Medication-related factors associated with health-related quality of life in patients older than 65

16 Pages·2017·1.26 MB·English

RESEARCHARTICLE
Medication-related factors associated with
health-related quality of life in patients older
than 65 years with polypharmacy
AlonsoMontiel-Luque1☯*,AntonioJesu´sNu´ñez-Montenegro2☯,EstherMart´ın-Aurioles3☯,
JoseCarlosCanca-Sa´nchez4☯,MariaCarmenToro-Toro5☯,Jose´AntonioGonza´lez-
Correa6☯,onbehalfofthePolipresactResearchGroup¶
1 SanMiguelHealthCenter,CostadelSolPrimaryHealthcareDistrict,AndalusianHealthService,Ma´laga,
Spain,2 NorthMa´lagaHealthArea,AndalusianHealthService,Ma´laga,Spain,3 LaRocaHealthCenter,
Ma´laga-GuadalhorcePrimaryHealthcareDistrict,AndalusianHealthService,Ma´laga,Spain,4 CostadelSol
a1111111111
HealthAgency,AndalusianHealthService,Marbella(Ma´laga),Spain,5 CampilloHealthCenter,North
a1111111111
Ma´lagaHealthArea,AndalusianHealthService,Ma´laga,Spain,6 DepartmentofPharmacology,Biomedical
a1111111111 ResearchInstituteofMa´laga.UniversityofMa´laga,Ma´laga,Spain
a1111111111
a1111111111 ☯Theseauthorscontributedequallytothiswork.
¶MembersofthePolipresactgrouparelistedintheAcknowledgments
*[email protected]
Abstract
OPENACCESS
Citation:Montiel-LuqueA,Nu´ñez-MontenegroAJ,
Inthecurrentpublichealthframework,theimportanceofmedicationasadeterminantofciti-
Mart´ın-AuriolesE,Canca-Sa´nchezJC,Toro-Toro
zens’healthhasemergedasafactorwarrantingspecialattention.Moststudiesinvestigat-
MC,Gonza´lez-CorreaJA,etal.(2017)Medication-
relatedfactorsassociatedwithhealth-related ingtherelationshipbetweenmedicationandqualityoflifedosofromtheperspectiveof
qualityoflifeinpatientsolderthan65yearswith adherence.However,othermedication-relatedfactorsidentifiedathomevisitsmaybe
polypharmacy.PLoSONE12(2):e0171320.
associatedwithhealth-relatedqualityoflife.
doi:10.1371/journal.pone.0171320
Editor:TerenceJ.Quinn,UniversityofGlasgow,
Methodsanddesign
UNITEDKINGDOM
Received:June30,2016 Objective:Todescribetherelationshipbetweenmedication-relatedfactorsandthehealth-
relatedqualityoflifeinpatientsolderthan65yearswhousemultiplemedications
Accepted:January19,2017
(polypharmacy).
Published:February6,2017
Design:Cross-sectionaldescriptivestudy.
Copyright:©2017Montiel-Luqueetal.Thisisan
Setting:Primarycare.
openaccessarticledistributedunderthetermsof
Participants:Patientsolderthan65yearswhousemultiplemedications(n=375).
theCreativeCommonsAttributionLicense,which
permitsunrestricteduse,distribution,and Measurements:Themainoutcomemeasurewashealth-relatedqualityoflifeaccordingto
reproductioninanymedium,providedtheoriginal theEuroQol-5Dinstrument.Sociodemographic,clinicalandmedication-relatedvariables
authorandsourcearecredited.
wererecordedduringhomeinterviews.
DataAvailabilityStatement:Allrelevantdataare
withinthepaperanditsSupportingInformation
Results
files.
