INVESTIGATING PREDICTORS AND HEALTH OUTCOMES OF POLYPHARMACY AMONG OLDER ADULTS WITH TYPE 2 DIABETES MELLITUS AT A PRIMARY HEALTHCARE CENTER IN LEBANON

Abstract

Background: Globally, demographics have shifted in the past several decades, with a rise in the elderly population, and polypharmacy has emerged as a significant public health concern. Older adults over the age of 65 with T2DM may need multiple medications to treat their disease and any associated or unrelated comorbidities; a situation often resulting in polypharmacy. Thus, the goal of this research was to determine the proportion of polypharmacy, its predictors, and associated health outcomes in older adults with T2DM at a primary health care facility in Lebanon.

Aims/objectives/hypothesis: The research had three objectives: to determine the proportion of patients with polypharmacy in the sample, to identify polypharmacy predictors, and to determine the health consequences associated with polypharmacy. We hypothesized that, polypharmacy is positively associated with age, gender, BMI, smoking status, and the study-specific comorbidity index. Also, polypharmacy is associated with an increased risk of falls and hospitalization.

Methods: The research was a secondary analysis of deidentified data from a retrospective cohort study on older adults aged 65 years or older (with and without dementia) who were seen at a primary healthcare center in Lebanon; our sample consisted of all patients with T2DM (n=190) in the original dataset. We resorted to descriptive statistics. We also used logistic regression to examine possible predictors of polypharmacy, and to determine the association between polypharmacy and health outcomes (falls and hospitalization).

Results: Our study discovered that 81.6 % (n=155) of patients had polypharmacy. Patient ages varied from 65 to over 90 years old, with a mean of 77.48± 6.34 years . More than half of the sample (54.7%) were between 75 to 84 years of age. Female participants were the larger group of 58.5 % (n=111). The average number of medications used was 8.14 ± 4.285 drugs per patient. Age, gender, smoking status, BMI and number of comorbidity were not predictors of polypharmacy in our sample. There was no significant associations between polypharmacy and falls [OR 1.873, 95% CI 0.529-6.627, p =0.330], or between polypharmacy and hospitalizations [OR 2.077, 95% CI 0.989-4.363, p= 0.054]. BMI and the use of CNS active agents were associated with hospitalization in unadjusted models. An increase in number of comorbidities was associated with higher odds of hospitalization in both unadjusted [OR 1.430 95% CI 1.119-1.828, p= 0.004] and adjusted models [AOR 1.398 95% CI 1.075-1.818, p= 0.012]. Conclusion: Polypharmacy is more prevalent among patients 65 years and older, which may be related to the rising frequency of various chronic conditions in this demographic. In our research sample at a primary healthcare facility, we discovered a significant proportion of older patients with T2DM were on polypharmacy. Additional data on possible predictors may aid in the identification of factors associated with polypharmacy in Lebanese older adults with T2DM. In our sample, we found no relationship between polypharmacy and falls or hospitalizations. Further examination of the context-specific definition of polypharmacy and the relationship of polypharmacy with other complications may be informative.