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Control Poly-Pharmacy: Elderly Patients’ Practices

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American Journal of Pharmacological Sciences, 2021, Vol. 9, No. 2, 56-62
Available online at http://pubs.sciepub.com/ajps/9/2/2
Published by Science and Education Publishing
DOI:10.12691/ajps-9-2-2

Control Poly-Pharmacy: Elderly Patients’ Practices

Hanan Elzeblawy Hassan1,*, Soheir Badr Elden2, Sameer Hamdi3, Mohamed Elsayed Aboudonya4
1
Maternal and Newborn Health Nursing, Faculty of Nursing, Beni-Suef University, Egypt
2
Community Health Nursing, Faculty of Nursing, Cairo University, Egypt
3
Community Health Nursing, Faculty of Nursing, Beni-Suef University, Egypt.
4
Nursing Science Teaching Specialist in Technical Health Institute of Imbaba, Egypt
*Corresponding author:

Received August 20, 2021; Revised September 24, 2021; Accepted October 08, 2021
Abstract Background: Poly-pharmacy is an area of concern for the elderly. Poly-pharmacy was initially coined
to refer to specific problems linked to multiple drug intake and excessive drug usage. Aim of the study: The study
aims to assess practices used by old-age patients to control Poly-pharmacy. Design: Descriptive cross-sectional
study design was used to answer the research questions. Subjects & Setting: sample size was 114 elderly patients
from elderly patients visiting outpatient clinics monthly. Tools: A checklist to assess poly pharmacies’ practices.
Results: the majority of the study sample wasn’t reading the labels of the medications nor adhering to the
immunization system of the old age (79.8% and 78%, respectively). The highest satisfactory level (66.6%) of
practice was for the university education, followed by the urban area residents (60%), and finally, in the third level
were the secondary level of education 59.1%. Conclusion: The prevalence of polypharmacy and its consequences
among the elderly is significantly affected by the level of education. University education was the highest
satisfactory adherence to the alternative practices that control poly-pharmacy, followed by secondary education, then
primary then illiterate. Recommended: Designing an educational program for the elderly to increase their awareness
and knowledge about the phenomenon of drug abuse and its consequences.
Keywords: poly-pharmacy, old age, life style, practices
Cite This Article: Hanan Elzeblawy Hassan, Soheir Badr Elden, Sameer Hamdi, and Mohamed Elsayed Aboudonya,
“Control Poly-Pharmacy: Elderly Patients’ Practices.” American Journal of Pharmacological Sciences, vol. 9,
no. 2 (2021): 56-62. doi: 10.12691/ajps-9-2-2.

multiple drug intake and excessive drug usage, and it first

appeared in the medical literature more than one and a
1. Introduction half centuries ago. Since then, it has been used in a variety
of papers and reports, with various definitions and
The old-age population suffers from chronic diseases connotations, such as “unnecessary drug usage” and
and multi-morbidity and is treated with an increasing “medication use without indication.” Although older
number of drugs which arises the phenomenon of people make up approximately a third of the worldwide
Poly-pharmacy. [1] Poly-pharmacy has been defined as population, they consume about a third of all prescription
per a systematic review conducted in 2017 as the medicines. Poly-pharmacy has been a topic of concern for
concurrent use of five or more different prescription primary care physicians, geriatricians, pharmacists,
medications. [2] Poly-pharmacy is an area of concern for healthcare payers, and regulatory agencies as a result of
the elderly mainly because of: (1) adverse drug reactions, the development of modern medicine and the fast increase
(2) falls, and (3) medication noncompliance. [3] of the older population. [3,6]
Developing countries are witnessing an increasing number In one study, Poly-pharmacy was associated with
of geriatric populations due to ongoing improvement in duplicate therapy and contraindicated drug combinations.
the health sector and elderly people are living longer. In addition, clinical practice guidelines provide a step-like
Although the number of old people in developing nations approach to the management of many of the frequently
is frequently considerable, the percentage of elderly diagnosed chronic illnesses. Multiple medicines are
people is usually minimal. Moreover, 280 million persons included in the standards suggested in guidelines; for
aged 60 or older lived in developing countries in 1990, example, a patient with severe congestive heart failure
accounting for 58 percent of the world's elderly. [4] Until may take medications from four distinct pharmacological
January 2019, Egypt's elderly population had reached 6.5 groups. We've already reached Poly-pharmacy with a
million; 3.5 million males and 3 million females; this is COPD diagnosis, which may involve three different
according to the Central Agency for Public Mobilization inhaled medicines as well as oral steroids. [7]
and Statistics. [5] Individuals with chronic illnesses find it difficult to
Poly-pharmacy is a geriatric syndrome. Poly-pharmacy perform at the greatest level possible. Physicians, nurse
was initially coined to refer to specific problems linked to practitioners, specialists, and hospitalists are all
57 American Journal of Pharmacological Sciences

accountable for doing a comprehensive examination of the materials that include simple questions to encourage
entire patient as their patients' caregivers. In reality, patients to be active participants in their therapeutic
however, prescribers may ignore the bigger picture and decision-making. For example, the five moments for Drug
prescribe with only one illness condition in mind. [8] Safety focuses on five important moments in the
Standard steps to avoid Poly-pharmacy include taking medication use process where the patient, family member
advantage of medication reconciliation opportunities. or caregiver may substantially minimize the risk of harm
These can be found at admission to the hospital, or connected with the use of pharmaceuticals by taking
between admission and transfer to sub-acute care or action. The tool aims to engage and empower patients to
long-term care, or from sub-acute care to the community. be involved in their care more proactively and feel
When drugs used to treat acute illnesses are continued responsible for it, encourage their curiosity about the
post-discharge together with prescriptions the patient has medications they are taking, empower them to
been taking at home, it's usual to detect duplications. At communicate openly with their health professionals and
each care transition, there is a chance to evaluate all be involved in shared decision-making. The technology
medicines and supplements and conduct a crucial could improve both patient experience and medication
stop-and-think evaluation to eliminate unneeded drugs. adherence. Furthermore, it has the potential to enable
Multiple standards of practice recommendations identify patients to be active participants in medication reviews.
complete medication reconciliation as a critical activity. However, more research is required to evaluate strategies
[9] for integrating such tools into clinical practice and to
One such requirement for medicines is included in the ensure they meet their potential in improving patient
Joint Commission's 2016 National Patient Safety Goals: outcomes and creating value for all users. [13]
Keep track of and provide accurate information regarding
a patient's medications. Compare and contrast those 1.1. Significance of the Study
medications with the new medications that the patient was
given. Ascertain that the patient understands what Altered pharmacokinetics can make an old age patient
medications to take at home. Inform patients that it is more susceptible to the side effects of drugs. Common
critical to bring an up-to-date list of medications to every side effects include sedation, nephrotoxicity, hepatoxicity,
appointment so that medication reviews may be completed cardiotoxicity, confusion, dizziness, hypotension, and
and appropriate action can be taken. [10] hypoglycemia. [14]
Raising patient awareness about the problems of The nursing role is vital in controlling Poly-pharmacy
Poly-pharmacy and non-adherence is important, as among old-age patients in different health care settings.
patients can play a key role in the prevention and early Key nursing strategies in managing Poly-pharmacy in
detection of inappropriate Poly-pharmacy. Patients should geriatric patients include: Understanding the Effects
be seen as shared decision-makers on the use of of Poly-pharmacy, Performing Routine and Complete
medication, and health care professionals need to support Assessment, Building and Maintaining Close Relationships,
patients, families, and caregivers in order to enable them Educating and Motivating Patients, Monitoring and
to undertake this role. Patients should be encouraged and Identifying the Barriers, Consulting with Multidisciplinary
supported to disclose all the medications they are taking, Team Members, Following-up the Progress, Documenting,
including Over-The-Counter (OTC) and traditional and Reporting and Advocating for Patient’s Safety and
complementary medicines, especially if they are suffering Wellness. [14,15] Therefore, the study aims to assess the
from multiple conditions and are being treated with used alternative practices to control Poly-pharmacy among
Poly-pharmacy. Health literacy, social norms, and cultural old age patients.
factors would need to be considered when considering the
role of patients and designing materials for patient 1.2. Aim of the Study
education. [11]
Patient Tools and materials can support the engagement The current study aims to:
and empowerment of patients, families, and caregivers in Assess the safe alternative practices used by old age
playing an active role in health care, such resource patients to control poly-pharmacy.
materials may include: (1) Patient-held medication list
or patient-held medication record, sometimes called 1.3. Research Questions
medication passport (either paper or electronic), can help
to optimize patients’ medicines. The use of these tools What are the alternative practices used by old age
has received positive feedback from patients. Such patients to control poly-pharmacy?
lists, provided that they are up to date, can also be helpful
at care transitions. (2) Patient resource materials that
enable patients to understand how to make decisions 2. Subjects and Methods
regarding the management of their health conditions and
their medications are available. An example of a tailor- Subjects and methods of this study were portrayed
made tool is the Medicine Sick Day Rules card, which under the four main topics as follows:
explains to patients which medicines should be 2.1. Technical design.
temporarily stopped during dehydration due to an illness. 2.2. Operational design.
[12] 2.3. Administrative design.
Different organizations, including WHO, have developed 2.4. Statistical design.
 American Journal of Pharmacological Sciences 58

2.1. Technical Design age patients to control poly-pharmacy. It consists of 11

items as Checkup and follows up with the same physician,
The technical design for this study includes research use the same pharmacy, and Review your medication with
design, research setting, and subjects of the study, and your physicians. If the client reported doing the
tools of data collection. recommended action the score was “1” and not doing “0.”
The scores were summed up and converted into a percent
2.1.1. Research Design score. A patient who got a 60% or higher total score was
Descriptive design was used to fulfill the aim of the considered as having adequate practice, and otherwise
study. inadequate.

