Polypharmacy and Iatrogenesis: elderly people and their medication

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In France, 71% of people aged 50 years old and above take daily mediations; 45.000 people aged 70 years and above have medical prescriptions given by their doctors that exceed 10 different types of medicine per day. In fact, elderly people having several chronic diseases may need various medical prescriptions from different doctors (general practitioner, specialists). However, polypharmacy can cause iatrogenesis risks.In this context, Teva laboratories presented the intermediate results of their pharmaco-epidemiological study called IPOP (Investigation of prescriptions delivered in pharmacy for elderly people on Tuesday, 23th of June 2015. This study relied on 1.000 prescriptions of patients aged 65 years and above.

Focus on IPOP study’s intermediate results

In the framework of the IPOP study, 493 files (containing prescriptions and questionnaires) from 50 pharmacies were treated and assessed. The average age for the 1.000 prescriptions is 77: all the participants were between 65 and 98 years old.

How do patients understand their medical treatment?

  • 30 % of patients admit ignoring why their medications are prescribed
  • 59 % of them are looking for information about their prescriptions
  • 49 % look for information on the medication boxes’ instruction
  • 88 % of patients take and prepare their medications by themselves

First indications of medications use

  • 41 % say that they have already forgotten to take their medications at times
  • 12 % say that they don’t take their prescribed medications because according to them it hurts them more than it improves their health.

In all cases, whether it is an omission or a refusal, patients call the doctor or question the pharmacist in order to enquire about the discontinuation effects.

What do the prescriptions contain?

Among the 3.624 analysed prescriptions, the study notes that:

  • On average, there are 7 medications per prescription (in this case study, the data vary between 3 and 18 medications per prescription),
  • 5 prescriptions out of 7 are made by a specialised doctor,
  • And 2 out of 7 are given with INN medications (An International Non-proprietary Name).

What are the pharmacist first given information?

iatrogenesis pharmacistsRegarding medication advice, 91% of surveyed pharmacists give recurring advice to patients whom 55% concern recently prescribed medication.

Regarding advice about medicinal interaction risks:

  • 68% verbally indicate the possible interactions between medications
  • 23% warn about the interactions between different types of medication
  • 29% warn about the interaction between medication and food
  • 42% give the advised schedules for medication, 82% of which are indicated under the prescription boxes.

Finally, regarding the knowledge of patients’ pathologies by the pharmacist, in 60 % of cases, the pharmacists don’t precisely know the pathology.

That’s why, according to the study’s preliminary results, the pharmacists tell only in 10% of cases that there could be cardiac pathologies risks, and in 5% of cases that appear renal insufficiencies could appear.

From 2 to 4 % of the pharmacists say they have access to clinical or biological parameters concerning renal, hepatic and cardiac functions:

  • 36 % of the pharmacists verify the dosage adaptation for the cardiovascular function,
  • 50 % for the hepatic function,
  • 57 % for the renal function.

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