Prevalence, Characteristics and Determinants of Polypharmacy Among Elderly Patients Attending Primary Health Care Centers in Bahrain: A cross-sectional study

Objectives: This study aims to determine the prevalence, characteristics and determinants of polypharmacy among elderly patients in Bahrain. Methods: A cross-sectional study was conducted in the period between March and April 2022 in all primary healthcare centres in Bahrain. A simple random sample was obtained. An elderly patient was defined as a patient aged 60 years or above. In addition, polypharmacy was defined as the concomitant use of 5 medications or more and excessive polypharmacy was defined as the concomitant use of 10 medications or more. Results: A total of 977 patients were included, more than half of them were females (n=533, 54.44%) and the mean age of the participants was 67.90 ±6.87 years. Essential hypertension, hyperlipidemia and diabetes mellitus were the most common comorbidities among the participants (61.51%, 57.63% and 53.22%, respectively). Of the cohort, 443 were on 5 or more medications i.e., polypharmacy (45.34%), and around 7% were on at least 10 medications (n=66, 6.76%). A multivariate analysis revealed that patients with diabetes (OR=5.836, CI 4.061-8.385, P<0.001), hypertension (OR=6.231, CI= 4.235-9.168, P<0.001), hyperlipidemia (OR 3.999, 95% CI 2.756-5.802, P<0.001), cardiovascular diseases (OR 3.589, 95 CI 1.787-7.205, P<0.001) and asthma (OR 3.148, 95% CI 1.646-6.019, P<0.001) were significantly more likely to suffer from polypharmacy. Conclusion: Polypharmacy was prevalent among elderly patients in Bahrain, particularly among those with non-communicable diseases. Polypharmacy should be considered while delivering elderly healthcare services, especially in patients with non-communicable diseases. Keywords: Aged, Bahrain, Elderly, Polymorbidity, Polypharmacy

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries