Polypharmacy in the elderly with multimorbidity and the manifestation of cognitive impairments and functional deficit

Marta Tundzeva, Ljubin Sukriev, Vesna Velikj Stefanovska, Katerina Kovachevikj, Azra Gicic, Sashka Janevska, Katarina Stavrikj

Keywords: Polypharmacy, cognitive impairments, functional deficit,

Background:

Polypharmacy in the elderly with multimorbidity in particular results in drug interactions and the manifestation of cognitive impairments and functional deficits.

Research questions:

Do polypharmacy among adults older than 60 years with a diagnosed chronic illness influence possible cognitive impairment?

Method:

A national prospective multicenter study started in 2022 in 46 outpatient clinics of family medicine specialists in primary care. The selection of PHC practices was done randomly. Subjects older than 60 years with a confirmed minimum of one chronic disease at risk for dementia were included. 3 standardized questionnaires: Mini-cog test, IADL test, GDC tests were used to assess risk of dementia and cognitive and functional deficits. Statistical analisis processed using the SPSS software package, version 22.0 for Windows (SPSS, Chicago, IL, USA).

Results:

Eight hundred fifty eight participants were analyzed, with female predominance (57.69%). Sex and age as independent predictors significantly affect the variability of polypharmacy consistently 0.7% vs. 0.5%. 57.92% of patients received daily ≤2 groups of medications. Respectivly most of the patients receive 2 groups of medications for treatment of chronic diseases (34,27%). There is no significant association between the obtained Mini-cog test scores and the number of medication groups they receive (p=0.12). The higher GDS score was significantly associated with polypharmacy (p=0.03). patients receiving ≥3 groups of medications were 1.47 times more likely to have mild depression compared to those receiving ≤2 medications [OR=1.47 (1.09 – 1.97) 99% CI]. A non-significant negative correlation was found between the height of the IADL score and the number of medication groups used for the therapy of chronic diseases (p=0.38).

Conclusions:

Our study has shown that Risk factors(age and sex) related to health comorbidities and other sociodemographic factors have not been observed to result in the development of excessive polypharmacy. Patients with less prescribed group of medications had an increased risk of major depression.

Points for discussion:

Correlation of drug interactions and sociodemografic factors on cognitive impairments.

Correlation of the GDS,IADL score, and risk of dementia in patients with polyphamacy.