Predictors of Polypharmacy Among Elderly Patients in China: The Role of Decision Involvement, Depression, and Taking Chinese Medicine Behavior

Introduction: The prevalence of polypharmacy is gradually increasing in geriatrics, which may contribute to adverse effects, such as potential drug–drug and drug–disease interactions. These side effects remain an important challenge in patient safety, which has a significant impact on mortality and incidence rate.Aims: Therefore, this study aims to understand the epidemiology of polypharmacy and identify factors that have an impact on the management of potentially inappropriate prescribing.Methods: This study is a cross-sectional study, analyzing the prescription data from 720 hospitalized patients aged 50+ with a random cluster sampling method. We used inverse probability treatment weighting (IPTW) method to group and match polypharmacy and non-polypharmacy patients, and logistic regression was conducted to explore the factors associated with polypharmacy.Results: The prevalence of polypharmacy accounted for 50.14% among the old patients in this study. Female patients (67.34%) have more polypharmacy than male patients, and key predictors associated with polypharmacy in the logistic regression model included the following: domicile (AOR = 0.63, 95% CI 0.42–0.95), annual income (AOR = 0.38, 95% CI 0.20–0.70), the number of chronic diseases (AOR = 3.68, 95% CI 2.69–5.06), taking Chinese medicine (AOR = 1.70, 95% CI 1.22–2.36), decision involvement (AOR = 1.49 95% CI 1.10–2.03), and depression (AOR = 1.42, 95% CI 1.03–1.96).Conclusion: Polypharmacy is common among the participants with chronic diseases in Hubei province, China. The study emphasizes that gerontology practitioners should be prudent in applying clinical guidelines to provide personalized, comprehensive assessment of decision making of prescriptions, especially in socioeconomically deprived areas.

Download Full-text

Multimorbidity patterns in old adults and their associated multi-layered factors: a cross-sectional study

BMC Geriatrics ◽

10.1186/s12877-021-02292-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jiao Lu ◽

Yuan Wang ◽

Lihong Hou ◽

Zhenxing Zuo ◽

Na Zhang ◽

...

Keyword(s):

Latent Class ◽

Metabolic Diseases ◽

Ecological Model ◽

Explanatory Power ◽

Cross Sectional Study ◽

Shanxi Province ◽

Cluster Sampling ◽

Cross Sectional ◽

Old Patients ◽

Old Adults

Abstract Background Influenced by various factors such as socio-demographic characteristics, behavioral lifestyles and socio-cultural environment, the multimorbidity patterns in old adults remain complex. This study aims to identify their characteristics and associated multi-layered factors based on health ecological model. Methods In 2019, we surveyed a total of 7480 participants aged 60+ by using a multi-stage random cluster sampling method in Shanxi province, China. Latent class analysis was used to discriminate the multimorbidity patterns in old adults, and hierarchical regression was performed to determine the multi-layered factors associated with their various multimorbidity patterns. Results The prevalence of multimorbidity was 34.70% among the old patients with chronic disease. Over half (60.59%) of the patients with multimorbidity had two co-existing chronic diseases. “Degenerative/digestive diseases”, “metabolic diseases” and “cardiovascular diseases” were three specific multimorbidity patterns. Behavioral lifestyles-layered factors had the most explanatory power for the three patterns, whose proportions of explanatory power were 54.00, 43.90 and 48.15% individually. But the contributions of other multi-layered factors were different in different patterns; balanced diet, medication adherence, the size of family and friendship network, and different types of basic medical insurance might have the opposite effect on the three multimorbidity patterns (p < 0.05). Conclusions In management of old patients with multimorbidity, we should prioritize both the “lifestyle change”-centered systematic management strategy and group-customized intervention programs.

Download Full-text

Etiology Exploration of Non-alcoholic Fatty Liver Disease From Traditional Chinese Medicine Constitution Perspective: A Cross-Sectional Study

Frontiers in Public Health ◽

10.3389/fpubh.2021.635818 ◽

2021 ◽

Vol 9 ◽

Author(s):

Ke Zhu ◽

Yongsong Guo ◽

Chenghao Zhao ◽

Shixin Kang ◽

Jialiang Li ◽

...