Funding:ThisstudywasfundedbyTheAndalusian Meanagewas74.72±5.59years,and65.5%ofourparticipantswerewomen.Theglobal
HealthService,filenumber:111222SAS, levelofhealth-relatedqualityoflifeaccordingtotheEQ-5Dvisualanalogscalewas59.25±
accordingtoResolutionofApril15,2011,
20.92.OfthefiveEuroQoldimensions,anxiety/depressionandpainwerethemostfrequently
publishedinBOJANo.92of12May2011.(http://
reported,whilemobilityandself-carewerethedimensionswiththegreatestimpactonself-
www.juntadeandalucia.es/boja/2011/92/32toAML,
AJNM,EMA,MCTT).Thefundershadnorolein reportedqualityoflife.Multivariateanalysisindicatedthatfunctionalindependencewasthe
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Health-relatedqualityoflifeandprescriptioninelderly
studydesign,datacollectionandanalysis,decision factormoststronglyassociated(β=14.27p<0.001)withbetterhealth-relatedqualityof
topublish,orpreparationofthemanuscript. life,whileilliteracy(β=−13.58p<0.001),depression(β=−10.13p<0.001),socialrisk
CompetingInterests:Theauthorshavedeclared (β=−7.23p=0.004)andusingmorethan10medicines(β=−4.85p=0.009)werestrongly
thatnocompetinginterestsexist. associatedwithapoorerhealth-relatedqualityoflife.
Conclusions
Factorsinherentwithinthepatientsuchasfunctionalincapacity,cognitiveimpairmentand
socialandemotionalproblemswerethemainconstraintstoqualityoflifeinourstudypopu-
lation.Thenumberofmedicinestakenwasnegativelyrelatedwithqualityoflife.
Introduction
InrecentdecadesthepopulationofSpainhasagedsomuchthataccordingtoUnitedNationsesti-
matesthatby2050Spainwillhavetheworld’soldestpopulation[1,2].Sociodemographicchanges
andscientificadvancesinthelastdecadeshaveturnedterminaldiseasesintochronicdiseasesand
resultedinasignificantincreaseinlifeexpectancy.Asaresultofthesechangesanewhealthcare
scenariohasemerged,andthelongevityoftheelderlyhasincreasedalbeitattheexpenseoftheir
qualityoflife[3].Inthisconnection,withintheframeworkoftheHorizon2020Programmethe
EuropeanUnionhasidentified“HealthyLivingandActiveAgeing”asapriority,inorderto
improvethequalityoflifeoftheelderlyandhelpthemcontributetosocietyastheygrowolder[4].
Schumakerdefineshealth-relatedqualityoflife(HRQoL)as"thesubjectiveperceptioninflu-
encedbythecurrenthealthstatusoftheabilitytoperformactivitiesimportantfortheperson"
[5,6].EffortstoassessHRQoLarebecomingincreasinglyimportantinresponsetoneedsto
examinethehealthstatusofthepopulationandanalyzetheefficacyandeffectivenessofhealth
careinterventions[7].Consequently,arangeofquestionnairesandinstrumentshasbeendevel-
opedtomeasureandcharacterizeHRQoL[8,9].AssessmentsofHRQoLmakeitpossibleto
evaluatetheinfluenceofhealthstatusandotherassociatedfactorsonthegeneralwell-beingof
individuals[10].However,studiespublishedthusfarregardingfactorsassociatedwithHRQoL
inpeopleolderthan65yearshavereporteddiscrepantandcontroversialresults.Someauthors
havefoundpoorerHRQoLassociatedwithage,femalesex,functionalimpairment,depression,
chronicdiseasesorpolypharmacy[11–17].
Inthecurrentpublichealthframework,theimportanceofmedicationasadeterminantof
citizens’healthhasemergedasafactorwarrantingspecialattention[18].Moststudiesthat
haveinvestigatedtherelationshipbetweenmedicationandqualityoflifehavedonesofrom
theperspectiveofadherence[19–22].However,othermedication-relatedfactorsidentifiedat
homevisitsmaybeassociatedwithHRQoL,butthesefactorshavenotbeenextensivelystudied
todate.Abetterknowledgeofthesefactorsmaybeusefultotailorinterventionstotheneeds
ofindividualsineffortstoimprovebothcareandHRQoL[23].
Accordingly,thisstudywasdesignedtodescribetherelationshipbetweenmedication-
relatedfactorsandHRQoLinpatientsolderthan65yearswhousemultiplemedications.
Methods
Thiscross-sectionaldescriptivestudywasdoneoveraperiodof1year;theparticipantswere
patientsolderthan65yearswithpolypharmacywhowerebeingtreatedatdifferentprimary
carecentersintheCostadelSolHealthDistrictandNorthMa´lagaHealthArea(southern
Spain),whichincluded19clinicalmanagementunits.
