospital of Andaman
and Nicobar Island. Int J Pharm Res 2017;7:94-7.
24. Kanagasanthosh K, Topno I, Aravindkumar B. Prevalence of
potentially inappropriate medication use and drug utilization pattern
in elderly patients: A prospective study from a tertiary care hospital.
Int J Res Med Sci 2017;3:2062-72.
25. Pandey M, Saharan V. Prevalence and risk factors of polypharmacy
among elderly in Mumbai. World J Pharm Pharm Sci 2017;6:902-7.
26. Mohammed SS, Sreenath MK, Vishnu VG, Jose F, Siraj ST,
Anand VPR. The prevalence of polypharmacy in South Indian
patients: A pharmacoepidemiological approach. Indian J Pharm
Pract 2012;5:40.
27. Raut A, Pawar A, Diwan A, Naruka G, Sonar C. Clinically signicant
drugdrug interactions and their association with polypharmacy in
elderly patients. J Adv Sci Res 2018;7:3055-9.
28. Romana A, Kamath L, Sarda A, Muraraiah S, Jayanthi CR.
Polypharmacy leading to adverse drug reactions in elderly in a tertiary
care hospital mortality. Int J Pharm Bio Sci 2012;6:7.
29. Battula P, Summiah Afreen S, Raviteja A, Lavanya K. Evaluating
noncommunicable diseases in geriatrics with emphasis on
polypharmacy and its cost burden. J Global Trends Pharm Sci
2017;8:4505-13.
30. Harugeri A, Joseph J, Parthasarathi G, Ramesh M, Guido S.
Potentially inappropriate medication use in elderly patients: A study
of prevalence and predictors in two teaching hospitals. J Postgrad Med
2010;56:186-91.
31. Joy BA, Jaykar B, Arul B. Pharmacist led medication assessment on
polypharmacy and potentially inappropriate medication use in senior
adults with cancer. J Cancer Res Therap 2017;13:1-453.
32. Manjaly SP, Francis G, Mathew B. Potentially inappropriate medication
use among elderly inpatients at a teaching hospital in South India.
JMSCR 2016;4:14028-48.
33. Rathnakar UP, Ullal SD, Sadanand S, Mishra S, Sahu SS, Kotian M,
[Downloaded free from http://www.ijcfm.org on Saturday, March 26, 2022, IP: 10.232.74.23]
Sharma, et al.: Polypharmacy status in indian states
Indian Journal of Community and Family Medicine | Volume 5 | Issue 1 | January-June 2019 9
et al. Prole of drug utilization among elderly patients attending a
cardiology clinic in Mangalore, India. J Pharm Res 2010;3:1835-7.
34. Rakesh KB, Chowta MN, Shenoy AK, Shastry R, Pai SB. Evaluation of
polypharmacy and appropriateness of prescription in geriatric patients:
A cross-sectional study at a tertiary care hospital. Indian J Pharmacol
2017;49:16-20.
35. Sehgal V, Bajwa SJ, Sehg al R, Bajaj A, Khaira U, Kresse V. Polypharmacy
and potentially inappropriate medication use as the precipitating factor
in readmissions to the hospital. J Family Med Prim Care 2013;2:194-9.
36. Nandagopal A, Koneru A, Rahman A, Pasha MK, Ali MK. Assessment
of rational drug prescribing pattern in geriatric patients in Hyderabad
metropolitan. Indian J Pharm Pract 2017;10:175.
37. Gujjarlamudi HB. Polytherapy and drug interactions in elderly. J Midlife
Health 2016;7:105-7.
38. Gupta M, Agarwal M. Understanding medication errors in the elderly.
N Z Med J 2013;126:62-70.
[Downloaded free from http://www.ijcfm.org on Saturday, March 26, 2022, IP: 10.232.74.23]
... Although there is no unanimous definition, polypharmacy is considered the routine use of five or more medicines [1]. Its prevalence is around 40-50% in high-income countries [2,3]; while in Indian studies, it is reported to vary from 2-93% [4,5]. Elderly (≥ 60 years of age) individuals are at a high risk to experience polypharmacy [6]. ...
... This was a single-center study from an urban municipality area of Kolkata, India. As mentioned, the prevalence of polypharmacy varies widely from 2-93% across various Indian states depending on several factors, such as the sample size of the study; the definition of polypharmacy used; and differences in socioeconomic conditions, risk factors, and quality of healthcare services [4,5]. However, we did not primarily aim to find the prevalence of polypharmacy in the study area. ...