2.1.2. Research Setting 2.2.2. Pilot Study

This study was conducted at the outpatient (OPD) A pilot study was carried out on 12 patients to evaluate
clinics affiliated to Beni-Suef university hospital. the applicability, efficiency, clarity of tools, assessment of
the feasibility of fieldwork, besides to detect any possible
2.1.3. Subjects obstacles that might face the researcher and interfere with
Representative cross-sectional convenient sample data collection. Necessary modifications were done based
consisted of 114 elderly patients visiting OPD clinics in on the pilot study findings to strengthen their contents or
the pre-determined setting for more simplicity and clarity. The pilot sample was
excluded from the main study sample.
2.1.4. Tools of Data Collection
2.2.3. Field-Work
Two tools were used for data collection for the current
study namely, geriatric patient’s poly-pharmacy Data collection of the study was started on 15th June
knowledge, Check the list to assess poly-pharmacy 2019 and completed by the end of December 2019. The
alternative practices. researcher attended the outpatient clinics three days per
Tool (I):- Check the list to assess poly-pharmacy week (Sunday, Monday, and Wednesday) from 9 am to 2
alternative practices. To assess the alternative practices pm at Beni-Suef university hospital for all the older adults
used by old age patients to control poly-pharmacy. It was who are already diagnosed with multi comorbidities disease
developed by the researcher; the tool consists of 11 items and receiving medical treatments. The researcher first
in the form of (Yes) or (No) explained the aim of the study to the participants and
reassures them that information collected will be treated
2.1.5. Tools Validity confidentially and that it will be used only for the research
The content validity of the study tools was assessed by and they have the right to withdraw from the study at any point
a jury group consisted of five experts of the Community without any harm or effect on the service they are receiving.
Health Nursing. All of them were Faculty members of the
2.2.4. Ethical Consideration
Community Health Nursing Department in the Faculty of
Nursing affiliated to Cairo University and Beni-Suef The study was conducted with careful attention to the
University. Jury group members judge tools for ethical standards of research and the rights of participants.
comprehensiveness, accuracy, and clarity of the used Verbal consent was taken from each nurse as well as
language. Based on their recommendation, correction, patient to participate in this study. During the initial
addition, and/or omission of some items were done. interview, the purpose of the study and the procedures
were explained to the participants. Subjects were assured
2.1.6. Tools Reliability that all information will be treated confidentially and will
The tool's accuracy was based on Cronbach’s Alpha. be used for research only to assure the confidentiality of
the participants. Participants will be assured that their
participation in the study is voluntary and that they
2.2. Operational Design can refuse/withdraw from the study at any time. It was
The operational design for this study included three explained that there are no costs to participate in the study
phases namely, preparatory phase, pilot study, and field- and no harm from withdrawal or Refusing to participate.
work.
2.3. Administrative Design
2.2.1. Preparatory Phase
An official letter requesting permission to conduct the
This phase started with a review of current and past,
study was submitted to the director of Beni-Suef
national and international related literature concerning the
university hospital to obtain his approval to carry out this
subjects of the study, using textbooks, articles, journals,
study. This letter included the aim of the study and
and websites. This review was helpful to the researcher in
photocopy from data collection tools to get permission
reviewing and developing the data collection tools, and
and help for the collection of data.
then the researcher tested the validity of the tool through a
jury of expertise to test the content, knowledge, accuracy,
and relevance of questions for tools. 2.4. Statistical Design
Scoring system: The collected data were organized, tabulated, and
Check-list to assess poly pharmacy’s alternative statistically analyzed using SPSS version 19 created by
practices: To assess the alternative practices used by old
59 American Journal of Pharmacological Sciences

