INTRODUCTION As the inflammatory bowel disease (IBD) patient population is aging, the prevalence of polypharmacy is rising. However, data exploring the prevalence, risk factors, and clinical outcomes associated with polypharmacy among older adults with IBD are limited. The aim of the study is to determine (i) prevalence of polypharmacy (≥5 medications) and potentially inappropriate medication (PIM) utilization in older adults with IBD, (ii) changes in medications over time, (iii) predictors of polypharmacy, and (iv) the impact of polypharmacy/PIMs on 1-year hospitalization rates. METHODS We conducted a retrospective single-center study of older adults with IBD from September 1, 2011, to December 31, 2022. Wilcoxon-signed rank and McNemar tests were used to assess changes in polypharmacy between visits, with ordinal logistic regression and Cox proportional hazards models used to determine risk factors for polypharmacy and time to hospitalization, respectively. RESULTS Among 512 older adults with IBD, 74.0% experienced polypharmacy at the initial visit, with 42.6% receiving at least one PIM. In addition, severe polypharmacy (≥10 medications) was present among 28.6% individuals at the index visit and increased to 38.6% by the last visit ( P < 0.01). Multivariable analysis revealed that age ≥70 years, body mass index ≥30.0 kg/m 2 , previous IBD-related surgery, and the presence of comorbidities were associated with polypharmacy. Moreover, severe polypharmacy ( adj hazard ratio 1.95, 95% confidence interval 1.29-2.92), as well as PIM use ( adj hazard ratio 2.16, 95% confidence interval 1.37-3.43) among those with polypharmacy, was significantly associated with all-cause hospitalization within a year of the index visit. DISCUSSION Severe polypharmacy was initially present in more than 25% of older adults with IBD and increased to 34% within 4 years of the index visit. Severe polypharmacy, as well as PIM utilization among those with polypharmacy, were also associated with an increased risk of hospitalization at 1 year, highlighting the need for deprescribing efforts in this population.

中文翻译：

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严重的多重用药会增加患有炎症性肠病的老年人住院的风险。


简介 随着炎症性肠病 (IBD) 患者群体的老龄化，多重用药的流行率正在上升。然而，探索老年 IBD 患者中与多重用药相关的患病率、危险因素和临床结果的数据有限。该研究的目的是确定 (i) 患有 IBD 的老年人中多重用药（≥ 5 种药物）的流行率和潜在的不适当药物 (PIM) 使用，(ii) 药物随时间的变化，(iii) 多重用药的预测因素，以及(iv) 复方用药/PIM 对 1 年住院率的影响。方法 我们对 2011 年 9 月 1 日至 2022 年 12 月 31 日期间患有 IBD 的老年人进行了一项回顾性单中心研究。使用 Wilcoxon 符号秩和 McNemar 检验来评估就诊之间的多药用药变化，并采用序数 Logistic 回归和 Cox 比例风险模型分别用于确定多药治疗的风险因素和住院时间。结果 在 512 名患有 IBD 的老年人中，74.0% 的人在初次就诊时接受过多种药物治疗，其中 42.6% 的人至少接受过一种 PIM。此外，首次就诊时有 28.6% 的个体存在严重的多重用药（≥10 种药物），到最后一次就诊时这一比例增加至 38.6% ( P < 0.01)。多变量分析显示，年龄≥70岁、体重指数≥30.0 kg/m 2 、既往IBD相关手术以及合并症的存在与多药治疗相关。此外，严重的多重用药（调整风险比 1.95，95% 置信区间 1.29-2.92）以及多重用药患者中 PIM 的使用（调整风险比 2.16，95% 置信区间 1.37-3.43）与全因用药显着相关索引访问后一年内住院。 讨论 最初，超过 25% 的 IBD 老年人存在严重的多重用药，并在首次就诊后 4 年内增加至 34%。严重的多重用药以及多重用药患者中 PIM 的使用也与 1 年住院风险增加相关，这凸显了在该人群中取消处方的必要性。