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Prevalence and Appropriateness of Polypharmacy in Older Adults with Inflammatory Bowel Diseases

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Abstract

Background

Despite the growing prevalence of older adults with inflammatory bowel diseases (IBD), polypharmacy, an important geriatric construct, is poorly understood. We described polypharmacy and its implications in older adults with IBD.

Methods

In a cross sectional study of adults ≥ 60 years with IBD, we obtained medication lists from the medical record and patients. We assessed medications by the Beer’s criteria, anti-cholinergic burden and drug-drug interactions. We constructed multi-variate logistic regression models to assess association between polypharmacy with low quality-of-life, controlling for age, sex, IBD-type, number of comorbidities and depression.

Results

In 100 adults ≥ 60 years with IBD, with a median age of 68 years, 56% met criteria for remission by a validated disease activity index. Polypharmacy, defined as ≥ 5 concomitant medications, was noted in 86% of the cohort and 45% had severe polypharmacy, defined as ≥ 10 concomitant medications. In this cohort, 48% were on ≥ 1 medication that met Beer’s criteria for potentially inappropriate in older adults and 24% had a cumulative anti-cholinergic drug burden score of ≥ 3, the threshold for serious adverse events attributed to anti-cholinergic burden. Serious drug-drug interactions were found in 26% with 7% involving an IBD medication. Controlling for potential confounders, polypharmacy, defined both numerically (OR 22.79, p < 0.01) and by medication appropriateness (OR 1.95, p < 0.01), was significantly associated with low quality of life.

Conclusion

Polypharmacy is prevalent in older adults with IBD and independently associated with low quality of life. Describing polypharmacy can guide de-prescription strategies tailored to GI clinic for older adults with IBD.

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Funding

Funding for this work was provided by R03AG074059 (Kochar), R01AG059183 (Lai) and K24AG080021 (Lai), R01DK127171 (Ananthakrishnan), and the Chleck Family Foundation (Ananthakrishnan).

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Authors and Affiliations

  1. Division of Gastroenterology, Massachusetts General Hospital, Crohn’s & Colitis Center, 165 Cambridge Street, 9th Floor, Boston, MA, 02114, USA

    Bharati Kochar, Alison Rusher, Elizabeth Araka, Rachel Glasser & Ashwin N. Ananthakrishnan

  2. The Mongan Institute, Boston, MA, USA

    Bharati Kochar, Christine Ritchie & Ashwin N. Ananthakrishnan

  3. Harvard Medical School, Boston, MA, USA

    Bharati Kochar, Christine Ritchie & Ashwin N. Ananthakrishnan

  4. Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, CA, USA

    Jennifer Lai

  5. Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, MA, USA

    Christine Ritchie

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  1. Bharati Kochar
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Correspondence to Ashwin N. Ananthakrishnan.

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Kochar, B., Rusher, A., Araka, E. et al. Prevalence and Appropriateness of Polypharmacy in Older Adults with Inflammatory Bowel Diseases. Dig Dis Sci 69, 766–774 (2024). https://doi.org/10.1007/s10620-023-08250-3

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