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Participants
Patientswereselectedbystratifiedrandomizedsamplingfromthelistsofpatientsolderthan
65yearswhowereusingmultiplemedications.Thelistsofthesepatientstreatedateachofthe
19clinicalmanagementunitswereprovidedbythepharmacyserviceofeachhealthdistrict.
Atotalof375patientswereincludedinthestudy.Thesamplesizeaccordingtooneofthe
independentvariablesrelatedtomedicationuse,i.e.adherence,wasestimatedas344patients
(375includingenoughpatientstocompensatefordropouts)assumingameanstandarddiffer-
enceinqualityoflifeof0.35pointsbetweenpatientswithlowandhighadherencetomedica-
tion,fora95%confidencelevel,with80%powerandagroupratioof1:1.
Toachievethenecessarysamplesize(N=375)weselected1125patientsolderthan65
yearswhousedmultiplemedications.Ofthese,430didnotmeetthecriteriaforinclusionor
exclusion,123couldnotbelocatedand197(17.5%)refusedtoparticipateinthestudy.
Inclusioncriteria
• Age(cid:21)65years.
• Polypharmacy:useoffiveormoremedicationsforaperiod(cid:21)6months[24].
• Inclusionintheelectronicprescriptionprogram(75.9%ofpatientsduringthestudyperiod)
[25].
Exclusioncriteria
• Functionaland/orcognitiveimpairmentpreventingautonomousmanagementofmedica-
tion(Barthel(cid:20)60ormorethanfourerrorsinthePfeiffertest).
• Inpatientsatpublic/privateinstitutions.
• Patientswithpsychiatricdisorders.
• Refusaltoprovidewrittenconsent.
• Patientswithlanguageimpairmentpreventingfluentcommunication.
Studyvariables
Dependentvariable. Health-relatedqualityoflife.
Predictorvariables. Sociodemographic,clinicalandmedication-relatedvariables.
Sociodemographic:Age,sex,placeofresidence,cohabitation,socioeconomicstatus
(accordingtoaminimumwageinSpainof641.40€/month):Low:<641.40€/month;Middle:
641.40€/monthto962.10€/month;High:>962.10€/month,educationallevel,andsocialrisk
basedontheGijo´nscale(S1File).Thisinstrumentassessessocialandfamilyrisk,andconsists
of5items:familysituation,economicsituation,housing,socialrelationsandsocialsupport
network.Thecutoffscoreforthedetectionofsocialriskis16.
ClinicalData:Functionalassessment(Barthelindex)(S1File),cognitiveassessment(Pfeif-
fertest)(S1File),assessmentofemotionalstatus:anxiety/depression(Goldbergscale)(S1
File),medicalconditionsandhistoryofemergencyroomvisits.
ThePfeiffertestorShortPortableMentalStatusQuestionnaire(SPMSQ)providesamea-
surementofcognitivefunctioningofelderlypeople.ThetenitemsintheSPMSQcoverorien-
tationintimeandplace,remotememory,andgeneralknowledge.TheSPMSQestablishfour
categoriesofseverityofchronicbrainsyndromeaccordingtonumberoferrorsmade:0–2
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errors:normal;3–4errors:mildcognitiveimpairment;5–7errors:moderate;8ormoreerrors:
severe.
TheGoldbergscale(GADS)scoreisbasedonresponsesof‘Yes’or‘No’toninedepression
andnineanxietyitems,askinghowrespondentshavebeenfeelinginthepastmonth.Goldberg
etal.consideredpatientswithanxietyscoresof5ormoreorwithdepressionscoresof2or
moreashavinga50%chanceofaclinicallyimportantdisturbance.
Medication:Numberofmedicines,medicationerrors(drug-relatedproblems[DRP]accord-
ingtoPCNEclassificationV6.2,abilitytoidentifymedicineswithdisease(patient’sabilitytorelate
themedicineswiththediseaseforwhichtheywereprescribed),presenceofdifferentbrandsof
medicines,andmedicationadherence(Morisky-Greentest).TheMoriskyMedicationAdherence
Scale(MMAS)isagenericself-reportedmedication-takingbehaviorscale.Althoughitwasorigi-
nallydevelopedfortheassessmentofcomplianceinhypertensivepatients,subsequentlyhasbeen
validatedforotherchronicdiseases.Itconsistsoffouritemswithascoringschemeof“Yes”or
“No”.Adherenceisconsideredtobepresentifthepatientrespondscorrectlytoall4items.