IBM. For numerical values, the mean and standard abdominal colic. Finally, the least complaint was for
deviations were calculated, while the Chi-square test was blurred vision as closed to the third of the studied sample
used to detect the statistical differences between variables. (32.4%) was reported among the older adults.
When the chi-square test was not suitable due to the Figure 3 clarified the distribution of the study sample
presence of observations with a small number, Monte according to self-reported practice to reduce Poly-
Carlo exact test was used. The correlation between study pharmacy. The data revealed that the majority of the study
variables was calculated using Pearson’s correlation sample wasn’t reading the labels of the medications nor
coefficient the level of significance was adopted at p<0.05. adhering to the immunization system of the old age 79.8%
and 78% respectively. Almost three-quarters of the study
sample (74.5%) wasn’t practicing exercise, while
3. Results two-thirds of the study sample (61.4%) was asking about
the right dose and right route. More than half of the study
Figure 1 clarifies that the distribution of the study sample was either sharing or borrowing medications
sample according to their medical history. Data illustrated and Follow non-pharmacological measures to reduce
that around half of the studied sample (48.2%) has constipation 56.1 % and 58.7 % respectively. More than
cardiovascular disease, while liver disease and diabetes one-third of the study sample (38.5%) wasn’t asking about
mellitus represented 43.9% & 35.1, respectively. On the the right dose and right route. Less than a quarter of
other hand, the least reported diseases were respiratory the study sample were Following non-pharmacological
problems and renal diseases (17.5 & 13.2%, respectively). measures to reduce pain and reading the label of the
Figure 2 described that the distribution of the studied medications 23.6% and 20.2%, respectively.
sample regarding their common health complaints. The Figure 4 shows that the highest satisfactory level
table revealed that the majority of the study sample was (66.6%) of practice was for the university education,
complaining of heartburn (83.3%). More than three- followed by the urban area residents (60%), and finally, in
quarters of the study sample (78.9%) were complaining of the third level were the secondary level of education
headache, two-thirds of the study sample (66.6%) was 59.1%, On the other hand, the highest unsatisfactory level
complaining of constipation. Near half of the study sample of practice was from the illiterate patients 80% followed
(47.4%) were complaining from joint pain, more than by both the primary level of education 76.6% and finally,
one-third (39.4%) of older adults were complaining from in the third level were the male patients 68.8%.

Medical History of the Studied Older Adults

13.2
Cardio-vascular diseases
48.2
Diabetes Mellitus (DM)
43.9
respiratory problems
Liver diseases
Renal diseases
17.5 35.1

Figure 1. Distribution of studied older adults according to their medical history

Common Health Complaints of the Studied Older Adults

47.4 66.6

83.3
Constipation
78.9
Headache
Blurred vision
Abdominal colic
39.4
32.4 Heartburn
Joint pain

Figure 2. Distribution of the studied older adults according to their common health complaints
 American Journal of Pharmacological Sciences 60

Study Sample's Self-Reported Practice to Reduce Poly-Pharmacy

90

80

70

60

50

40

30

20

10

Done
Not done

Figure 3. Distribution of the study sample according to their self-reported practice to reduce Poly-pharmacy

Study Sample's Total Level of Practice in Relation to Their Socio-Demographic

Characteristics
80

60

40

20

Illiterate Primary
Secondary
University
Male
Female
Satisfactory Rural
Urban
Unsatisfactory

Figure 4. Demographic characteristics of the study sample in relation to their total level of practice

4. Discussion near half of the studied sample have cardiovascular disease,

this might be explained by a lack of awareness about the
Poly-pharmacy increases the risk of adverse drug-related importance of a healthy lifestyle in preventing cardiac
events in old because a greater number of medicines mean a diseases within the rural community. These results were
greater chance of dangerous drug-drug interactions as supported by Weheida. S.M., et al., (2020) and Algameel,
weight loss, degradation of liver and renal excretion, a M., (2020) who concluded that near half of their studied
reduction in cardiac output, and body composition subjects were having cardiovascular disease. [18,19]
modification are all linked with ageing process. [16,17] On the other hand, the least reported diseases by the
In relation to the sample distribution regarding the medical current study sample were respiratory problems and renal
history of the subjects, the current study illustrated that diseases these results were in the same line with the results
61 American Journal of Pharmacological Sciences

reported by Dawood S., et al., (2020). [20] While • Activating the role of patient-family-educators
Schapira M., et al., (2020) stated that the highest while inpatients discharge and within ambulatory
prevalence of the disease among his studied sample were care services to enhance the use of non-
cardiovascular diseases while the less prevalent diseases pharmacological interventions and safe medication
were renal and respiratory. [21] administration for the elderly and caregivers.
The current study revealed that most of the study • Further studies should be conducted in different
subjects were complaining of heartburn and constipation, setting.
this might be a result of the aging process and medication's
side effects. on the same line as Mahmoud N., et al.,
(2020) stated that the main health problems of older adults References
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