{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T23:27:56Z","timestamp":1790378876400,"version":"4.1.0"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,2,11]],"date-time":"2021-02-11T00:00:00Z","timestamp":1613001600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003197","name":"Agenzia Italiana del Farmaco, Ministero della Salute","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003197","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100009879","name":"Regione Emilia-Romagna","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100009879","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pharmacol."],"abstract":"<jats:p><jats:bold>Backround:<\/jats:bold> We aimed at assessing the prevalence of polypharmacy and potential drug-drug interactions (DDIs) with clinical relevance in elderly patient on Emilia Romagna area. Both outpatients and residents in nursing homes were assessed, with only partially overlapping strategies.<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> We defined a list of 190 pairs of potentially interacting drugs, based on literature appraisal and availability of therapeutic alternatives. January-June 2018 data on drug use in patients over 65\u00a0years-old were collected from nine Local Health Authorities of Emilia Romagna: data on community-dwelling subjects were extracted from archives of reimbursed prescriptions, while drug use in a sample of nursing homes was recorded from clinical charts in one index day within the same semester. The frequency of polypharmacy (at least five or at least 10 concurrent drugs) and of each DDI was calculated.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> In line with different rates of polypharmacy (80% vs 16%), the risk of exposure to at least one interaction was 53.7% in nursing homes and 26.4% in outpatients. Among DDIs, in nursing homes antidepressants\u2014anxiolytics (11.9%) ranked first, followed by antidepressants\u2014aspirin (7.4%). In outpatients, ACE-inhibitors\u2014non-steroidal anti-inflammatory drugs (NSAIDs) reached 7.2% followed by the calcium channel blockers\u2014\u03b1-blockers (2.4%).<\/jats:p><jats:p><jats:bold>Discussion:<\/jats:bold> Polypharmacy and risk of DDIs appeared very different in the two settings, due to both technical and clinical reasons. In order to reduce use of benzodiazepines, NSAIDs, antidepressants and relevant DDIs, 1) defining alternative options for pain relief in elderly outpatients, and 2) implementing non-pharmacological management of insomnia and anxiety in nursing homes should be prioritized.<\/jats:p>","DOI":"10.3389\/fphar.2020.624888","type":"journal-article","created":{"date-parts":[[2021,2,8]],"date-time":"2021-02-08T23:44:19Z","timestamp":1612827859000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":22,"title":["Comparing the Prevalence of Polypharmacy and Potential Drug-Drug Interactions in Nursing Homes and in the Community Dwelling Elderly of Emilia Romagna Region"],"prefix":"10.3389","volume":"11","author":[{"given":"Sofia","family":"Burato","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Leonardi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ippazio Cosimo","family":"Antonazzo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emanuel","family":"Raschi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Ajolfi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuela","family":"Baraghini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonella","family":"Chiarello","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentina","family":"Delmonte","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucio","family":"Di Castri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monia","family":"Donati","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonella","family":"Fadda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"Fedele","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandra","family":"Ferretti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Gabrielli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Gobbi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sereno","family":"Lughi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martina","family":"Mazzari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio","family":"Pieraccini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Renzetti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elsa","family":"Russi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Scanelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"Zanetti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabetta","family":"Poluzzi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,2,11]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e711","DOI":"10.3399\/bjgp18X699101","article-title":"Prevalence of drug-herb and drug-supplement interactions in older adults: a cross-sectional survey","volume":"68","author":"Agbabiaka","year":"2018","journal-title":"Br. J. Gen. Pract."