Measurementinstrument
TomeasurethedependentvariableHRQoL,weusedtheEuroQol-5Dinstrument,ageneric
HRQoLquestionnairethathasbeentranslatedintoSpanishandvalidated[26].TheEQ-5D
hasmanyapplicationsinprimarycare.Oneofitsadvantagesisthatitcanbedeliveredand
completedrapidlyandeasily(2–3min).Inaddition,thedataityieldscanbeusedfordifferent
purposesfromthedescriptionoftheoverallhealthstatusbydimensionstotheeconomiceval-
uationofhealthcareservices.Thepropertiesofthisquestionnairehavebeenvalidatedbothfor
thegeneralpopulation[27]andfordiseasegroups[28],andthereisanindexofpreferenceval-
uesforhealthstatesfortheSpanishpopulation[29].
Themodelusedinthisstudyconsistedofthreeparts:
EQ-Index:Descriptionofhealthstatusaccordingtofivedimensions(mobility,self-care,
usualactivities,pain/discomfortandanxiety/depression).Respondentsareaskedtochoose
amongthreelevelsofseverity(“noproblems”,“some/moderateproblems”or“severeprob-
lems”)todescribetheirownhealthstatus”today”.Foreaseofpresentationinthetables,the
severitylevelsarereportedaseither“withproblem”or“withoutproblem”.
EQ-VAS:Thisvisualanaloguescale(VAS)isanchoredat100atthetop(bestimaginable
healthstatus)and0atthebottom(worstimaginablehealthstatus).Respondentsareaskedto
drawalinefrom0towhicheverpointofthescalebestdescribestheirhealthstate“today”.
Inthethirdpartofthequestionnairerespondentswereaskedtoratetheircurrenthealth
stateduringtheprevious12monthsasbetter,thesame,orworse.
Datacollection
Onestudyleaderperhealthdistrict,areaandparticipatingcenterwasappointedfordatacol-
lection.Oncestratifiedrandomizedsamplingwascompleted,recruitmentwasdonebythe
studyleadersateachcenterordistrict.
Inbothhealthdistrictsthedatawerecollectedbythesameperson,afellowcontractnurse
withknowledgeofpharmacology,trainedinthemethodologyusedinthestudy.Face-to-face
interviewsweredoneatthepatient’shomeusingaspecifically-designedquestionnairethat
includedalltestsandvariablestobeassessedinthestudy.
Statisticalanalysis
ThedatawereanalyzedwithSPSSsoftware(IBMSPSSStatisticsforWindowsversion22.0,
Armonk,NY:IBMCorp.,underlicensetotheCentralComputerSystemoftheUniversityof
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Malaga,Spain).Aninitialdescriptiveanalysisofvariableswasperformedtoobtainmeasures
ofcentraltendencyanddispersionforquantitativevariables,andfrequenciesandpercentages
forqualitativevariables.Student’sttestwasusedtoidentifydifferencesbetweenEuroQol
indexandEQ-VASvalueswithrespecttothedifferentvariables,ifthevaluesmetthecriteria
forquantitativevariablesregardingnormaldistributionandhomogeneityofvariance.Other-
wise,theequivalentnonparametricMann–WhitneyUtestwasused.Thechi-squaredtestwas
usedforqualitativevariables.One-wayanalysisofvariancewasfollowedbyBonferronicorrec-
tion.Multivariateanalysiswasdonebymultiplelinearregressioninordertoidentifyfactors
associatedwithHRQoLforboththeEQ-VASandtheEQindex.
Ethicalaspects
ThisstudywasapprovedbytheEthicsandResearchCommitteesoftheCostadelSolHealth
DistrictandNorthMa´lagaHealthArea,whichverifiedthatthestudywasperformedinaccor-
dancewithallethicalstandardsandtheDeclarationofHelsinki.
Confidentialityandvoluntaryparticipationinthestudywereassured,andwritteninformed
consentwasobtained.Allthedatacollectedwereanonymous,inaccordancewiththeprovi-
sionsofOrganicLaw15/1999of13DecemberontheProtectionofPersonalDataandthe
Spanish41/2002Actof14November,whichregulatespatients’autonomy,rightsandrespon-
sibilitiesintheareaofclinicalinformationanddocumentation.