Keyword(s):

Logistic Regression ◽

Chinese Medicine ◽

Traditional Chinese Medicine ◽

Fatty Liver Disease ◽

Blood Stasis ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Alcoholic Fatty Liver ◽

Alcoholic Fatty Liver Disease

Background: From the traditional Chinese medicine (TCM) constitution theory perspective, the phlegm-dampness constitution is thought to be closely related to the occurrence of non-alcoholic fatty liver disease (NAFLD). However, this viewpoint still lacks rigorous statistical evidence. This study aimed to test the association between the phlegm-dampness constitution and NAFLD.Methods: We conducted a cross-sectional study. Participants were residents living in Chengdu, China, undergoing health checkups at the health management center of Affiliated Hospital of Chengdu University of Traditional Chinese Medicine between December 2018 and September 2020. TCM constitution type was diagnosed by DAOSH four examinations instrument, NAFLD was diagnosed according to the liver ultrasonography and medical history. Multivariate logistic regression and propensity score matching (PSM) were used to analyze a total of 1,677 qualified data.Results: 1,037 participants had biased constitution(s), 67.8% of which had mixed constitutions (with at least two constitutions). Among 1,677 participants, the phlegm-dampness constitution was associated with the yang-deficiency, yin-deficiency, dampness-heat, qi-depression, and blood-stasis constitutions. The correlation coefficients were 0.11, 0.32, 0.42, 0.20, 0.14, respectively. Between the phlegm-dampness constitution and NAFLD, the odds ratio (OR) and the 95% confidence interval (CI) was 2.05 (1.57–2.69) in the crude model. After adjusting for age, gender, Body mass index (BMI), other biased constitutions, smoking, high blood pressure, diabetes, and dyslipidemia, the OR reduced to 1.51 (1.04–2.18). The associations of seven other biased TCM constitutions and NAFLD were not statistically significant in the fully adjusted model. The PSM analysis showed consistent results with the logistic regression.Conclusions: Among eight biased TCM constitutions, the phlegm-dampness constitution is independently associated with NAFLD. We speculate the phlegm-dampness constitution is a risk factor of NAFLD. Longitudinal studies are needed to confirm this causal relationship in the future. In addition, inconsistent with some TCM practitioners' experience, we disagree that the blood-stasis constitution is associated with NAFLD.

Download Full-text

Association of Edentulism With Various Chronic Diseases in Mexican Elders 60+ Years: Results of a Population-Based Survey

10.20944/preprints202103.0577.v1 ◽

2021 ◽

Author(s):

Alejandro José Casanova-Rosado ◽

Juan Fernando Casanova-Rosado ◽

Mirna Minaya-Sánchez ◽

José Luís Robles-Minaya ◽

Juan Alejandro Casanova-Sarmiento ◽

...

Keyword(s):

