Clinical Features of Hyperpolypharmacy in Older Patients With Degenerative Cervical Myelopathy

Polypharmacy, hyperpolypharmacy, and potentially inappropriate medication (PIM) in older adults are growing health concerns in the aging population. Older patients with degenerative cervical myelopathy (DCM) often have multiple comorbidities and are prescribed numerous medications. Thus, we investigated the current status of medication use among older patients with DCM, identified the characteristics of those with hyperpolypharmacy, and evaluated its impact on postoperative outcomes.

This retrospective study included 130 older patients with surgery for DCM. All participants completed the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ) before and 1 year after surgery.

Forty-two patients had hyperpolypharmacy (H group), and 88 had non-hyperpolypharmacy (N group). The commonly prescribed PIMs were antidiabetics (24.6%), nonsteroidal anti-inflammatory drugs (21.5%), and hypnotics (20.8%). Hypnotic use was significantly higher in the H group than in the N group (p < 0.001). The H group exhibited significantly more advanced frailty than the N group (p = 0.001). The preoperative JOACMEQ scores for upper extremity, lower extremity, and bladder function were significantly worse in the H group than in the N group (p = 0.020, 0.003, and 0.007, respectively) and remained significant following the multivariable model. Both groups had favorable surgical outcomes, but quality of life improvements were significant in the N group (p = 0.005) but not in the H group (p = 0.900).

Older DCM patients with hyperpolypharmacy had more severe preoperative symptoms. Although surgery is a viable treatment option for this population, thorough preoperative informed consent regarding surgical outcomes is critically important.