Results
Duringthe1-yeardatacollectionperiodatotalof375patientswhomettheeligibilitycriteria
wereinterviewed.Theirmeanagewas74.72±5.59years,63.5%ofthesamplewerewomenand
livedintheCostadelSolDistrict77.9%ofthecases.
Table1showsthemainstudyvariablesalongwithsamplecharacteristics.Thedatafor
sociodemographicvariablesshowedthat22.8%ofpatientslivedalone,and90.1%ofpatients
hadamiddlesocioeconomiclevel.Regardingeducationallevel,57.9%couldreadandwrite,
19.5%wereilliterateand16.3%hadanintermediatesocialrisk.
InthefunctionalandcognitiveassessmentaccordingtotheBarthelscaleforusualactivities,
averagescorewas96.68±6.01,and68.5%ofthepatientswereconsideredindependent.In
termsofcognitiveability,only9patients(2.4%)hadmildcognitiveimpairmentaccordingto
thePfeiffertest.
Themostprevalentconditionswerehypertension(88%),dyslipidemia(65.1%)anddiabetes
mellitus(52.5%).AccordingtotheGoldbergscale,60.5%and34.1%ofpatientswereatriskof
sufferingfromanxietyordepression,respectively.Slightlymorethanhalf(54.1%)ofthe
respondentshadbeenseenintheemergencyroominthepreviousyear.
Atotalof47.7%ofpatientstookmorethan10drugsdaily.AccordingtotheMorisky-
Greentest,48.3%ofpatientsshowedpooradherencetotreatment.Nodifferenceswereidenti-
fiedaccordingtoage,p=0.426orsex,p=0.376,respectively.
Wefoundthat83.2%ofpatientshadsomecausesofDRP.CategoriesC5.1(62.1%)and
C5.6(50.1%)werethemostfrequentcauses.Differentbrandsofthesamemedicationwere
foundin84.3%ofcases.
Table2showsglobalperceptionofqualityoflifeasassessedbytheEQ-VAS(0–100)and
EQ-Index(0–1).Menhadahighermeanscorethanwomen,andpatientsolderthan75years
obtainedlowerEuroQolIndexvaluescomparedtotheremainingpatients.
AmongtheEuroQol-5Ddimensions(Table3),anxiety/depressionwerethemostprevalent
disorders(69.1%),followedbypain/discomfort(58.4%)andmobilityproblems(54.9%).With
respecttosex,significantdifferenceswerefoundinalldimensionsexceptself-care,witha
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Table1. Studyvariablesanddescriptionofthesample.
Variables(N=375) Categories n %
Sociodemographicvariables
Age(years) 65–69 86 22.9
70–74 99 26.4
75–79 109 29.1
(cid:21)80 81 21.6
Sex Male 137 36.5
Female 238 63.5
Residence CostadelSol 292 77.9
NorthMalaga 83 22.1
Cohabitation Alone 85 22.8
Accompanied 290 77.2
Socioeconomiclevel Low 19 5.1
Middle 338 90.1
High 18 4.8
Socialassessment(Gijo´nscale)1 Lowornormal 314 83.7
Intermediate 61 16.3
Clinicalvariables
BADL(Bartheltest)2 Independent 257 68.5
Milddependence 50 13.3
Moderatedependence 68 18.2
Mentalassessment(Pfeiffertest)3 Normal 366 97.6
Mildimpairment 9 2.4
Emotionalstate(Goldbergscale)4 Anxiety 227 60.5
Depression 128 34.1
Mainpathologies Hypertension 330 88
Dyslipidemia 244 65.1
Diabetes 197 52.5
ER5visits(previous12months) No 172 45.9
Yes 203 54.1
Medicationvariables
Numberofmedicines (cid:21)10 196 52.3
>10 179 47.7
Medicationadherence(Morisky-Green) Adherence 194 51.7
Nonadherence 181 48.3
Drug-relatedproblems(P1,P2)6 No 63 16.8
Yes 312 83.2
C7.1-Patientforgottouse/takedrug No 216 57.6
Yes 159 42.4
C.5.5-Wrongdrugtaken No 363 96.8
Yes 12 3.2
C5.6-Drugabused(unregulatedoveruse) No 187 49.9
Yes 188 50.1
C5.1-Inappropriatetimingofadministrationand/ordosingintervals No 142 37.9
Yes 233 62.1
Differentbrandsofmedicines No 59 15.7
Yes 316 84.3
Identifiesmedicineswithdisease No 76 20.3
(Continued)
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Table1. (Continued)
Variables(N=375) Categories n %
Yes 299 79.7
Qualityoflife
Healthperceptiontoday(about1yearago) Better 63 16.8
Equal 142 37.9
Worse 170 45.3
EuroQolVisualAnalogueScale(EQ-VAS) <60 201 53.6
(cid:21)60 174 46.4
1Gijo´nscale(Socialrisk):<10:normalorlow;10–16:intermediate;>16:high.