},{"key":"B2","doi-asserted-by":"publisher","first-page":"546","DOI":"10.1080\/0361073X.2015.1085737","article-title":"The association in elderly hospitalized patients, between psychotropic drugs and hip fractures resulting from falls","volume":"41","author":"Aizenberg","year":"2015","journal-title":"Exp. Aging Res."},{"key":"B3","doi-asserted-by":"publisher","first-page":"106","DOI":"10.1111\/fcp.12088","article-title":"Incidence of hospital admissions due to adverse drug reactions in France: the EMIR study","volume":"29","author":"B\u00e9nard-Laribi\u00e8re","year":"2015","journal-title":"Fundam. Clin. Pharmacol."},{"key":"B4","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1007\/s40264-015-0378-5","article-title":"Appropriate polypharmacy and medicine safety: when many is not too many","volume":"39","author":"Cadogan","year":"2016","journal-title":"Drug Saf."},{"key":"B5","doi-asserted-by":"publisher","first-page":"916","DOI":"10.1093\/eurpub\/ckaa063","article-title":"Measuring multimorbidity inequality across Italy through the multisource comorbidity score: a nationwide study","volume":"30","author":"Corrao","year":"2020","journal-title":"Eur. J. Publ. Health"},{"key":"B6","doi-asserted-by":"publisher","first-page":"489","DOI":"10.1002\/pds.3592","article-title":"Hospital admissions\/visits associated with drug-drug interactions: a systematic review and meta-analysis","volume":"23","author":"Dechanont","year":"2014","journal-title":"Pharmacoepidemiol. Drug Saf."},{"key":"B7","doi-asserted-by":"publisher","first-page":"656","DOI":"10.1007\/s11096-015-0106-3","article-title":"Pharmacists\u2019 role in handling problems with prescriptions for antithrombotic medication in Belgian community pharmacies","volume":"37","author":"Desmaele","year":"2015","journal-title":"Int. J. Clin. Pharm."},{"key":"B8","doi-asserted-by":"publisher","first-page":"e95419","DOI":"10.1371\/journal.pone.0095419","article-title":"Can Italian healthcare administrative databases Be used to compare regions with respect to compliance with standards of care for chronic diseases?","volume":"9","author":"Gini","year":"2014","journal-title":"PloS One"},{"key":"B9","doi-asserted-by":"publisher","first-page":"989","DOI":"10.1016\/j.jclinepi.2012.02.018","article-title":"Polypharmacy cutoff and outcomes: five or more medicines were used to identify community-dwelling older men at risk of different adverse outcomes","volume":"65","author":"Gnjidic","year":"2012","journal-title":"J. Clin. Epidemiol."},{"key":"B10","doi-asserted-by":"publisher","first-page":"228","DOI":"10.1111\/jcpt.12502","article-title":"Potential drug-drug and drug-disease interactions in well-functioning community-dwelling older adults","volume":"42","author":"Hanlon","year":"2017","journal-title":"J. Clin. Pharm. Therapeut."},{"key":"B11","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1111\/bcp.14589","article-title":"Appropriate and inappropriate polypharmacy \u2013 choosing the right strategy","volume":"87","author":"Hughes","year":"2020","journal-title":"Br. J. Clin. Pharmacol."},{"key":"B12","doi-asserted-by":"publisher","first-page":"202","DOI":"10.1016\/j.archger.2018.01.005","article-title":"Medication use in a cohort of newly admitted nursing home residents (Ageing@NH) in relation to evolving physical and mental health","volume":"75","author":"Ivanova","year":"2018","journal-title":"Arch. Gerontol. Geriatr."},{"key":"B13","doi-asserted-by":"publisher","first-page":"465","DOI":"10.1007\/s00392-019-01526-7","article-title":"Drug interactions with oral anticoagulants in German nursing home residents: comparison between vitamin K antagonists and non-vitamin K antagonist oral anticoagulants based on two nested case-control studies","volume":"109","author":"Jobski","year":"2020","journal-title":"Clin. Res. Cardiol."},{"key":"B14","first-page":"485","article-title":"Although antidepressants and anxiolytics are frequently used together to treat depression in the acute phase, how effective is the concomitant use of these drugs?","volume":"29","author":"Kanba","year":"2004","journal-title":"J. Psychiatry Neurosci."},{"key":"B15","doi-asserted-by":"publisher","first-page":"e74","DOI":"10.2196\/mhealth.8613","article-title":"Consumer mobile apps for potential drug-drug interaction check: systematic review and content analysis using the mobile app rating scale (MARS)","volume":"6","author":"Kim","year":"2018","journal-title":"JMIR Mhealth Uhealth"},{"key":"B16","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1517\/14740338.2012.631910","article-title":"Epidemiology and characteristics of adverse drug reactions caused by drug-drug interactions","volume":"11","author":"Magro","year":"2012","journal-title":"Expet Opin. Drug Saf."