Objective: To identify and address polypharmacy and drug related problems (DRPs) in geriatric patients (>65 years old) in an Integrated Parkinson’s Disease clinic.

Background: Management of Parkinson’s Disease in the elderly is considered more complex due to coexistence of other geriatric syndromes. As a consequence of being prescribed multiple medicines, elderly patients with Parkinson’s Disease face problems with regards to polypharmacy and harmful drug related problems [1]. High levels of polypharmacy associated with complex drug regimens have been linked to poor adherence, reducing therapeutic benefits such as improved mobility, activity, emotional wellbeing, cognition, communication and body comfort [2,3].

Method: A total of 19 patients >65 years old, referred to the Integrated Parkinson’s Disease Hub received a pharmacist led medication reconciliation at their first visit. Polypharmacy was identified as use of >5 chronic medications. A follow up phone call was made by the pharmacist at 6 weeks to enquire about medication adherence and address DRPs related to Parkinson medications. DRPs were categorized into different domains according to the PCNE classification V5.01. Changes to medication and dosage were made as indicated after discussing with the primary geriatrician.

Results: The cohort of patients had a mean age of 76.73± 7.8. 52% had a Charlson Comorbidity Index >3 which indicates a 10-year survival of >54%. Polypharmacy defined as >5 chronic medications was identified in 52.6% and 26.3% had at least one DRP. The most common domain was ascertained to be P1.1 non allergic adverse effects according to the PCNE classification V5.01. Changes in the medication regime were made for 36.8% of patients. Patient reported medication adherence was 73.6% at 6 weeks.

Conclusion: Polypharmacy and drug related problems are a significant issue among elderly patients with Parkinson’s Disease. Early medication reconciliation and identification of drug related problems will help with reducing adverse events and optimizing Parkinson therapy suited to the unique needs of the geriatric population.

References: 1. Klietz, M., Greten, S., Wegner, F., and Höglinger, G. U. (2019). Safety and Tolerability of Pharmacotherapies for Parkinson’s Disease in Geriatric Patients. Drugs Aging 36 (6), 511–530. doi:10.1007/s40266-019-00654-z
2. Daley, D. J., Myint, P. K., Gray, R. J., and Deane, K. H. (2012). Systematic Review on Factors Associated with Medication Non-adherence in Parkinson’s Disease. Parkinsonism Relat. Disord. 18 (10), 1053–1061. doi:10.1016/j.parkreldis.2012.09.004
3. Daley, D. J., Deane, K. H., Gray, R. J., Clark, A. B., Pfeil, M., Sabanathan, K., et al. (2014). Adherence Therapy Improves Medication Adherence and Quality of Life in People with Parkinson’s Disease: a Randomised Controlled Trial. Int. J. Clin. Pract. 68 (8), 963–971. doi:10.1111/ijcp.12439

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MDS Abstracts - https://www.mdsabstracts.org/abstract/polypharmacy-and-drug-related-problems-in-geriatric-patients-with-parkinsons-disease/