BMC Geriatrics · 5 authors, 1 centre
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Over an 11-year period, 46.1% of elderly individuals in a Brazilian primary care setting developed polypharmacy (use of 5+ drugs). The number of health problems was the only significant risk factor, with each additional disease increasing the incidence of polypharmacy by 17%. These findings highlight the need for policies promoting rational drug use in aging populations.
**Background:** Polypharmacy is a global public health challenge, especially among the elderly, and is linked to adverse outcomes such as drug interactions, hospitalizations, and mortality. However, few studies have examined its incidence and risk factors, particularly in low- and middle-income countries. This study aimed to investigate the incidence and risk factors for polypharmacy over 11 years among elderly individuals in primary care in Brazil.
**Methods:** This was a prospective, longitudinal, census-based study conducted in Coxilha, Rio Grande do Sul, Brazil. Baseline data were collected in 2010 from all residents aged 60 years or older. The second wave occurred in 2021. The study included 128 elderly individuals who did not use polypharmacy at baseline and were reinterviewed in 2021. Polypharmacy was defined as the simultaneous use of 5 or more drugs. Data were collected via face-to-face household interviews using a structured questionnaire. Independent variables included sociodemographic factors (gender, age, education, marital status, income, area of residence), health conditions (self-reported health problems, number of health problems), and functionality (cognitive state via MMSE, basic and instrumental activities of daily living). Poisson regression with robust variance was used to estimate relative risks (RR) and 95% confidence intervals (CI).
**Key Results:** The incidence of polypharmacy over 11 years was 46.1% (59 of 128 participants). In bivariate analysis, polypharmacy was significantly associated with a higher number of health problems (median 6.00 vs. 3.00, p<0.001), dependence in basic activities of daily living (BADL: 66.7% vs. 38.0%, p=0.003), and dependence in instrumental activities of daily living (IADL: 57.3% vs. 30.2%, p=0.002). In the adjusted multivariate model, only the number of health problems remained a significant risk factor (RR=1.177; 95% CI 1.093–1.267), meaning each additional health problem increased the incidence of polypharmacy by an average of 17%. The most common chronic conditions among those with polypharmacy were high blood pressure (83.1%), chronic pain (72.9%), nervousness problems (54.2%), spine problems (47.5%), and diabetes mellitus (39.0%). The main drug groups involved were cardiovascular (Group C, 89.8%), alimentary tract and metabolism (Group A, 76.3%), and nervous system (Group N, 61.0%).
**Clinical Implications:** The high incidence of polypharmacy (46.1%) over 11 years indicates that most elderly individuals may be exposed to polypharmacy at some point. The strong association with multimorbidity underscores the need for careful medication management in patients with multiple chronic conditions. The findings suggest that primary care practices should focus on rational prescribing, especially for drugs affecting the cardiovascular, gastrointestinal, and nervous systems. The study also highlights potential benefits of improved access to healthcare and medications in Brazil, but raises concerns about inappropriate polypharmacy. Future policies should aim to reduce unnecessary drug use and promote deprescribing, particularly in elderly patients with multiple diseases.