},{"key":"B17","doi-asserted-by":"publisher","first-page":"230","DOI":"10.1186\/s12877-017-0621-2","article-title":"What is polypharmacy? A systematic review of definitions","volume":"17","author":"Masnoon","year":"2017","journal-title":"BMC Geriatr."},{"key":"B18","doi-asserted-by":"publisher","first-page":"1667","DOI":"10.1007\/s00228-012-1309-3","article-title":"Adverse drug reactions caused by drug-drug interactions in elderly outpatients: a prospective cohort study","volume":"68","author":"Obreli-Neto","year":"2012","journal-title":"Eur. J. Clin. Pharmacol."},{"key":"B19","doi-asserted-by":"publisher","first-page":"1142","DOI":"10.1001\/archinternmed.2010.153","article-title":"Development and validation of a score to assess risk of adverse drug reactions among in-hospital patients 65\u00a0years or older: the GerontoNet ADR risk score","volume":"170","author":"Onder","year":"2010","journal-title":"Arch. Intern. Med."},{"key":"B20","doi-asserted-by":"publisher","first-page":"1011","DOI":"10.1007\/s00228-020-02871-7","article-title":"Drug prescriptions in nursing home residents: an Italian multicenter observational study","volume":"76","author":"Pasina","year":"2020","journal-title":"Eur. J. Clin. Pharmacol."},{"key":"B21","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1186\/s12911-019-0748-5","article-title":"Development and implementation of \u201cCheck of Medication Appropriateness\u201d (CMA): advanced pharmacotherapy-related clinical rules to support medication surveillance","volume":"19","author":"Quintens","year":"2019","journal-title":"BMC Med. Inf. Decis. Making"},{"key":"B22","doi-asserted-by":"publisher","first-page":"CD008165","DOI":"10.1002\/14651858.CD008165.pub4","article-title":"Interventions to improve the appropriate use of polypharmacy for older people","volume":"9","author":"Rankin","year":"2018","journal-title":"Cochrane Database Syst. Rev."},{"key":"B23","doi-asserted-by":"publisher","first-page":"1411","DOI":"10.1111\/bcp.12754","article-title":"Clinically important drug-drug interactions in poly-treated elderly outpatients: a campaign to improve appropriateness in general practice","volume":"80","author":"Raschi","year":"2015","journal-title":"Br. J. Clin. Pharmacol."},{"key":"B24","doi-asserted-by":"publisher","first-page":"19711","DOI":"10.18632\/aging.104018","article-title":"Risk of hospitalization from drug-drug interactions in the Elderly: real-world evidence in a large administrative database","volume":"12","author":"Swart","year":"2020","journal-title":"Aging (Albany NY)."},{"key":"B25","doi-asserted-by":"publisher","first-page":"347","DOI":"10.1007\/s40264-018-0732-5","article-title":"The role of European healthcare databases for post-marketing drug effectiveness, safety and value evaluation: where does Italy stand?","volume":"42","author":"Trifir\u00f2","year":"2019","journal-title":"Drug Saf."},{"key":"B26","doi-asserted-by":"publisher","first-page":"2230","DOI":"10.1182\/blood-2018-06-848747","article-title":"Drug-drug interactions in an era of multiple anticoagulants: a focus on clinically relevant drug interactions","volume":"132","author":"Vazquez","year":"2018","journal-title":"Blood"},{"key":"B27","doi-asserted-by":"publisher","first-page":"807","DOI":"10.1007\/s00198-005-0065-y","article-title":"Anxiolytics, sedatives, antidepressants, neuroleptics and the risk of fracture","volume":"17","author":"Vestergaard","year":"2006","journal-title":"Osteoporos. Int."},{"key":"B28","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1111\/j.1365-2125.2006.02744.x","article-title":"Polypharmacy as commonly defined is an indicator of limited value in the assessment of drug-related problems","volume":"63","author":"Viktil","year":"2007","journal-title":"Br. J. Clin. Pharmacol."},{"key":"B29","doi-asserted-by":"publisher","first-page":"769","DOI":"10.1007\/s40266-019-00686-5","article-title":"Reducing psychotropic drug use in nursing homes in Belgium: an implementation study for the roll-out of a practice improvement initiative","volume":"36","author":"Wauters","year":"2019","journal-title":"Drugs Aging"},{"key":"B30","volume-title":"ATC classification index with DDDs","year":"2020"},{"key":"B31","volume-title":"World report on ageing and health","year":"2015"}],"container-title":["Frontiers in Pharmacology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphar.2020.624888\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,2,8]],"date-time":"2021-02-08T23:44:23Z","timestamp":1612827863000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphar.2020.624888\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2,11]]},"references-count":31,"alternative-id":["10.3389\/fphar.2020.624888"],"URL":"https:\/\/doi.org\/10.3389\/fphar.2020.624888","relation":{},"ISSN":["1663-9812"],"issn-type":[{"value":"1663-9812","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,2,11]]},"article-number":"624888"}}