Description of topical medications in the prescription patterns in older patients living in the community

Context: Polypharmacy is a growing concern among older patients. In this context, topical drug prescriptions are often not taken into account in the literature. This study aims to provide information about topical drug prescriptions in 75 years or older patients living in the community and followed by a family practitioner. Objective: Description of the drug prescription patterns of topical treatments in older patients aged 75 years and more in order to assess : 1. The prevalence and the number of topical drugs prescribed in older patients a. According to age and sex 2. The prevalence of the main classes of topical drugs prescribed in older patients Study design: Secondary analysis of medication data collected as part of a cluster-randomised trial. This clinical trial evaluates the efficacy of an Active Geriatric Evaluation for geriatric syndromes (AGE tool) as a clinical intervention to prevent functional decline in older patients followed in family medicine. Setting: Family medecine Patients: Community-dwelling 75 years or older patients included in the cluster-randomised trial. Forty-two family practitioners (working twenty or more hours per week and established as family practitioners in the french-speaking part of Switzerland) were asked to recruit twelve patients each into the study. Results: There were 429 patients recruited. Women represented 62.7% (269/429) of the patients and the median age was 81.8 years. The median number of topical drug prescription taken by a patient was 1 and IQR was 0 to 2 topical drug prescription, including medication in reserve. Of all 429 patients, 167 patients (38.9%) did not have any topical drug prescription and more than half of the patients were prescribed 1 to 4 topical medications (54.5%). The numbers of topical drug prescription were similar in both men and women (p=0.7) and there was no difference between the two groups of age separeted by the median value of 81.8 years old (p=0.6064). The most frequent topical galenic form were the dermocosmetics for skin application, followed by medication for pulmonary inhalation and ophtalmic drops. The most prevalent drug classes according to the Anatomical Therapeutic Chemical code (ATC code) were the topical products for joint and muscular pain M02, prescribed to 23.1% of the study population. Emollients and protectives D02 for the skin were prescribed to 17.7% of patients. Ophtalmological drugs S01, drugs for obstructive airway diseases R03 and vasoprotectives C05 were the next most prevalent drug classes with a prescription rate of 17.0%, 11.7% and 11.7% respectively. The topical drugs the most prescribed were diclofenac M02AA15 (16.1%), artificial tears S01XA20 (9.8%), soft paraffine and fat products D02AC (9.1%) and carbamide D02AE01 (7.7%). Conclusion: Topical drug prescriptions concerns a large population of older patients and is often overlooked in the context of ageing and polypharmacy. In western Switzerland, about two third of the patients in family medicine, living in the community and aged over 75 years had topical drug prescriptions; the majority had 1 to 4 topical drugs prescribed. Considerations about topical medication and polypharmacy in older people is poorly studied and further reasearch could explore either potentially inappropriate medications and potential adverse local and systemic effects or safer alternatives to oral treatments