Prevalence and Predictors of Potentially Inappropriate Medications Among Patients Aged ≥65 Years on Hospital Admissions in Kuwait

Figures & data

Table 1 Patient Characteristics and Relevant Clinical Information

		Mean	Minimum	Maximum
Age (years)		76 (±7)	65	98
		Count		%
Gender	Male	201		47.5%
	Female	222		52.5%
		Number of medications upon hospital admission		Number of potentially inappropriate medications upon hospital admission
Mean		8.57		1.10
Minimum		3		0
Maximum		21		5
Sum		3626		464
Polypharmacy		Prevalence (%)
0–4 medications		13 (3.1%)
≥5 medications		410 (96.9%)
Comorbidities
Mean (SD)		4.77 (±1.5)

Table 2 Comorbidities of Study Participants

	Number	%		Number	%
Hypertension	419	99.1	Hypothyroidism	84	19.9
Type-1 diabetes mellitus	27	6.4	Deep-vein thrombosis	8	1.9
Type-2 diabetes mellitus	304	71.9	Benign prostate hypertrophy	57	13.5
Dyslipidemia	135	32.0	Chronic kidney disease	190	44.9
Bronchial asthma	74	17.5	Interstitial lung disease	7	1.7
Ischemic heart disease	180	42.6	Hyperthyroidism	5	1.2
Chronic obstructive pulmonary disease	34	8.0	Osteoarthritis	34	8.0
Cerebrovascular accident	112	26.5	Parkinson disease	27	6.4
Heart failure	47	11.1	Depression	15	3.5
Gastroesophageal reflux disease	26	6.1	Liver diseases	5	1.2
Atrial fibrillation	80	18.9	Rheumatic heart disease	1	0.2
Acute coronary syndrome	14	3.3	Inflammatory bowel syndrome	11	2.6
Osteoporosis	7	1.7	Pulmonary embolism	3	0.7
Rheumatoid arthritis	5	1.2	Gout	10	2.4
Epilepsy	16	3.8	Alzheimer’s disease	53	12.5

Table 3 Proportion of PIMs for Patients Aged ≥65 Years Upon Hospital Admission

	Number	%
Total number of cases	423
Total number of cases without potentially inappropriate medications	176	41.6
Number of cases with potentially inappropriate medications
1	113	26.7
2	74	17.5
3	42	9.9
4	15	3.5
5	3	0.7

Table 4 Prevalence of PIMs Using BC 2019

Potentially inappropriate medications that should be avoided	Number (%)
Proton pump inhibitors	128 (30.3%)
Antipsychotic agents	42 (9%)
Methyldopa	19 (4.5%)
Chlordiazepoxide	11 (2.6%)
Glimepiride	8 (1.9%)
Orphenadrine	8 (1.9%)
Peripheral alpha-blockers	3 (0.7%)
Nifedipine	2 (0.5%)
Amitriptyline	1 (0.2%)
Metoclopramide	1 (0.2%)
Paroxetine	1 (0.2%)
Total	66.8%
Potentially inappropriate medications that should be used with caution	Number (%)
Diuretic	100 (23.6%)
Selective serotonin reuptake inhibitors	24 (5.7%)
Carbamazepine	12 (2.8%)
Dextromethorphan	10 (2.4%)
Mirtazapine	5 (1.2%)
Oxcarbazepine	1 (0.2%)
Total	35.9%
Potentially inappropriate medications dependent upon creatinine clearance	Number (%)
Levetiracetam	18 (4.3%)
Pregabalin	12 (2.8%)
Gabapentin	11 (2.6%)
Apixaban	5 (1.2%)
Spironolactone	4 (0.9%)
Rivaroxaban	3 (0.7%)
Total	12.5%
Potentially inappropriate medications leading to disease–drug interactions	Number (%)
Heart failure and verapamil	6 (1.4%)
Total	1.4%
Potentially inappropriate medications causing drug–drug interactions	Number (%)
Antipsychotic and antiepileptic	8 (1.9%)
Antidepressant and antipsychotic	8 (1.9%)
Antidepressant and antiepileptic	3 (0.7%)
Antidepressant and antidepressant	2 (0.5%)
Antiepileptic and antiepileptic	1 (0.2%)
Combination with an inhibitor of the renin–angiotensin system	1 (0.2%)
Total	5.4%

Table 5 Predictors of PIM Prescription. Logistic Regression

		Status of Potentially Inappropriate Medications
		Without Potentially Inappropriate Medications		With Potentially Inappropriate Medications		P	Significance	OR	95% CI
		Number	%	Number	%
Sex	Male	95	22.5	105	24.8	0.590
	Female	81	19.1	142	33.6
Nationality	Kuwaiti	115	27.2	190	44.9
	Non-Kuwaiti	61	14.4	57	13.5
Hypertension		175	41.8	244	58.2	0.819
Type-1 diabetes mellitus		16	59.3	11	40.7	0.033	*	0.349	0.133–0.917
Type-2 diabetes mellitus		113	37.2	191	62.8	0.203
Dyslipidemia		64	47.1	72	52.9	0.111
Bronchial asthma		30	40.5	44	59.5	0.201
Ischemic heart disease		69	38.3	111	61.7	0.375
Chronic obstructive pulmonary disease		6	17.6	28	82.4	0.111
Cerebrovascular accident		47	42.0	65	58.0	0.588
Heart failure		8	17.0	39	83.0	0.057
Gastroesophageal reflux disease		9	34.6	17	65.4	0.106
Atrial fibrillation		26	32.5	54	67.5	0.903
Acute coronary syndrome		7	50.0	7	50.0	0.363
Osteoporosis		3	42.9	4	57.1	0.182
Rheumatoid arthritis		1	20.0	4	80.0	0.575
Epilepsy		7	43.8	9	56.3	0.946
Hypothyroidism		24	28.6	60	71.4	0.028	*	1.982	1.076–3.653
Deep-vein thrombosis		1	12.5	7	87.5	0.051
Benign prostate hypertrophy		25	43.9	32	56.1	0.766
Chronic kidney disease		62	32.6	128	67.4	0.034	*	1.662	1.038–2.661
Interstitial lung disease		1	14.3	6	85.7	0.887
Hyperthyroidism		2	40.0	3	60.0	0.611
Osteoarthritis		10	29.4	24	70.6	0.744
Parkinson disease		10	37.0	17	63.0	0.405
Depression		1	6.7	14	93.3	0.030	*	10.742	1.260–91.550
Liver diseases		1	20.0	4	80.0	0.446
Rheumatic heart disease		1	100.0	0	0.0	0.498
Inflammatory bowel syndrome		1	9.1	10	90.9	0.049	*	8.892	1.012–78.100
Pulmonary embolism		1	33.3	2	66.7	0.711
Gout		3	30.0	7	70.0	0.680
Alzheimer’s disease		12	22.6	41	77.4	0.001	**	3.940	1.771–8.763
Number of comorbidities		(Mean)	4	(Mean)	5	0.954
Polypharmacy						< 0.001	***	1.624	1.441–1.831

Notes: ***P < 0.001; **0.001≤ P <0.01; *0.01≤ P <0.05.