2BADL:Basicactivitiesofdailyliving.Barthelscale:independent(100);milddependence(91–99);moderatedependence(61–90).
3Pfeiffer:normal(0–2),mildimpairment(3–4).
4Goldberg:anxietysubscale((cid:21)4riskofanxiety);depressionsubscale((cid:21)6riskofdepression).
5ER:Emergencyroom.
6Drug-relatedproblems(DRP)accordingtoPCNEclassificationV6.2.P1:Treatmenteffectiveness(Thereisa(potential)problemwiththe(lackof)effectof
thepharmacotherapy);P2:Adversereactions(Patientsuffers,orwillpossiblysuffer,fromanadversedrugevent).
doi:10.1371/journal.pone.0171320.t001
higherprevalenceofself-careproblemsinwomen.Withregardtoage,statisticallysignificant
differenceswerefoundinpatientsolderthan75yearsinthedimensionsmobility,self-care
andautonomyforperformingusualactivities.
RegardingtheinfluenceofeachEuroQol-5Ddimensiononself-reportedqualityoflife
assessedwiththeEQ-VAS(Fig1),thepresenceofproblemsinanyofthedimensionshasasta-
tisticallysignificantimpactonHRQoLcomparedtopatientswithoutanyproblems.Patients
withthehighestoverallHRQoLscorewerethosewithnomobilityproblems(EQ-VAS67.83±
20.05),whereaspatientswiththelowestscorewerethosewhohadself-careproblems(EQ-VAS
48.80±19.14)(Fig1).
Table4showsthevaluesfortheEQ-VASandEQ-Indexaccordingtootherstudyvariables.
Astatisticallysignificantrelationshipwasfoundbetweenworsequalityoflifeandilliteracy,
socialrisk,cognitiveimpairment,anxiety,depression,visitstotheemergencyroominthepre-
viousyearandmedication-relatedfactors:takingmorethan10drugs,nonadherencetotreat-
ment,medicationerrors,andinabilitytoidentifythemedicationwiththedisease.Conversely,
asignificantrelationshipwasobservedbetweengoodqualityoflifeandahighsocioeconomic
levelandautonomyforperformingusualactivities.
RegardingthecausesDRP,categoryC5.6wasthemostfrequentlyobservedfactorin
patientswithdifferentbrandsofamedicineintheirhomes(52.2%vs.39%,p<0.002)andin
patientswhowerenotabletorelatetheirmedicationwiththedisease(61.8%vs.47.2%,
p<0.05).
Table2. MeanEuroQol-5Dresultsbyageandsex.
Variable Total Male Female (cid:20)75 >75
EQ-VAS(0–100)1 59.25±20.92 64.19±19.10* 56.43±21.43 59.07±21.34 59.47±20.46
EQ-Index(0–1)2 0.65±0.19 0.72±0.17* 0.62±0.19 0.67±0.20 0.63±0.17*
1EQ-VAS:EuroQolVisualAnalogueScale
2EQ-Index:EuroQolIndex.
*p<0.05.
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Table3. PercentageofparticipantswithproblemsineachdimensionsoftheEQ-Indexbyageandsex.
Dimension Total Male Female (cid:20)75 >75
Mobility 54.9 46.7 59.7* 45.6 66.3*
Self-care 34.4 29.2 37.4 27.7 42.6*
Usualactivities 47.2 35 54.2* 37.9 58.6*
Pain/discomfort 58.4 42.3 67.6* 55.8 61.5
Anxiety/Depression 69.1 54.7 77.3* 71.4 66.3
*p<0.05.
doi:10.1371/journal.pone.0171320.t003
Multivariateanalysis(Table5)showedarelationshipbetweengoodqualityoflifeandage,
malesexandfunctionalindependence.Conversely,poorqualityoflifewasassociatedwithlow
educationallevel,socialrisk,takingmorethan10medications,cognitiveimpairment,anxiety
anddepression.