Article
Full-text available
We assessed the association between polypharmacy and cardiovascular autonomic function among community-dwelling elderly patients having chronic diseases. Three hundred and twenty-one patients from an urban municipality area of Kolkata, India were studied in August 2022. The anticholinergic burden and cardiac autonomic function (Valsalva ratio, orthostatic hypotension, change in diastolic blood pressure after an isometric exercise, and heart rate variability during expiration and inspiration) were evaluated. Binary logistic regression analysis was performed to find out the association of polypharmacy and total anticholinergic burden with cardiac autonomic neuropathy. A total of 305 patients (age, 68.9 ± 3.4; 65.9% male) were included. Of these patients, 81 (26.6%) were on polypharmacy. Out of these 81 patients, 42 patients were on ninety-eight potential inappropriate medications. The anticholinergic burden and the proportion of patients with cardiac autonomic neuropathy were significantly higher among patients who were on polypharmacy than those who were not (8.1 ± 2.3 vs. 2.3 ± 0.9; p = 0.03 and 56.8% vs. 44.6%; p = 0.01). The presence of polypharmacy and a total anticholinergic burden of > 3 was significantly associated with cardiac autonomic neuropathy (aOR, 2.66; 95% CI, 0.91–3.98 and aOR, 2.51; 95% CI, 0.99–3.52, respectively). Thus, polypharmacy was significantly associated with cardiac autonomic neuropathy among community-dwelling elderly patients.
... On the other hand, a great variation between geographical areas has also been reported [20]. And also variations of polypharmacy have been reported according to the pathologies: The most common multi-drug combinations is to treating manifestations of metabolic syndrome [21] and the cardiovascular diseases (31%) followed by the infectious diseases (24 %) and gastrointestinal disorders (24%), and the lowest prevalence of polypharmacy in dermatological diseases (1% -2%), and infectious diseases (20%) [21]. ...
... In any case, the incidence and prevalence of ADRs and DDIs increases with the number of drugs used. It can be admitted that ADRs occur in approximately 20% of the patients in drug treatment (20). One-quarter of these patients have possible adverse events or diminished treatment effectiveness that may have been at least partly caused by DDIs (43). ...
Article
Full-text available
All patients, especially elderly patients, those with certain pathologies, those with multimorbidity, or those who live in institutions, are exposed to polypharmacy. The prevalence of polypharmacy is high (18-30%) and the prevalence of excessive polypharmacy (10+ drugs) is 12%. Polypharmacy affects between 40% and 50% of all older adults. The incidence rate of polypharmacy is 20% person-years, ranging from 17% in individuals aged 65-74 years to 33% in those aged ≥95 years. From this point of view, polypharmacy seems to be a concept of quantity or volume of prescriptions. It can lead to serious adverse events related to a wide variety of drug-drug interactions (DDIs) and adverse drug reactions (ADRs): the frequency of ADR is 6% when a patient takes two medications, 50% when he takes five and almost 100% when he takes eight or more medications. Of every 100 courses of drug treatment, there are 20 adverse drug ADRs, between 5 and 25 of clinically observable DDIs and between 15 and 50 potential DDIs, which arrive to 100 in geriatric patients. But on the other hand, low-quality pharmacological care reports are not uncommon. About 60% of patients may be exposed to at least one potentially inappropriate medication: benzodiazepines, psychotropics, proton pump inhibitors, analgesics (including opiates), laxatives, NSAIDs, antacids, etc. Adverse health outcomes related to inappropriate medications for the population, and especially the elderly, include falls, strokes, delirium and death. The quantity of drugs as a defining concept of polypharmacy implies poor quality. The more drugs that are prescribed to a patient, not only there are more possibilities of inappropriate prescriptions or of little value, but even suitable prescriptions tend to lose their indication, and from a certain level of quantity or volume of prescriptions, the increase IDDs and ADRs makes their value decrease in such prescriptions, and they begin to be inappropriate and give rise to poor quality. In other words, there is no adequate and valuable polypharmacy; the high quantity originates low quality.
... To control the exponentially rising COVID-related mortality rate in India, physicians have been extraordinarily recommending steroids. India's population is prone to practicing polypharmacy, as much as 93% in Uttaranchal [11]. Contributing to excessive steroid use is the easy availability of over-the-counter medicines in pharmacies across India. ...
... Research shows that older adults in India frequently use multiple medications. There are wide regional variations in the prevalence ranging from 5.8% in West Bengal (west region) and 93.1% in Uttaranchal (North India) (Sharma et al., 2019). Although medications are essential to improve a patient's health status and quality of life, suboptimal prescribing and the use of multiple drugs may have adverse outcomes (Pravodelov, 2020;O'Mahony, 2020;Bala et al., 2019). ...
