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Due to advanced age, multimorbidity and polypharmacotherapy, older patients are predisposed to drug interactions and the adverse effects of inappropriate drug combinations.To provide up-to-date data on predisposing factors and the prevalence of possible drug interactions in the Polish geriatric population and to promote automated analysis programs as part of safe pharmacotherapy.We used the Lexicomp® Drug Interactions database to assess pharmacological interactions between active substances included in all types of preparations (prescription drugs, over-the-counter drugs, vitamins, nutritional preparations, and dietary supplements) used at least once in the 2 weeks preceding the study, among 2633 home-dwelling people aged65 years. The variables measured included age, sex, place of residence, level of education, and multimorbidity. Post-stratification was used to weigh the sample structure against the Polish population in 2017.Drug interactions were identified in 81.2% of all individuals. The mean number (with 95% confidence interval (95% CI)) of all drug interactions was 4.24 (4.02-4.46), and the median value (with 1st and 3rd quartiles (Q1-Q3)) was 3 (1-6). At least 1 category C interaction was observed in 75.8% of all study participants, 24.3% had 1 or more category D interaction, and 4.3% had 1 or more category X interaction. The most important predisposing factor to drug interactions was multimorbidity.This study identified a high prevalence of potential drug interactions in the Polish geriatric population. Automated analysis systems deliver useful information on pharmacological interactions and should be promoted in the Polish healthcare community as tools to support pharmacotherapy.

The world's older population is growing dramatically. Pharmacotherapy in seniors is particularly challenging due to changes in metabolism, multimorbidity, and great interest in non-prescription drugs.We aimed to provide up-to-date data on the pharmacotherapy of Poland's geriatric population, determine factors predisposing to polypharmacy and excessive polypharmacy, and identify seniors most likely to require multidisciplinary interventions in the field of pharmacotherapy.All prescription and non-prescription drugs used within two weeks preceding the study by a representative national sample of 3014 home-dwelling people over 65 years old were analyzed. The variables of age, sex, place of residence, level of education, and multimorbidity were considered. Post-stratification was used to balance the sample structure to match the Polish population of 2017.Consumption of at least one drug was acknowledged by 90.7% of people over 65 years old, with a mean number (with 95% CI) of 5.01 (4.87-5.15). At least one non-prescription drug was indicated by 44.2% of the respondents, with a mean number (with 95% CI) of 0.52 (0.49-0.55). More than five drugs were identified in 53.5% of the entire population, while more than ten drugs were found in 8.7% of the respondents, with multimorbidity as the most predisposing factor. Single pill combinations accounted for 27.2% of medications.Polypharmacy resulting from multimorbidity confirms the need for combined medical and pharmaceutical care of geriatric patients.

Supplementary Figure 1. Percentage of people with at least one drug interaction from category C (monitor therapy) broken down by main variables. Supplementary Figure 2. Percentage of people with at least one drug interaction from category D (consider modifying therapy) broken down by main variables. Supplementary Figure 3. Percentage of people with at least one drug interaction from category X (avoid combination) broken down by main variables. Supplementary Figure 4. Distribution of the Charlson Comorbidity Index (CCI) values in the entire population and by sex. Supplementary Table 1. Percentage of older people taking drugs (%). Supplementary Table 2. Number of all drug interactions. The results are presented as medians with the first and third quartiles. Supplementary Table 3. Percentage of people taking drugs based on the anatomical-therapeutic-chemical classification (ATC) (%). Detailed results in subgroups are presented for values above 5%. Supplementary Table 4. Results of data normality checking with Shapiro-Wilk test.

Pharmacological therapy in the elderly is particularly complicated and challenging. Due to coexistence of three main predisposing factors (advanced age, multiple morbidity and polypharmacotherapy), this group of patients is prone to occurrence of drug interactions and adverse effects of incorrect drug combinations. Since many years patient safety during the treatment process has been one of key elements for proper functioning of healthcare systems around the world, thus different preventive measures have been undertaken in order to counteract factors adversely affecting the therapeutic effect. One of the avoidable medical errors is pharmacological interactions. According to estimates, one in six elderly patients may be at risk of a significant drug interaction. Hence the knowledge about mechanisms and causes of drug interactions in the elderly, as well as consequences of their occurrence are crucial for planning the process of pharmacotherapy. For the purpose of pharmacovigilance, a review of available methods and tools gives an insight into possible ways of preventing drug interactions. Additionally, recognizing the actual scale of this phenomenon in geriatric population around the world emphasizes the importance of a joint effort among medical community to improve quality of pharmacotherapy.