Objectives:

The iatrogenic triad are a significant global health problem in the elderly population. This study aims to evaluate the iatrogenic triad in the elderly and identify potential preventative measures to mitigate its occurrence.

Methods:

A preliminary observational study was conducted on 150 ambulatory elderly patients to assess potentially inappropriate medications (PIM), polypharmacy, and drug interactions. AGS Beers Criteria, 2019, Polypharmacy, Medication Complexity Regimen Index (MRCI) and Micromedex (a drug information software) were used to assess the harmful triad. Before and after data collection, we observed, identified, and unfolded potential strategies to avoid the harmful triad in the elderly population.

Results:

The medication regimen complexity index (MRCI) is 30.49 ± 13.77, suggesting a moderate level of complexity in the drug regimens of elderly patients. Among the potentially inappropriate medications (PIMs) identified by the AGS Beer criteria for 2019, glimepiride (45) and diclofenac (23) were found to be the most frequently prescribed. Moderate-level drug-drug interactions were identified between aspirin and metoprolol (20), metoprolol and metformin (13), and aspirin and enalapril (11). All drug-ethanol and drug-food interactions were found to be rapid and often unknown to patients. Furthermore, the study found that MRCI and polypharmacy were statistically significantly associated with the number of PIMs and drug interactions (p<0.01). Based on data collection, the study identified three possible ways to prevent the iatrogenic triad in elderly patients: interaction, collaboration, and continuing education.

Conclusions:

In conclusion, this study sheds light on the medication regimen complexity, PIMs, and drug interactions in elderly patients. The study also highlights three possible ways to prevent the iatrogenic triad, namely interaction, collaboration, and continuing education. By implementing these strategies, healthcare providers can help to prevent harm and improve the quality of care for elderly patients.

Keywords: aged, potentially inappropriate medication list, drug interactions, polypharmacy, medication regimen complexity index.