Rationally decreasing the number of drugs seems to be a useful therapeutic approach in older adults: 6-month follow-up study

Abstract

Aims: Older adults are at risk for polypharmacy, which has multidimensional safety, clinical and economic implications. Therefore, the optimization of drug therapy is one of the critical components of geriatrics clinical practice. This study is aimed to investigate the effect of drug rationalization on comprehensive geriatric assessment(CGA) parameters. Materials and Methods: The study was a retrospective and longitudinal study examining the effect of change in drug number on functionality and physical performance. A total of 515 patients were included in the study. Detailed medication history, laboratory findings, CGA parameters were recorded in the first admission. Polypharmacy was accepted as concurrent usage of five or more drugs. Medications of each patient were reviewed with the guidance of CGA and Beers Criteria. Results: The mean age of patients was 74.13 +/- 7.29 years, and 68.7% were female. The baseline mean number of drugs was 5.11 +/- 3.34. The polypharmacy group(269 patients) had a higher rate of geriatric syndromes and lower CGA scores in the first admission. After optimization of medications, the mean drug number decreased to 4.76 +/- 2.72. Depression, mobility and nutritional scores improved at the end of six months in the patients whose total number of drugs decreased, while global cognition, activities of daily living scores, and gait speed were preserved. Increasing the number of drugs was associated with lower mobility and functionality. Conclusion: Drug rationalization guided with CGA improves the nutritional, physical, and psychosocial status of geriatric patients. Thus, medication reviews have key importance in the management of older patients.