(134) Prevalence and factors associated with polypharmacy and self-medication among the elderly population residing in urban Indian communities

Background: The elderly (age ≥60 years) population is at risk of polypharmacy and un-informed or unsafe self-medication. This study estimated the prevalence and factors associated with polypharmacy and self-medication among elderly individuals residing in Indian urban communities.

Methods: This cross-sectional study was conducted among 600 elderly individuals, selected by systematic random sampling, residing in six Indian cities. Individual interviews were conducted in the households using a pre-tested questionnaire. The updated STOPP-START (Screening Tool of Older Persons’ Prescriptions and Screening Tool to Alert to Right Treatment) criteria were used to identify potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs), respectively. The knowledge, attitude, and reported practice of the individuals regarding self-medication were assessed using a questionnaire. The primary outcome was the prevalence of polypharmacy and self-medication. Binary logistic regression analysis was performed to find the factors associated with polypharmacy and self-medication.

Results: The most common medicines used were anti-hypertensive (40.2%), followed by anti-diabetic (31.3%) medicines. The overall prevalence of polypharmacy was 33.7% [95% confidence interval (CI): 29.9-37.6%]. The associated significant factors were the presence of multiple (three or more) comorbidities [adjusted odds ratio (aOR): 2.5 (95% CI: 1.1-4.1)], transition of care within 3 months [aOR: 3.3 (95% CI:1.4-5.7)], and hospitalization within 3 months [aOR: 4.6 (95% CI: 2-7.7)]. The overall proportions of prescriptions having PIMs and PPOs were 28.8% (95% CI: 25.2-32.6%) and 20.3% (95% CI: 17.2-23.8%), respectively. The overall prevalence of self-medication (over-the-counter and prescription medicines) was 19.7% (95% CI: 16.6-23.1%). The associated significant factors were staying alone [aOR: 4.5 (95% CI: 2.4-6.6)], the presence of three or more comorbidities [aOR: 3 (95% CI: 1.4-6.7)], and hospitalization within 3 months [aOR: 4.8 (95% CI: 1.5-8)]. Among those who self-medicated, 65.3% lacked knowledge of un-informed or unsafe self-medication, 50% did not comprehend the associated risks, and 40.7% had reported unsafe self-medication practices.

Conclusion: The prevalence of polypharmacy and un-informed and unsafe self-medication among elderly individuals residing in Indian urban communities was high. The associated common factors were three or more comorbidities and recent hospitalization.