Polypharmacy and potential inappropriateness of pharmaco-logical treatment among community-dwelling elderly patients.

In this study, we describe the phenomenon of polypharmacy and the frequency of the potential inappropriate medication use, according to the criteria of Beers (Beers, M.H. (1997): Explicit criteria for determining potentially inappropriate medication use by the elderly. An update. Arch. Intern. Med. 157. 1531-153 C) among elderly subjects in Poland. The study involved 680 individuals (including 438 women and 242 men) aged 65 years and more (mean age: 72.6+/-6.5 years) residing in Poznan (P) and 320 (216 women and 104 men (mean age: 72.5+/-6.0 years) residing in Glogow (G). The average number of all drugs taken by the analyzed patients was more than 6 (P: 6.9+/-3.2, range: 0-17 drugs, and in G: 6.6+/-3.1, 0-16), of prescribed drugs, more than 5 (P: 5.3+/-2.8, range: 0-15 drugs, G: 5.2+/-2.8, ranging 0-16) and of non-prescribed drugs, more than 1 (P: 1.6+/-1.5, range: 0-11 drugs, G: 1.4+/-1.4, range 0-8). As far as the frequency of the potential inappropriate medication use is concerned, almost one third of all persons, (285 persons, 28.2% of all), in P: 195 persons (28.6% of the subjects), in G: 90 (27.2%) used at least one of the potential inappropriate medications. Polypharmacy and the potential inappropriateness of pharmacological treatment are common in community-dwelling elderly subjects in Poland. There is a great need to improve the quality of medication use in this group of patients. In order to do it we have elaborated and nowadays we introduce the project of pharmaceutical care in Poland.

Duplicate use of angiotesin-converting enzyme (ACE) inhibitors in a community-dwelling elderly population in Poland.

In this paper the data on the duplicate use of ACE inhibitors among a community-dwelling elderly population are presented. Using a questionnaire, 1000 subjects were interviewed concerning the use of drugs, 654 females, mean+/-SD age: 72.6+/-6.5 years. They were divided into two groups: Group A (5%) taking at least two ACE inhibitors (n=50) and Group B: those who used either a single ACE inhibitor or no ACE inhibitor (n=950). In Group A, 49 individuals were taking two different ACE inhibitors concomitantly and one was using three. The most commonly used ACE inhibitor was enalapril (29 of 50 subjects). Subjects in Group A consumed significantly more drugs, both of prescription (Rx) and nonprescription (OTC), compared to those in Group B (total means: 8.4+/-2.8 vs. 6.7+/-3.2; p<0.01, Rx means: 6.3+/-2.5 vs. 5.2+/-2.8, p<0.05, OTC means: 2.0+/-1.6 vs. 1.6+/-1.5, p<0.05). Also, they were more likely to have consulted a cardiologist (17/50 vs. 201/950, p<0.05). The duplicate use of ACE inhibitors in 5% of a population of community-dwelling elderly patients seems to be caused by both poor doctor-doctor communication and polypharmacy. This phenomenon could possibly be dangerous especially when potential additive adverse effects are taken into account.

Drug consumption among Polish centenarians.

The aim of the study was to describe the quantitative and qualitative aspects of pharmacotherapy of Polish centenarians. The studied group consisted of 92 centenarians (mean age: 101.7±1.2 years, 77 females, mean age: 101.5±1.2; 15 males mean age: 102.2±1.2). Among the studied subjects, 18 individuals (19.6% of all subjects) did not use any drugs in his or her daily regimen. The mean number of drugs per person was 2.5±2.5 drugs (prescription drugs: 1.9±2.2 and non-prescription drugs: 0.5±0.8). Fifty-six centenarians (60.9% of all studied subjects) took concomitantly 0-3 drugs daily while 36 (39.1%) took more than 3 drugs daily. Within this group, 30 centenarians (32.6%) took 5 or more drugs concomitantly every day. The most commonly used groups of drugs were: gastrointestinal drugs (55 centenarians, 74.3% of all drug consumed), cardiovascular drugs (51 centenarians, 68.9%) and central nervous system drugs (N) (38 centenarians, 51.4%). In the studied group, 6 persons (8.1% of all drug consumers) were taking one potentially inappropriate drug based on the Beers criteria. To conclude, the mean number of drugs, the prevalence of polypharmacy, and the tendency for potential inappropriateness of treatment are lower among Polish centenarians comparing to the common elderly.