Angina Pectoris ◽

Chronic Diseases ◽

Population Based ◽

Cross Sectional Study ◽

Self Report ◽

World Health ◽

Cluster Sampling ◽

World Health Survey ◽

Cross Sectional ◽

Multi Stage

Objective: To determine the association of edentulism with different chronic diseases in Mexicans aged 60 years and over. Material and Methods: A cross-sectional study was carried out using data from the World Health Survey for Mexico, which had a probabilistic, multi-stage and cluster sampling. The results of the self-report of chronic diseases (diabetes, arthritis, depression, angina pectoris, asthma and schizophrenia) and of edentulism were analyzed. Dental data were available for 20 of the 32 States of the Mexican Republic. Statistical analysis was performed in Stata 14.0 using the svy module for complex samples. Results: In total, 4213 subjects were included, representing a population of 7,576,057 individuals. The mean age was 70.13 ± 7.82 years (limits 60 to 98). Women represented 56.2%. The chronic diseases analyzed were presented as follows: diabetes 15.0% (N = 1,132,693); arthritis 13.2% (N = 1,001,667); depression 5.5% (N = 414,912); angina pectoris 4.5% (344,315); asthma 3.6% (N = 269,287); and schizophrenia 2.2% (N = 16,988). The prevalence of edentulism was 26.3%, which represents 1,993,463 people aged 60 years and over with this characteristic. For the presence of angina in women aged 60 to 69 years (p &lt;0.05) and depression in men aged 70 years and over (p &lt;0.0001), a higher prevalence of edentulism was observed. Conclusions: In general, there was no observation of association between edentulism was observed on the different chronic diseases included in the study. In the stratified analysis, only in women aged 60 to 69 years, for angina, and in men aged 70 and over, for depression, were associated.

Download Full-text

Deprescribing: What are the views and factors influencing this concept among patients with chronic diseases in a developed Asian community?

Proceedings of Singapore Healthcare ◽

10.1177/2010105817699633 ◽

2017 ◽

Vol 26 (3) ◽

pp. 172-179 ◽

Cited By ~ 13

Author(s):

Wei Ling Ng ◽

Mark Zhong Wei Tan ◽

Eileen Yi Ling Koh ◽

Ngiap Chuan Tan

Keyword(s):

Chronic Diseases ◽

Primary Healthcare ◽

Inappropriate Prescribing ◽

The Elderly ◽

Cross Sectional Study ◽

Adverse Outcomes ◽

Potentially Inappropriate Medications ◽

Prescription Medications ◽

Cross Sectional ◽

Physician Trust

Objective: Public primary healthcare clinics in Singapore manage a large proportion of elderly patients with chronic diseases. Inappropriate prescribing of medications and polypharmacy in the elderly are associated with adverse outcomes. It is hence important to stop potentially inappropriate medications in this vulnerable group. An approach coined ‘deprescribing’ has been used to describe a patient-centred process of optimising medication regimens. The study aimed to elucidate patients’ attitudes towards the number of medications they were taking and identify factors that might influence acceptance of deprescription. Method: A cross-sectional study using the validated Patients’ Attitudes Towards Deprescribing (PATD) questionnaire was performed at two public primary healthcare institutions in Singapore. Participants were on regular follow-up at the clinics for chronic disease management and had at least five regular prescription medications. Results: The study found that participants (with a mean age of 68) had an average of four medical conditions and six prescription medications, with the majority (60.3%) expressing that they were taking a large number of medications. Of note, 93.4% of participants were willing to stop one of their medications if advised by the doctor. This was associated with a younger age (<65 years old), not having a discount card for medications and having a higher physician trust score (Wake Forest Physician Trust Score). Conclusions: This study showed that majority of the participants were willing to cease a medication that their physician thought was no longer required. Factors were also identified which potentially may be targeted to facilitate deprescription.

Download Full-text

Medication Adherence and Patients’ Characteristics in Chronic Diseases: A National Multi-Center Study

Clinical Nursing Research ◽

10.1177/10547738211033754 ◽

2021 ◽

pp. 105477382110337

Author(s):

Huda Al-Noumani ◽

Maryam Al-Harrasi ◽

Jimmy Jose ◽

Zakariya Al-Naamani ◽

Sathiya M. Panchatcharam

Keyword(s):

Logistic Regression ◽

Medication Adherence ◽

Chronic Diseases ◽

Cross Sectional Study ◽

Improve Medication Adherence ◽

Cross Sectional ◽

Factors Affecting ◽

High Adherence ◽

Multi Center Study ◽

The Individual

Chronic diseases constitute a significant threat to health. Worldwide, medication adherence in chronic diseases remains unsatisfactory. Understanding factors affecting adherence is essential. This study examined medication adherence by characteristics of patients with chronic diseases. This cross-sectional study included 800 patients. The Adherence to Chronic Diseases Scale was used to measure adherence. Descriptive statistics and logistic regression was used to examine factors influencing medication adherence. Low adherence was found in 19.5% of the patients, 45% had medium adherence, and 35.5% had high adherence. Logistic regression showed that retired ( OR 0.496, 95% CI [0.33–0.75]), having COPD ( OR 0.460, 95% CI [0.32–0.67]) and duration of disease ≤5 years ( OR 1.554, 95% CI [1.11–2.17]) remain independent predictors for high adherence. Mixed findings regarding the relationship between medication adherence and patients’ characteristics were noticed. Patients’ characteristics should be examined with the individual population when examining and attempting to improve medication adherence in clinical practice.