Discussion
Weinvestigatedself-reportedqualityoflifeofasamplefromapopulationofpatientsolder
than65yearswhousedmultiplemedications(polypharmacy),andidentifiedmedication-
Fig1.Perceivedqualityoflife(EQ-VAS)accordingtodifferentdimensions.
doi:10.1371/journal.pone.0171320.g001
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Table4. ResultsontheEQ-Index(0–1)andEQ-VAS(0–100)accordingtothestudyvariable.
Variable Categories EQ-Index1(0.65±0.19)a EQ-VAS2(59.25±20.93)b
Cohabitation Livingalone 0.62±0.18 55.65±21.28
Livingwithapartner 0.68±0.19c 60.20±21.02
Others 0.59±0.18 60.86±20.16
Socioeconomiclevel Low 0.59±0.21 47.89±22.06
Middle 0.65±0.19 59.19±20.72d
High 0.77±0.16c 73.24±16.01c
Levelofeducation Illiterate 0.57±0.18c 49.18±18.72c
Literate 0.66±0.17 58.89c±20.67
Primarystudies 0.69±0.21 66.13±19.49
Highschool 0.78±0.20 67.41±19.57
Universitystudies 0.71±0.19 79.33±14.50e
Socialassessment(Gijo´nscale) Lowornormal 0.68±0.18c 61.34±20.40c
Intermediate 0.54±0.18 48.52±20.46
BADL3(Bartheltest) Independent 0.72±0.17c 64.65±17.84c
Milddependent 0.52±0.14 48.50±18.27
Moderatedependent 0.49±0.11 46.84±18.76
Mentalassessment(Pfeiffertest) Normal 0.66±0.19c 59.84±20.71c
Mildimpairment 0.50±0.16 35.56±15.89
Anxiety(Goldbergscale) Yes 0.59±0.17c 55.80±20.09c
No 0.75±0.18 64.53±20.78
Depression(Goldbergscale) Yes 0.56±0.18c 0.49±21.13c
No 0.70±0.18 64.11±19.12
ERvisits(previous12months) No 0.70±0.18 62.63±19.67
1–3times 0.63±0.19f 57.60±21.24f
>3times 0.52±0.15c 46.59±22.16c
Numberofmedicines (cid:20)10 0.71±0.18c 64.13±20.84c
>10 0.60±0.18 53.94±19.74
Adherence(Morisky-Green) Adherence 0.68±0.19c 61.44±20.99c
Non-adherence 0.63±0.18 56.89±20.65
Drug-relatedproblems(P1,P2)4 Yes 0.64±0.19c 58.04±20.92c
No 0.71±0.19 65.32±19.99
C7.1-Patientforgetstouse/takedrug Yes 0.63±0.18 56.45±19.86c
No 0.67±0.19 61.33±21.49
C.5.5-Wrongdrugtaken Yes 0.54±0.19 47.50±27.67c
No 0.65±0.19 59.64±20.60
C5.6-Drugabused(unregulatedoveruse) Yes 0.61±0.18c 56.01±21.13c
No 0.69±0.19 62.53±20.24
C5.1-Inappropriatetimingofadministrationand/ordosingintervals Yes 0.62±0.19c 57.94±21.16
No 0.69±0.19 61.42±20.41
Differentbrandsofmedicines Yes 0.65±0.18 58.94±20.52
No 0.63±0.22 60.93±23.05
Identifiesmedicineswithdisease Yes 0.65±0.19 60.74±20.72c
No 0.63±0.19 53.42±20.82
1EQ-VAS:EuroQolvisualanaloguescale
2EQ-Index:EuroQolIndex
3BADL:Basicactivitiesofdailyliving.