Article
Full-text available
Background: Older people often receive multiple medications for chronic conditions, which often result in polypharmacy (concomitant use of 5‒9 medicines) and hyperpolypharmacy (concomitant use of ≥10 medicines). A limited number of studies have been performed to evaluate the prevalence of polypharmacy, hyperpolypharmacy, and potentially inappropriate medication (PIM) use in older people of developing countries. The present study aimed to investigate regional variations in the prevalence of polypharmacy, hyperpolypharmacy, and PIM use in older people (60 + years) in India. Methods: Studies were identified using Medline/PubMed, Scopus, and Google Scholar databases published from inception (2002) to September 31, 2020. Out of the total 1890 articles, 27 were included in the study. Results: Overall, the pooled prevalence of polypharmacy was 49% (95% confidence interval: 42–56; p < 0.01), hyperpolypharmacy was 31% (21–40; p < 0.01), and PIM use was 28% (24–32; p < 0.01) among older Indian adults. Polypharmacy was more prevalent in North-east India (65%, 50–79), whereas hyperpolypharmacy was prevalent in south India (33%, 17–48). Region-wize estimates for the pooled prevalence of PIM use in India were as follows: 23% (21–25) in East, 33% in West (24–42), 17.8% in North (11–23), and 32% (26–38) in South India. The prevalence of PIM use in adults aged ≥70°years was 35% (28–42), in those taking more medications (≥5.5/day) was 27% (22–31), and in adults using a high number of PIMs (≥3) was 29% (22–36). Subgroup analysis showed that cross-sectional studies had a higher pooled prevalence of polypharmacy 55% (44–65) than cohorts 45% (37–54). Hyperpolypharmacy in inpatient care settings was 37% (26–47), whereas PIM use was higher in private hospitals 31% (24–38) than government hospitals 25% (19–31). Conclusion: Polypharmacy and hyperpolypharmacy are widely prevalent in India. About 28% of older Indian adults are affected by PIM use. Thus, appropriate steps are needed to promote rational geriatric prescribing in India. Systematic Review Registration : https://clinicaltrials.gov , identifier [CRD42019141037].
Article
Full-text available
Introduction Polypharmacy is most commonly defined as the use of five or more medications daily by an individual. In India, the prevalence of polypharmacy varies from 5.82 % to 93.14% in different states. Concerns about polypharmacy include increased adverse drug reactions, drug interactions, prescribing cascade, and higher costs. Methods It is a non-interventional, observational, descriptive study carried out in 240 patients attending the medicine outpatient department of a tertiary care hospital, over a one-and-a-half-year duration. Results The study was carried out in 240 patients whose mean age was 53.97 ± 7.62 years, out of which 52.5% were male and 47.5% were female. 62% of the study population were from low socioeconomic status and 38 % were from the middle class. The mean duration in years for hypertension and diabetes was 7.1± 4.3years and 7.94+ 4.66 years respectively. Apart from various antihypertensive and antidiabetic medicines prescribed the study population was also prescribed Vitamins (51.6%), Hypolipidemics (42.5%), Miscellaneous (41.6%), Antiplatelets (40%), H2 blockers/PPI (35.8%), and Antibiotics (22.5%). Polypharmacy (5 or more than 5 drugs) was seen in 33.75% of the study population. Conclusion Polypharmacy has been found to be integral in patients suffering from hypertension with coexisting diabetes mellitus and other comorbidities. It is essential to practice judicious prescribing especially in patients with multiple conditions.
Article
Background: Inappropriate medication use poses a sizable health safety hazard in the elderly owing to aging-associated physiological and anatomic changes. Inappropriate drug prescribing and polypharmacy in this population elevates the risk of adverse drug reactions (ADR). To assess the prevalence and predictors of Potentially Inappropriate Medication (PIM) use in elderly patients according to updated Beers Criteria 2019. Method: Medical Records of 402 patients aged ≥65 years admitted a tertiary care hospital from June 2018 to May 2019 were analyzed. The patients who experienced at least one PIM based on the 2019 Updated Beers Criteria were considered as cases and others as control. Data were presented as descriptive statistics and logistic regression was performed to assess the factors affecting the outcomes. Result: The mean age was found to be 73.7 ±6.4 years in the test and 70.5±5.5 years in the control group. The prevalence of PIMs to be used with caution was found to be 54%. Whereas the prevalence of PIMs to be avoided and to be used with reduced dose was found to be 45% and 1% respectively. The most prescribed PIMs were aspirin, diuretics, long-acting sulfonylureas, and proton pump inhibitors (PPIs). Increasing age, polypharmacy, and the number of drugs in medication history were significantly (P<0.05) correlated with a substantial risk of PIM use. The risk of developing serious and moderate drug-drug interactions (DDIs) was significantly high in the test group (P<0.05) when compared to the control group. Conclusion: A high prevalence of PIMs was observed in this study. Age, polypharmacy and ≥3 drugs in medication history were identified as risk factors for PIM use and were at a higher risk of developing DDIs. Continuous medication review by clinical pharmacists can aid in reducing the occurrence of PIMs amongst geriatrics.
