Polypharmacy in geriatric patients treated in palliative care service; evaluation of "Turkish inappropriate medication use in the elderly" criteria

Aim: The world population is aging.There is an increase in the rate of chronic diseases and cancer with aging.Palliative care is also needed for end-of-life care. Elderly individuals receiving palliative care treatment have multiple comorbidities and concomitant use of multiple drugs. Pharmacokinetic and pharmacodynamic processes show age-related changes. Elderly individuals are more susceptible to drug side effects. Some drug side effects can be perceived as a new clinical situation and cause a prescription cascade. As a result, serious health problems can be seen. Many drug side effects are caused by inappropriate drug use. In this study, we aimed to examine the drugs used by geriatric individuals who were treated in palliative care services in public hospitals in Samsun with the "Turkey Inappropriate Medication Use Criteria in the Elderly (TIME)" Criteria. Materials and Methods: The population of our cross-sectional and analytical study consists of patients who were hospitalized in palliative care services in Samsun city center and its districts between April 1 2022 and October 15 2022. Patients aged 65 and over and using at least one drug were included in the study. Sociodemographic characteristics, primary diagnosis, comorbidities, drugs used and laboratory values of the patients were recorded. MNA-SF, Katz ADL and Charlson comorbidity index scores of the patients were calculated. Using 5 or more drugs was accepted as polypharmacy. The drugs used by the patients were analyzed by TIME criteria. SPSS 25.0 package program was used for data analysis in the study. Results: The mean age was 78.00±9.08 year. %54.0 of the patients were women. There was 5.28±2.72 drug use per patient. The most common chronic disease was hypertension with a rate of %52.6. Polypharmacy was present in %59.2 and hyperpolypharmacy in %10.8 of the patients. There was a statistically significant correlation between polypharmacy and falls due to dizziness (p=0,022), upper arm circumference (p=0.010), calf circumference (p=0.003) and marital status (p=0.017). There was at least one inappropriate drug use in %56.3 of the patients. Potentially inappropriate drug (PUI) use was %18.3 according to the TIME to START criteria and %48.4 according to the TIME to STOP criteria. The most frequently neglected TIME to START criteria are; vaccines, gastrointestinal system and supplement section. The most frequently neglected TIME to STOP criteria are; musculoskeletal system criteria and analgesic drugs were cardiovascular system criteria. There was a statistically significant correlation between the use of PUI and PLT (p=0.040), creatine (p=0.010) and GFR (p=0.034) values. In addition, there was a higher rate of inappropriate drug use according to TIME to STOP criteria in the group with polypharmacy in our study (p<0,001). Conclusion: More than half of the patients included in the study had polypharmacy and at least one inappropriate drug use. Polypharmacy should be questioned in elderly individuals who become sensitive to drug side effects with aging. Polypharmacy can be a warning sign for inappropriate drug use. To determine inappropriate drug use in elderly individuals; TIME criteria, which are suitable for the conditions of our country, can be used more frequently in clinical practice as a good screening tool. In this respect, we think that our study can be a guide to other studies with the results we have obtained. Keywords: palliative, elderly, polypharmacy, inappropriate drug, TIME criteria