Download Full-text

Several Components of the Lebanese Mediterranean Diet and Particular Sociodemographic, Medical and Lifestyle Factors may be Associated with Gastroesophageal Reflux Disease in Adults: A Cross-sectional Study in a Middle Eastern Setting

Current Nutrition & Food Science ◽

10.2174/1573401316999200518095448 ◽

2020 ◽

Vol 17 (1) ◽

pp. 82-93

Author(s):

Mary-Joe Youssef ◽

Antoine Aoun ◽

Aline Issa ◽

Lana El-Osta ◽

Nada El-Osta ◽

...

Keyword(s):

Logistic Regression ◽

Gastroesophageal Reflux Disease ◽

Perceived Stress ◽

Dietary Habits ◽

Cross Sectional Study ◽

Lifestyle Factors ◽

P Value ◽

Sectional Study ◽

Cross Sectional ◽

Gerd Symptoms

Background: The prevalence of gastroesophageal reflux disease (GERD) is increasing worldwide and the related chronic symptoms can be associated with morbidity and poor quality of life. Objective: The objective of this study was to identify foods and beverages consumed by the Lebanese population, dietary habits, socio-demographic and lifestyle factors, health parameters and perceived stress, implicated in increasing GERD symptoms. Methods: This observational cross-sectional study was carried among Lebanese adults in 2016. A convenient sample of 264 participants was equally divided into a GERD group and a control group. Data on socio-demographic characteristics, lifestyle, health status and dietary habits including Lebanese traditional dishes were collected. The perceived stress scale (PSS) was also used to assess the participants’ perception of stress. Logistic regression analyses were conducted with GERD symptoms (presence or absence) being the dependent variable. Results: The GERD symptoms were significantly associated with age (-p-value=0.017), family history of GERD symptoms (-p-value<0.001), smoking (-p-value=0.003) and chronic medical conditions (-p-value<.001). Regarding the dietary factors, participants who ate three meals or less/day, between meals and outside homes were 2.5, 2.9 and 2.4 times at a higher risk of experiencing GERD symptoms than others, respectively. Moreover, the logistic regression model showed that the GERD symptoms were significantly associated with the consumption of coffee (-p-value=0.037), Lebanese sweets (-p-value=0.027), fried foods (-p-value=0.031), ‘Labneh’ with garlic (-p-value<0.001), pomegranate molasses (-p-value=0.011), and tomatoes (-p-value=0.007). Conclusion: Some specific lifestyle factors and components of the Lebanese Mediterranean diet could be associated with GERD symptoms.

Download Full-text

Non-compliance to Mass Drug Administration Associated with the Low Perception of the Community Members About their Susceptibility to Lymphatic Filariasis in Ankobra, Ghana

Infectious Disorders - Drug Targets ◽

10.2174/1871526519666190206210808 ◽

2020 ◽

Vol 20 (2) ◽

pp. 167-174

Author(s):

Ilo Dicko ◽

Yaya Ibrahim Coulibaly ◽

Modibo Sangaré ◽

Bismark Sarfo ◽

Priscillia Awo Nortey

Keyword(s):