4Drug-relatedproblems(DRP)accordingtothePCNEclassificationV6.2.P1:Treatmenteffectiveness(Thereisa(potential)problemwiththe(lackof)
effectofthepharmacotherapy);P2:Adversereactions(Patientsuffers,orwillpossiblysuffer,fromanadversedrugevent).
a,b(mean±SDofEQ-IandEQ-VAS)
cp<0.05comparedtoothercategories
dp<0.05middlesocioeconomiclevelvs.low
ep<0.05universitystudiesvs.othercategories
fp<0.051–3ERvisitsvs.novisits.
doi:10.1371/journal.pone.0171320.t004
PLOSONE|DOI:10.1371/journal.pone.0171320 February6,2017 9/16
Health-relatedqualityoflifeandprescriptioninelderly
Table5. Studyvariablesrelatedtoqualityoflife(multiplelinearregression).
EQ-VAS1 EQ-Index2
Variable β3 95%CI p β 95%CI p
Barthela 14.27 10.19/18.35 <0.001 0.18 0.15/0.21 <0.001
Depressionb −10.13 −13.98/−6.29 <0.001 −0.08 −0.11/−0.05 <0.001
Socialriskc −7.23 −12.17/−2.29 0.004 −0.06 −0.10/0.02 0.003
Levelofeducationd −13.58 −19.27/−7.89 <0.001 −0.04 −0.08/−0.01 0.019
Numberofmedicinese −4.85 −8.49/−1.20 0.009 −0.05 −0.08/−0.02 0.002
Agef 0.48 0.14/0.81 0.005 −0.01 −0.01/0.01 0.512
Levelofeducationg −7.40 −11.97/−2.82 0.002 0.01 −0.07/0.09 0.78
Pfeifferh −13.63 −26.06/−1.19 0.032 0.03 −0.07/0.13 0.557
Anxietyi −1.27 −5.16/2.62 0.520 −0.09 −0.12/−0.06 <0.001
Sexj 1.01 −2.97/4.98 0.620 0.04 0.01/0.07 0.013
1EQ-VAS:EuroQolvisualanaloguescale
2EQ-Index:EuroQolIndex
3Betaregressioncoefficient.
aIndependent
bRiskofdepression(Goldberg)
cIntermediatesocialrisk(Gijo´n)
dIlliterate
e>10medicines
fOlder
gLiterate
hMildimpairment
iRiskofanxiety(Goldberg)
jMale.
doi:10.1371/journal.pone.0171320.t005
relatedfactorsassociatedwithHRQoL.Weexcludedpeoplewithmoderatetoseverecognitive
impairmentbecausetheiranswerscouldnotbevalidatedthroughthetests.Inaddition,we
excludedpeoplewithseveredisabilitiesbecausetheaiminthisstudywastoassessHRQoLin
patientswhousedmultiplemedicationsandwereautonomousintermsoftheirmedication
management.
TheaveragescoreontheEQ-VAS(59.25)inoursamplematchestheresultsofothernational
studies[27,30].Ourmeanscoreisconsistentwithfindingsfromapreviousstudy[31]of>75
year-oldpatientsinsixEuropeancountries(61.9%)whichreportedvaluesrangingfrom60.0
forItalyto72.9forTheNetherlands.However,ourmeanEQ-VASscoreislowerthanthat
reportedbyKindetal.[32]intheirstudyof>60year-oldpatientsintheUnitedKingdom
(76.9%).
Thereweresignificantsexdifferencesinself-reportedqualityoflife.Womengenerallyhad
aworseperceptionoftheirownhealthstatusthanmen.Thistendencywasobservedinthe
overallresultsfortheEQ-VAS(56.43vs.64.19)andinalldimensionsoftheEQ-Index(0.62
vs.0.72).Mostofthestudieswereviewedalsonoteddifferencesbysex[32–34].Thissuggests
thepossibleexistenceofintrinsicorextrinsicfactorsthatinfluencethesubjectiveperception
oflonelinessanddisabilityoraffectivedisorders,whichareprevalentproblemsamongwomen
intheagegroupwestudied[13].
Ourresultsfortheinfluenceofagewerenotsoconclusive.Previousstudies[7,13]were
consistentwithourfindingthatolderpeopleobtainhigherscoresontheEQ-VAS(59.47vs.
59.07)andlowerscoresontheEQ-Index(0.63vs.0.67).Wealsofoundalowerprevalenceof
PLOSONE|DOI:10.1371/journal.pone.0171320 February6,2017 10/16