JMIR Publications

ABSTRACT

Background:

A rapidly aging population led to an increase in the number of patients with chronic diseases and polypharmacy. Although investigations on the appropriate number of drugs for older patients have been conducted, there is a shortage of studies on polypharmacy criteria in older inpatients from multiple institutions.

Objective:

The aim of this study was to examine the patterns of polypharmacy and determine a criteria for the number of drugs defining polypharmacy in the geriatric inpatient population.

Methods:

Electronic health records of four medical institutions for patients aged 65 years older hospitalized between 1 January, 2012 and 31 December, 2020 were analyzed for the study. The maximum number of drugs prescribed was obtained for each patient and, along with a literature review, were used to determine the appropriate polypharmacy level for our population.

Results:

Using a four-level polypharmacy category system of non-polypharmacy, polypharmacy, major polypharmacy, and excessive polypharmacy, concomitant drug counts in the patient population and previous studies, a major polypharmacy level of 10 – 19 concurrent drugs was considered an appropriate threshold for polypharmacy. Frequently prescribed therapeutic subgroups in this category were antibacterials for systemic use, anesthetics, and cardiac therapy.

Conclusions:

This study proposes a polypharmacy categorization system for older inpatients, which differs from the common definition of the concomittant prescription of five or more drugs. The older population tends to have severe conditions including those requiring major surgeries; therefore, a drug count corresponding to the definition of major polypharmacy is appropriate.