Lymphatic Filariasis ◽

Drug Administration ◽

Mass Drug Administration ◽

Health Workers ◽

Compliance Rate ◽

Cross Sectional Study ◽

Cluster Sampling ◽

Cross Sectional ◽

Improve Compliance ◽

Degree Of Association

Background: Lymphatic filariasis (LF) is a parasitic disease that has been targeted for elimination through the Mass Drug Administration (MDA.) Although the MDA started in the Ankobra community in Ghana in 2000, LF prevalence as reported in 2014 was relatively high (4.5%). Non-compliance to the MDA has been associated with the persistent LF prevalence in endemic regions. Objective: This study determined the factors associated with the non-compliance to the MDA among patients living in the Ankobra community, Ghana. Methods: A cross-sectional study using a one-stage cluster sampling method was used to collect data between June and July, 2017 in Ankobra. Questionnaires were used to collect data from health workers, the MDA drug distributors and study participants in Ankobra. Data analysis was performed using STATA 14. Logistic regression was used to measure the degree of association between the dependent (non-compliance) and independent variables. Non-compliance rate was defined as the percentage of individuals who self-reported that they did not actually swallow the drugs provided during the MDA. Results: The MDA coverage and non-compliance rates were 73.5% (147/200) and 33.33% (49/147) respectively. The main reason for non-compliance was fear of drug adverse events (75.51%, 37/49). Thought of “not being susceptible to LF” was significantly associated with the non-compliance (aOR= 2.83, [CI= 1.15, 6.98]). Conclusion: Health education about the susceptibility of residents getting LF disease in endemic community must be intensified to improve compliance to MDA medication ingestion and thus meet the Global Elimination of Lymphatic Filariasis by 2020.

Download Full-text

Portuguese Patient Dignity Question: A cross-sectional study of palliative patients cared for in primary care

Palliative & Supportive Care ◽

10.1017/s1478951520000164 ◽

2020 ◽

Vol 18 (6) ◽

pp. 658-661

Author(s):

Mafalda Lemos Caldas ◽

Miguel Julião ◽

Ana João Santos ◽

Harvey Max Chochinov

Keyword(s):

Primary Care ◽

Health Care Providers ◽

Cross Sectional Study ◽

Care Providers ◽

Sectional Study ◽

Clinical Tool ◽

Cross Sectional ◽

Old Patients ◽

Promising Tool ◽

Palliative Patients

AbstractIntroductionThe Patient Dignity Question (PDQ) is a clinical tool developed with the aim of reinforcing the sense of personhood and dignity, enabling health care providers (HCPs) to see patients as people and not solely based on their illness.ObjectiveTo study the acceptability and feasibility of the Portuguese version of the PDQ (PDQ-PT) in a sample of palliative care patients cared for in primary care (PC).MethodA cross-sectional study using 20 palliative patients cared for in a PC unit. A post-PDQ satisfaction questionnaire was developed.ResultsTwenty participants were included, 75% were male; average age was 70 years old. Patients found the summary accurate, precise, and complete; all said that they would recommend the PDQ to others and want a copy of the summary placed on their family physician's medical chart. They felt the summary heightened their sense of dignity, considered it important that HCPs have access to the summary and indicated that this information could affect the way HCPs see and care for them. The PDQ-PT's took 7 min on average to answer, and 10 min to complete the summary.Significance of resultsThe PDQ-PT is well accepted and feasible to use with palliative patients in the context of PC and seems to be a promising tool to be implemented. Future trials are now warranted.

Download Full-text

Association of Edentulism with Various Chronic Diseases in Mexican Elders 60+ Years: Results of a Population-Based Survey

Healthcare ◽

10.3390/healthcare9040404 ◽

2021 ◽

Vol 9 (4) ◽

pp. 404

Author(s):

Alejandro José Casanova-Rosado ◽

Juan Fernando Casanova-Rosado ◽

Mirna Minaya-Sánchez ◽

José Luís Robles-Minaya ◽

Juan Alejandro Casanova-Sarmiento ◽

...

