Bhagavathula Akshaya Srikanth, Gebreyohannes Eyob Alemayehu, Fialova Daniela
Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University, Hradec Králové, Czechia.
Division of Pharmacy, School of Allied Health, University of Western Australia, Crawley, Washington, Australia.
Gerontology. 2022;68(2):136-145. doi: 10.1159/000516075. Epub 2021 May 11.
Polypharmacy and potentially inappropriate medication (PIM) use in older populations (65+ years) have not yet been investigated by meta-analyses in developing countries. This systematic literature review and meta-analysis aimed to investigate the prevalence of polypharmacy and PIM use and major risk factors associated with PIM prescribing in older adults in Ethiopia.
We searched PubMed/MEDLINE, Scopus, Embase, and Google Scholar databases to identify relevant studies published between January 1990 and October 2020. Observational studies reporting the prevalence and association of risk factors with polypharmacy and PIM use in the older population were meta-analyzed. A multilevel meta-analysis was conducted to pool the prevalence estimates, and the risk of PIM use was reported as a relative risk (RR) with a 95% confidence interval (CI).
We identified by systematic literature review 404 articles. Of those, 8 studies fulfilled inclusion criteria, comprising a total sample of 2,608 participants. The overall prevalence of polypharmacy and PIM use pooled by meta-analysis in the Ethiopian older population was 33 and 37%, respectively. The risk factors of PIM use were analyzed in the meta-analysis (particularly polymorbidity, polypharmacy, gender, and older age), and only older age of 65+ (RR: 1.71, 95% CI: 1.16-2.51) was significantly associated with PIM use.
This first meta-analysis from a developing country revealed a high prevalence of polypharmacy and PIM use in the Ethiopian older population. There was no awareness about the risk of PIMs in patients with polypharmacy and polymorbidity, and older age significantly predicted PIM use. Interventions ensuring rational geriatric pharmacotherapy are essential in developing countries in order to reduce the expected burden of PIM-related geriatric morbidity, higher costs, and mortality.
发展中国家尚未通过荟萃分析对老年人群（65岁及以上）的多重用药及潜在不适当用药（PIM）情况进行研究。本系统文献综述与荟萃分析旨在调查埃塞俄比亚老年人多重用药及PIM使用的患病率以及与PIM处方相关的主要风险因素。
我们检索了PubMed/MEDLINE、Scopus、Embase和谷歌学术数据库，以识别1990年1月至2020年10月期间发表的相关研究。对报告老年人群多重用药及PIM使用患病率和风险因素关联的观察性研究进行荟萃分析。进行了多层次荟萃分析以汇总患病率估计值，PIM使用风险报告为相对风险（RR）及95%置信区间（CI）。
通过系统文献综述我们识别出404篇文章。其中，8项研究符合纳入标准，共纳入2608名参与者。埃塞俄比亚老年人群中，经荟萃分析汇总的多重用药和PIM使用总体患病率分别为33%和37%。在荟萃分析中对PIM使用的风险因素（特别是共病、多重用药、性别和高龄）进行了分析，只有65岁及以上的高龄（RR：1.71，95% CI：1.16 - 2.51）与PIM使用显著相关。
来自发展中国家的这首次荟萃分析显示，埃塞俄比亚老年人群中多重用药和PIM使用的患病率很高。多重用药和共病患者对PIM风险缺乏认识，高龄是PIM使用的显著预测因素。在发展中国家，确保合理的老年药物治疗干预措施对于减轻与PIM相关的老年发病预期负担、降低更高成本和死亡率至关重要。
