Elderly patients admitted to tertiary care hospitals suffered from multiple diseases and were prescribed as many as 16 medicines, with about a third of the prescriptions being inappropriate, according to a study recently published in the Indian Journal of Medical Research. This led to longer hospital stays and more corrective medicines, driving up costs of treatment. This is a significant finding considering the geriatric population in the country is on the rise. The number of people over the age of 60 years in India is projected to rise from 103 million in 2011 to 319 million by 2025. What did the study find? These findings are based on the medical data of nearly 1,000 geriatric patients admitted to a tertiary care centre in Delhi: Hospital stay: The duration of hospital stay among the elderly ranged from 1 to 18 days, with the average admission period being 6.8 days. At 7.4 days, the longest average hospital stay was among those with genito-urinary diseases. Importantly, those prescribed inappropriate medicines were more likely to have a longer hospital stay. Prescription pattern: The elderly patients admitted to the hospital were on anywhere between 3 and 16 medicines, with 8.3 medicines prescribed on average. Nearly a third of all the patients were on ten or more medicines, the researchers found. The highest number of medicines was prescribed in patients with respiratory diseases, 9.2 being the average. The most commonly prescribed medicines were pantoprazole (Pantocid) for acid reflux, ondansetron (Emset) for preventing nausea and vomiting, and the antibiotic ceftriaxone (Monocef). Adverse reactions: Adverse drug reaction was seen in 13.9% of the elderly patients, with the most common adverse reactions being nausea, bleeding, headache, constipation, and vertigo. The highest number of adverse reactions were attributed to ceftriaxone, pantoprazole, aspirin, and ondansetron. What is the impact of this on the health of the elderly? Mapping consequences, Dr Prasun Chatterjee, professor of geriatric medicine, says, “Elderly patients usually suffer from multiple conditions at the same time such as hypertension, diabetes, orthopaedic issues, depression among others. This results in them being prescribed several medicines by different specialists. Polypharmacy — which we consider to be a person being prescribed five or medicines at a time — is very common among elderly and it can lead to several problems.” He explains that certain drugs may not be effective when given together. “Different drugs, meant for the treatment of different conditions, may use the same receptors. If a person is prescribed two medicines with the same target, they compete with each other and one may not work effectively,” he says. He added that excess medicines also means the kidney has to work overtime to filter the residues. “Along with medicines needed for the treatment of a condition, there is also over-prescription of vitamin D, calcium, and pantoprazole.” What can be done? One, there is a need for more geriatricians who can distil the prescriptions from different specialties to cut down on the number of medicines that a person needs to take. Two, doctors need to consider adverse reactions, age, functionality, and life expectancy while writing prescriptions. Dr Chatterjee says, “Take for example the case of two people who have coronary artery disease -- a person in his 40s with another 40 years ahead needs medicines that protect his heart in addition to the one needed for immediate treatment. These medicines may not be necessary in the extremely old.” Three, there is also a need for treatment guidelines for patients with multiple conditions. “Most guidelines are meant for the treatment of one disease, but there needs to be comprehensive guidelines for those with several conditions at once,” adds Dr Chatterjee.