Article
Full-text available
The United Nations Population Fund suggests that the number of elderly persons is expected to grow to 173 million by 2026. The aging phase is further made adverse by conditions such as failty, multimorbidity and polypharmacy. Aim: To assess the status and associates of frailty among elderly (>60 years) residing in a peri-urban slum area in Delhi by using the EDMONSTON Frail scale and evaluate the interplay of multimorbidity (MM) and polypharmacy (PP) on the frail pre-frail spectrum of the community-dwelling elderly cohort. Method: A community study from Dec 2018 till July 2019 with a sample size of 300 participants who were willing and consented to the study. Frailty was assessed and the STOP criteria was used for PP assessment. Result: There were 76 frail, 51 pre-frail, and 173 non-frail elderly. A higher prevalence (51%) of multimorbidity among the pre-frails and a higher probability (74%) of polypharmacy among the frails were found. Of the total in the frail-prefrail spectrum (127), 29.1% had multimorbidity (MM) and 39.4% had polypharmacy (PP). MM and PP were significantly higher among the old. Factors such as sex, marriage, loneliness, social circle, and education also had a positive bearing on the frailty-prefrailty spectrum. The working group had an increased (86%) probability of PP with statistical significance. Regression analysis depicted significant increased odds of MM and PP among female, illiterate, very old, lone, and single subjects. Discussion and conclusion: Thus, we recommend earlier and timely intervention for the frail-prefrail which can revert their adversities.
Article
Full-text available
Purpose/Aim Diabetes mellitus is associated with several comorbid conditions. Thus, often, diabetic patients are prescribed multiple drugs. Although multiple drugs help to combat various diseases, they also increase the propensity of drug interactions and adverse drug reactions. The present study thus tried to evaluate the comorbid conditions and concurrent medications associated with type 2 diabetic patients. It also aimed to address patient compliance for the medications provided to them. Materials and Methods This was a cross-sectional observational study conducted for 2 months – January–February 2017. Data were collected from prescriptions of the patients and also by interviewing the willing patients, attending the Diabetic Clinic of R. G. Kar Medical College, Kolkata, India. Results During the study period, 150 patients were interviewed and their prescriptions were studied. Out of 150 patients, 69 (46%) were males and 81 (54%) were females. The mean age of the study population was 51.5 (±0.78) years. The present study evaluated that 83.3% (125) of the study population suffered from at least one comorbid conditions, the most common being hyperlipidemia (70.7%) and hypertension (47.3%). The average number of drugs prescribed is 4.72 (±0.11) per prescription. Metformin was prescribed to 96% of the patients. The concurrent medications recommended included hypolipidemics (72%), antihypertensives (68%), drugs for peptic ulcer (34.7%), and antiplatelets (10.7%). Conclusion The present study thus concluded that diabetic patients suffer from a number of comorbid conditions, most commonly, cardiovascular problems. The comorbidity increased with the age. The level of polypharmacy was also high, thereby increasing the pill burden for the patients.
