Psychotropic Polypharmacy among Elderly Patients with Mental Illness in a Malaysian University Hospital: A 10-Year Review of Hospital Databases

Psychotropic Polypharmacy among the Elderly
Vol. 16 No. 2 : 2021 (249-262)

Woon LSC Woon LSC
Gan LlY Gan LlY

Abstract
Psychotropic polypharmacy among elderly patients is problematic due to their multiple comorbidities. This study investigated psychotropic polypharmacy among elderly patients discharged from a Malaysian university hospital and its associated factors. Discharges of patients aged 65 years or above from the psychiatric wards from 2010 to 2019 were reviewed. Sociodemographic data, length of stay (LOS), psychiatric and other diagnoses, and psychotropic prescription upon discharge were extracted from electronic databases. Multiple logistic regression was conducted with age, gender, race, marital status, main psychiatric diagnosis, LOS, and the number of medical comorbidities as independent variables, and polypharmacy (>2 psychotropics) as the dependent variable. There were 354 discharges in this period. The mean age was 72.4 years (SD=5.9 years); 63.0% were female and 39.8% were Malays. Most were married (84.2%). The commonest category of psychiatric diagnosis was mood disorders (54.5%). A total of 76.8% of the discharges involved one or more medical comorbidities. The median number of psychotropics was two, with 38.1% prescribed three or more psychotropics. In the multiple regression model, female gender, Malay race, and being married were significantly associated with psychotropic polypharmacy. Sociocultural factors may contribute to psychotropic polypharmacy among elderly patients. Such factors require further investigations to elucidate their roles.
Keywords : Aged, comorbidity, mental disorders, polypharmacy, psychotropic drugs,
Abstrak
Polifarmasi psikotropik dalam kalangan para pesakit tua merupakan suatu permasalahan kerana mereka menghidapi pelbagai penyakit yang lain. Kajian ini menyiasat polifarmasi psikotropik dalam kalangan pesakit tua yang didiscaj daripada sebuah hospital pengajar di Malaysia dan menentukan faktor-faktor yang berkaitan dengannya. Laporan discaj pesakit berumur 65 tahun dan ke atas dari wad-wad psikiatri antara tahun 2010 sehingga tahun 2019 dikaji semula. Data sosiodemografik bagi tempoh kemasukan wad (‘Length of stay’, LOS), diagnosis psikiatrik dan lain-lain, serta preskripsi ubat psikotropik semasa discaj diambil daripada pangkalan data elektronik. Analisis ‘multiple logistic regression’ dilaksanakan dengan umur, jantina, bangsa, status perkahwinan, diagnosis psikiatrik utama, LOS, dan jumlah komorbiditi perubatan sebagai pembolehubah tidak bersandar, manakala polifarmasi (>2 ubat psikotropik) sebagai pembolehubah bersandar. Terdapat 354 discaj dalam tempoh ini. Purata usia ialah 72.4 tahun (SD-5.9 tahun) di mana 63.0% ialah wanita dan 39.8% ialah bangsa Melayu. Kebanyakannya telah berkahwin (84.2%). Kategori diagnosis psikiatrik yang paling utama ialah gangguan mood (54.5%). Sebanyak 76.8% discaj melibatkan satu atau lebih komorbiditi perubatan. Jumlah median ubat psikotropik ialah dua, dengan 38.1% terima tiga atau lebih ubat psikotropik. Dalam model ‘multiple regression’, didapati jantina perempuan, bangsa Melayu, dan berkahwin berkait rapat dengan polifarmasi psikotropik. Faktor-foktor sosiobudaya mungkin menyumbang kepada polifarmasi psikotropik dalam kalangan pesakit tua. Faktor-faktor begini perlu disiasat lebih lanjut untuk mengenalpasti peranan mereka. 
Kata Kunci : komorbiditi, penyakit mental, polifarmasi, ubat psikotropik, warga tua,

Correspondance Address
Dr. Luke Sy-Cherng Woon. Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia. Tel: +603-91456423 Email: lukewoon@ukm.edu.my