title: Older age and steroid use are associated with increasing polypharmacy and potential medication interactions among patients with inflammatory bowel disease.
abstract: BACKGROUND
  Comorbidity and polypharmacy, more prevalent among older persons, may impact the treatment of patients with inflammatory bowel disease (IBD). The aims of this study were to assess the frequency of polypharmacy and medication interactions within a cohort of older patients with IBD and describe IBD treatment patterns.
  
  
  METHODS
  Cohort study of 190 patients with IBD 65 years or older followed at a tertiary IBD referral center from 2006 to 2012. Data collected included demographics, IBD-specific characteristics including disease activity, and comorbidity. Medication histories were extracted from medical records, and data were used to classify polypharmacy, frequency, and severity of potential medication interactions and inappropriate medication use.
  
  
  RESULTS
  Older patients with IBD were prescribed an average of 9 routine medications. Severe polypharmacy (≥10 routine medications) was present in 43.2% of studied patients and associated with increasing age, greater comorbidity, and steroid use. Overall, 73.7% of patients had at least 1 potential medication interaction, including 40% of patients with potential IBD medication-associated interactions. Chronic steroids were prescribed to 40% of the older patients including 24% who were in remission or with mild disease activity. Only 39.5% of patients were on immunomodulators and 21.1% on biologics. Approximately, 35% of patients were given at least 1 Beers inappropriate medication and almost 10% were receiving chronic narcotics.
  
  
  CONCLUSIONS
  Older patients with IBD are at increased risk for severe polypharmacy and potential major medication interactions especially with increasing comorbidity and chronic steroid use. Steroid-maintenance therapies are prevalent among the older patients with IBD with lower utilization of steroid-sparing regimens.
authors: *Division of Gastroenterology, The Johns Hopkins School of Medicine, Baltimore, Maryland; and †Division of Digestive Diseases, Department of Gastroenterology, David Geffen School of Medicine at UCLA, Los Angeles, Los Angeles, California.
authors: Alyssa
authors: A
authors: Parian
authors: Christina Y
authors: CY
authors: Ha
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001688:Biological Products / Q000627:therapeutic use; D015897:Comorbidity; D004347:Drug Interactions; D005260:Female; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy*; D008297:Male; D009294:Narcotics / Q000627:therapeutic use; D019338:Polypharmacy; D000067561:Potentially Inappropriate Medication List; D012189:Retrospective Studies
chemical_list: D000305:Adrenal Cortex Hormones; D001688:Biological Products; D007155:Immunologic Factors; D009294:Narcotics