Keyword(s):

Angina Pectoris ◽

Mental Disorders ◽

Chronic Diseases ◽

Population Based ◽

Self Report ◽

World Health ◽

Complex Nature ◽

Cluster Sampling ◽

World Health Survey ◽

Cross Sectional

Objective: To determine the association of edentulism with different chronic diseases and mental disorders in Mexicans aged 60 years and over. Material and Methods: A cross-sectional study was carried out using data from the World Health Survey for Mexico, in a probabilistic, multi-stage cluster sampling framework. Data for self-report of chronic diseases (diabetes, arthritis, angina pectoris and asthma), mental disorders (depression and schizophrenia) and edentulism were analyzed. Edentulism data were available for 20 of the 32 States of Mexico. Statistical analysis was performed in Stata 14.0 using the svy module for complex sampling (Complex nature under which individuals are sampled). Results: In total 4213 subjects were included, representing a population of 7,576,057 individuals. Mean age was 70.13 ± 7.82 years (range 60 to 98); 56.2% were women. Chronic diseases’ prevalence and mental disorders prevalence were as follows: diabetes 15.0% (N = 1,132,693); arthritis 13.2% (N = 1,001,667); depression 5.5% (N = 414,912); angina pectoris 4.5% (344,315); asthma 3.6% (N = 269,287); and schizophrenia 2.2% (N = 16,988). The prevalence of edentulism was 26.3%, which pertained to 1,993,463 people aged 60 years and over. Angina in women aged 60 to 69 years (p < 0.05) and depression in men aged 70 years and over (p < 0.0001) were associated with higher prevalence of edentulism. Conclusions: There was generally sparse association between edentulism on chronic diseases and mental disorders included in the study, except for women aged 60 to 69 years for angina, and in men aged 70 and over, for depression. Although our findings are misaligned with previous reports, longitudinal studies are required to test causal and temporal relationships between edentulism with chronic diseases and mental disorders.

Download Full-text

Red Blood Cell Transfusion in the Emergency Department: An Observational Cross-Sectional Multicenter Study

Journal of Clinical Medicine ◽

10.3390/jcm10112475 ◽

2021 ◽

Vol 10 (11) ◽

pp. 2475

Author(s):

Olivier Peyrony ◽

Danaé Gamelon ◽

Romain Brune ◽

Anthony Chauvin ◽

Daniel Aiham Ghazali ◽

...

Keyword(s):

Emergency Department ◽

Logistic Regression ◽

Blood Cell ◽

Red Blood Cell ◽

Cross Sectional Study ◽

Red Blood Cell Transfusion ◽

Cross Sectional ◽

Acute Bleeding ◽

History Of ◽

Rbc Transfusion

Background: We aimed to describe red blood cell (RBC) transfusions in the emergency department (ED) with a particular focus on the hemoglobin (Hb) level thresholds that are used in this setting. Methods: This was a cross-sectional study of 12 EDs including all adult patients that received RBC transfusion in January and February 2018. Descriptive statistics were reported. Logistic regression was performed to assess variables that were independently associated with a pre-transfusion Hb level ≥ 8 g/dL. Results: During the study period, 529 patients received RBC transfusion. The median age was 74 (59–85) years. The patients had a history of cancer or hematological disease in 185 (35.2%) cases. Acute bleeding was observed in the ED for 242 (44.7%) patients, among which 145 (59.9%) were gastrointestinal. Anemia was chronic in 191 (40.2%) cases, mostly due to vitamin or iron deficiency or to malignancy with transfusion support. Pre-transfusion Hb level was 6.9 (6.0–7.8) g/dL. The transfusion motive was not notified in the medical chart in 206 (38.9%) cases. In the multivariable logistic regression, variables that were associated with a higher pre-transfusion Hb level (≥8 g/dL) were a history of coronary artery disease (OR: 2.09; 95% CI: 1.29–3.41), the presence of acute bleeding (OR: 2.44; 95% CI: 1.53–3.94), and older age (OR: 1.02/year; 95% CI: 1.01–1.04). Conclusion: RBC transfusion in the ED was an everyday concern and involved patients with heterogeneous medical situations and severity. Pre-transfusion Hb level was rather restrictive. Almost half of transfusions were provided because of acute bleeding which was associated with a higher Hb threshold.

Download Full-text