Comorbidity and Polypharmacy in Elderly Living in Nursing Homes

Abstract

IntroductionThe ageing process is characterized by a high level of complexity, due to the co-occurrence of multiple chronic diseases (comorbidity) that often results in the concomitant use of multiple drug therapies (polypharmacy) for treatment and prophylaxis. Institutionalized elderly may be regarded as the paradigm of this complexity because of their multiple chronic diseases and decreased functional and cognitive functions.ObjectiveTo explore and characterize the prevalence of comorbidity and polypharmacy in a sample of institutionalized elderly.MethodsA cross-sectional study was conducted with an elderly sample recruited from three Portuguese nursing homes. Clinical information was obtained through interview and by review of residents’ medical records. The Anatomical Therapeutic Chemical/ATC classification was used to indicate the main group of medicines used, and polypharmacy was categorized into minor (2–4 medicines) or major (≥ 5). Comorbidities were coded using the individual body systems of Cumulative Illness Rating Scale for Geriatrics/CIRS-G.ResultsThe sample included 175 elderly with a mean age of 81 (sd = 10) years and institutionalized for an average of 7 (sd = 11) years. Residents presented a mean of 9 (sd = 4) co-morbid medical conditions, mostly psychiatric (80.8%), vascular (76.7%) and endocrine/metabolic (70.3%). Major polypharmacy was verified for 73.9% of residents. The mean number of medicines was 7 (sd = 3), most commonly for cardiovascular (86.0%) and nervous system (79.1%) and for blood and blood-forming organs (69.2%).ConclusionsAs in other studies in similar settings, polypharmacy was fairly common. These results convey an important message considering that polypharmacy has been associated with negative clinical outcomes that could otherwise be preventable by reducing the number of prescribed medicines.Disclosure of interestThe authors have not supplied their declaration of competing interest.