Results
A total of 250 older adult patients were admitted to the cardiology/medicine department with the cardiac complaints and met inclusion criteria during the study period. Out of 250 inpatients, 60% (n=150) of the patients were males, the median age of the patient at the time of hospital admission was 65 years (range 65- 86 years). About 64% (n= 160) of the patients belonged to the age group of 65- 70 years, followed by 17.6% (n=44) patients aged between 71- 75 years, whereas only 8.8% (n=22) of the inpatients were above 80 years. A very high proportion of the patients (67.2%, n=168) were found to be illiterate. Approximately 16% (n=40) of the patients were a chronic smoker, and the same proportion of patients were found to be a chronic alcoholic, respectively. Table 1 represents the socio-demographic and clinical characteristics of the older adult patients.
It was observed that on average, each patient had 3 diagnosis, and the number of diagnosis ranged from one to seven. However, 36.8% (n=92) of the patients were having ≥4 diagnosis during their hospital stay. Moreover, patients have been categorized according to their length of hospital stay as prolonged hospital stay may increase the risk of adverse drug reaction. The median length of hospital stay was 6 days (range 3- 20 days). Also, it was found that nearly one-sixth of the older adult patients (64%, n=160) were prescribed with nine or more than nine medications during their hospital stay. Most of the patients were either on polypharmacy (5- 9 medications per day) or high- level polypharmacy (>10 medications per day) during their hospital stay. On the other hand, several comorbidities were documented in patients. The majority of the older adult patients suffered from chronic diseases such as Ischemic vascular disease (208 patients), Dilated cardiomyopathy (46 patients), followed by 56 patients with congestive heart failure. Figure 1 describes the prevalence of the chronic disease in 250 older adult patients.
A significant decline in kidney functions is often observed in the majority of the older adult patients. In our study, the mean creatinine clearance was 45.62ml/min (range 5-156). It has been clarified in Beers criteria that certain given medications either should be avoided or their dosage should be adjusted after having an eye on the kidney function or creatinine clearance of the patient. The mean serum creatinine of the patient was 5.6mg/dl (range 2.4- 18). Creatinine clearance (CrCl) was calculated with the help of Cockcroft- Gault formula, and the mean CrCl was 12.75ml/min (range 4- 36). About 37.6% (n= 94) of the patients were having CrCl less than 30ml/min followed by 33.6% (n=84) within the range between 31- 60 ml/min. A deficient proportion of patients (4.8%, n=12) were having CrCl above 90ml/min.