• M-C Weng, C-F Tsai, K-L Sheu, Y-T Lee, H-C Lee, S-L Tzeng, K-C Ueng, C-C Chen, and S-C Chen.
• Faculty of Medicine, Institute of Medicine and School of Medicine, Chung Shan Medical University, No. 110, Sec. 1, Jianguo N. Rd., Taichung 40201, Taiwan. sccy399@yahoo.com.tw.
• QJM. 2013 Nov 1; 106 (11): 1009-15.

BackgroundOlder patients with chronic diseases often take multiple prescription drugs, increasing their risk of adverse health events. However, polypharmacy remains ill-defined.AimTo investigate the impact of number of drugs prescribed on potentially inappropriate medication (PIM) and the associated risk factors in older outpatients with chronic diseases.DesignRetrospective cross-sectional study.MethodsWe retrospectively assessed 780 older patients (mean, 75.5 ± 7.1 years) with long-term (≥ 28 days) prescriptions for chronic diseases at the geriatric clinics of a university hospital from January to June 2012 using the Screening Tool of Older Person's potentially inappropriate Prescriptions (STOPP). Clinical information for each patient was analyzed. Logistic regression and receiver operating characteristic curve (ROC) analyses were performed; number needed to harm (NNH) was also estimated.ResultsAccording to STOPP criteria, 302 patients (39%) had at least one PIM. Multivariate analysis revealed that PIM risk was associated with the number of medications prescribed (P < 0.001) and the presence of cardiovascular (P < 0.001) or gastrointestinal disease (P = 0.003). The estimated area under the ROC for the number of medications needed to predict PIM risk was 0.680 (P < 0.001) with the optimal cut-off value of five medications. After adjusting covariates, patients prescribed ≥ 5 drugs [adjusted odds ratio (OR) = 5.4; adjusted NNH = 4.25; P < 0.001] and those prescribed 4 drugs (adjusted OR = 3.5; adjusted NNH = 6.88; P = 0.003) had significantly higher PIM risk than those prescribed ≤ 2 drugs.ConclusionsThe number of prescribed medications can be an index of PIM risk in older patients with chronic diseases. Clinicians should suspect high PIM risk in older outpatients with ≥ 5 prescriptions.

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