Article
Full-text available
Introduction: Elderly patients are the most common group who use heath care facilities. Use of potentially inappropriate medications results in adverse health outcomes thereby affecting quality of health care system. This study assesses the prevalence of prescription of potentially inappropriate medications in elderly patients presenting to the geriatric clinic of a tertiary care hospital in Kerala for first time. Materials and methods: The study was a hospital based retrospective study. The data from patients presenting to Geriatrics clinic from period of 1 st January 2016 to 31 st December 2016 were retrieved from the medical records and assessed for potentially inappropriate drugs in accord with modified 2012 Beer's criteria. Results A total of 275 patients were included in the study of which 110 (40%) were males and 165 (60%) were females. 81 (29.5%) out of 275 patients had at least one potentially inappropriate medication. The most common inappropriately prescribed medication belonged to psychotropic drug class (12.4%) followed by central nervous system (9.8%). It was found on statistical analysis that age and gender of the patients had no association with potentially inappropriate medication use. Conclusion The prescription potentially inappropriate medications is a serious problem which can affect overall quality of health care. Hence regular medication review and reconciliation practices should be implemented to prevent this to an extent
Article
Full-text available
Objective: This study was conducted to generate the data on drug utilization pattern among geriatric inpatients in general medicine department.Methods: The patient’s prescriptions and medical record files were randomly selected on the basis of inclusion and exclusion criteria at medicine department of Shri Mahant Indiresh Hospital, Dehradun and the required data for the study were collected in well-designed data collection form and evaluated after the period of 3 months.Results: Among 175 patients, males were predominant and 31.42% patients were in age group of 71-75 years. Cardiovascular diseases (28%) were most common cause of hospitalization followed by, respiratory disorders (20.57%). Hypertension (25.72%) was most commonly diagnosed disease followed by, diabetes mellitus (22.2%) and chronic obstructive pulmonary disease (14.28%). The most common co-morbidity was hypertension & diabetes mellitus. More than 3 co-morbidities were found in 79 patients. Cardiovascular drugs (22.17%) was most frequently prescribed drug followed by, gastrointestinal drugs (15.30%). Among individual drugs pantoprazole (A02BC02) was most commonly prescribed drugs. Total of 1581 drugs were prescribed with an average of 9.03 drugs per prescription. Only 9.63% drugs were prescribed by generic name. Antimicrobials were prescribed in 146 prescriptions, among them ceftriaxone (J01DD04) was frequently prescribed.Conclusion: Most of the drugs were utilized by male patients and the rate of polypharmacy was high.
Article
The growing size of the elderly population in developing world including India is undoubtedly posing mounting pressures on various socioeconomic fronts including increased inter-personal and health related problems, health care expenses etc. Moreover, this considerable population faces multiple physiological, medical and psychological problems with aging that are different than that of other stages; chronic diseases are common, the rate of drug related problems, drug interactions and inappropriate medication use is much disturbing and at times severe. So, there is an emerging need to pay greater attention to age-related issues. The aim of this study was to assess the prevalence of polypharmacy and its risk factors among elderly OPD patients of Government Medical College and Hospital, Tanda. A cross-sectional study was conducted on 371 elderly patients of ≥ 60 years old with concomitant use of 4 or more medications, defined as Polypharmacy. The results found that the percent prevalence of polypharmacy among the study population was 33.7%. The commonest disease affecting elderly was joint diseases, followed by hypertension, diabetes mellitus, respiratory disorders and sleep disorders. The study found that the use of polypharmacy was affected significantly by age (p= 0.01), place of residence (p = 0.05) and source of income (p= 0.04). No statistically significant relationship between polypharmacy and other factors (gender, educational status, family status, marital status) was found. The generated data of this study can be used to implement various programmes on awareness and prevention regarding Polypharmacy to reduce the adverse effects and misery to the elderly. Further, this can be utilized by programmers, policymakers, researchers, academicians and social workers who are working in the field of health of geriatrics.
Article
Introduction: Concomitant use of multiple drugs is often indicated to manage comorbid conditions and enhance efficacy. Such concomitant use of multiple drugs (five or more drugs) has been defined as 'polypharmacy.' Polypharmacy has been associated with adverse consequences such as greater healthcare costs, increased risk of adverse drug events, drug-drug interactions (DDIs), medication nonadherence, reduced functional capacity, and multiple geriatric syndromes. This study evaluated number of potential harmful DDIs due to polypharmacy. Materials and Methods: A prospective, cross-sectional, observational study was performed from July 2011 to June 2012. Approval was obtained from the Institutional Ethics Committee, Goa Medical College. Drug interactions were identified using a computerized DDI database system Lexi-Comp version: 2.4.1. Quantitative data analysis was done by the SPSS for Windows version 17.0. Results: Seven hundred and fifty-one out of 5424 (13.85%) prescriptions were observed to have polypharmacy with highest rates observed in the Department of Medicine. The median age of patients was 55.60 ± 13.86 (range 10-108 years). A total number of drugs per prescription ranged from minimum of 5 to maximum of 16 drugs, with an average of 7.96 ± 1.75. A large number of 596 prescriptions contained 6-9 drugs per prescription. Drugs involved in potential DDIs in our study included aspirin, antacids, beta-blockers, 3-hydroxy-3-methylglutaryl-coenzyme reductase inhibitors, calcium channel blockers, angiotensin-converting enzyme inhibitors, ondansetron, and H2 blockers. Conclusion: Patients taking multiple medications experience unique pharmacotherapy. Personalized drug prescribing strategies and close monitoring of patients taking drugs with potential DDIs are keys to optimal therapeutic result. © 2017 Perspectives in Clinical Research | Published by Wolters Kluwer - Medknow.