Drug-related problems in geriatric cardiovascular patients – a hospital setting

Drug-related problems in geriatric cardiovascular patients – a hospital setting | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Drug-related problems in geriatric cardiovascular patients – a hospital setting Kristína Szmicseková, Slávka Porubcová, Veronika Slezáková, Kristína Lajtmanová, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9063248/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background Older patients with cardiovascular diseases frequently experience polypharmacy and its associated complications, including drug-related problems (DRPs) and potentially inappropriate medications (PIMs). Hospitalization and therapy modifications may further complicate therapy. Structured pharmacotherapy review conducted collaboratively by pharmacists and physicians may enhance medication safety in this population. Methods This subgroup analysis included 80 patients aged ≥ 65 years hospitalized at the Vascular Surgery Department of the National Institute of Cardiovascular Diseases in Bratislava, Slovakia. Medication reconciliation and comprehensive medication review were performed at admission and discharge by trained pharmacists in collaboration with treating physicians. DRPs were classified using the Pharmaceutical Care Network Europe v9.00 system and PIMs identified using the EU(7)-PIM list. Patients’ understanding of pharmacotherapy was assessed using a three-point comprehension scale. Admission and discharge data were compared using the paired Wilcoxon signed-rank test. Results The mean age was 71.4 ± 5.0 years, and polypharmacy was highly present. Pharmacist intervention was associated with a significant reduction in DRPs at discharge (p = 0.003) and a modest decrease in the number of medications (p = 0.01), but not PIMs. DRPs were most frequently associated with statins and proton pump inhibitors. Most pharmacist recommendations addressed prescribing-related issues, with an overall physician acceptance rate of 59.8%. Although nearly half of patients demonstrated good understanding of their pharmacotherapy, important knowledge gaps persisted. Conclusions A pharmacist-led, structured pharmacotherapy review conducted collaboratively with physicians was associated with fewer DRPs at discharge in older cardiovascular patients, supporting its role in improving medication safety in complex clinical settings. drug-related problems pharmaceutical care older patients surgery patients Background The World Health Organization defines polypharmacy as "the concurrent use of multiple medications" [1]. While there is no universally accepted threshold, polypharmacy is frequently characterized by the regular use of five or more medications, including prescription drugs, over-the-counter (OTC) products, and traditional or complementary medicines [2,3]. Although widely used, the term "polypharmacy" lacks precision, and its definition remains a topic of ongoing debate. Reported prevalence varies widely depending on the patient population, healthcare setting, geographical region, and definitional criteria applied [3,4]. Polypharmacy in older adults has been consistently linked to a range of adverse clinical outcomes, such as frailty, increased risk of hospitalization, medication non-adherence, cognitive impairment, falls, and even mortality [5–10]. Geriatric pharmacotherapy, when not appropriately managed, further increases the likelihood of such events due to age-associated changes in pharmacokinetics and pharmacodynamics [11–13]. The complexity of prescribing in older adults has led to various tools to assess medication appropriateness. Notably, the EU-PIM list, along with the Beers Criteria, STOPP/START criteria, and FORTA list, are commonly used to identify potentially inappropriate medications (PIMs) in the geriatric population, which are associated with preventable adverse outcomes [14–17]. According to the Pharmaceutical Care Network Europe, a drug-related problem (DRP) is defined as “an event or circumstance involving drug therapy that actually or potentially interferes with desired health outcomes” [18]. DRPs are highly prevalent in both inpatient and outpatient settings, especially among patients with polypharmacy, polymorbidity, and those of advanced age. Certain comorbidities, such as cardiovascular disease and chronic kidney disease, further increase the likelihood of DRPs [10,19–22]. Recent estimates indicate that the prevalence of polypharmacy among older adults was approximately 37% as of 2022 [23]. While well-managed polypharmacy can be clinically appropriate, it remains a significant risk factor for DRPs and medication-related harm [24–26]. Hospitalization is a critical period during which older adults are particularly vulnerable to DRPs [20,25–27]. Additionally, transitions of care—such as admission to or discharge from hospital—represent high-risk periods for medication discrepancies, adverse drug events, and therapeutic failures [28,29). These problems frequently lead to longer hospital stays, increased healthcare costs, suboptimal pharmacotherapy, and adverse clinical outcomes [24–26]. Given these risks, several strategies have been proposed to reduce the incidence of DRPs. One of the most effective is the integration of pharmacists into multidisciplinary care teams [30–32]. Pharmacist-led interventions—including medication reconciliation, medication history taking, clinical medication reviews, use of prescribing support tools, and active participation in ward rounds—have demonstrated significant benefits. Studies have shown that pharmacists can reduce the number of PIMs, minimize drug interactions, and improve overall pharmacotherapy safety [18,33–37]. For example, a systematic review by Mekonnen et al. (2016) found that pharmacist-led medication reconciliation reduced medication discrepancies by up to 67% [35]. Collaboration between pharmacists, physicians, and nurses has been shown to improve clinical outcomes, particularly in vulnerable populations such as the elderly, patients with chronic diseases (e.g., cardiovascular conditions, chronic kidney disease, oncology patients, and those admitted to intensive care units [33,38–48]. The high rate of potentially inappropriate prescribing in older adults, combined with the rapid growth of the aging population, presents serious challenges—mainly due to polypharmacy and the increased risk of drug-related problems. Giving pharmacists a clearer and more consistent role in hospital care for older patients could help tackle these issues by improving medication safety, adherence, and overall treatment outcomes. In the initial PHAROS study, we found that vascular surgery patients experience a substantial number of DRPs. In the present subgroup analysis, we focus specifically on patients aged ≥ 65 years, as this population is particularly vulnerable to inappropriate prescribing and its consequences. Methods This study represents a post hoc subgroup analysis of data derived from a single-center, prospective, uncontrolled study conducted at the National Institute of Cardiovascular Diseases in Bratislava, Slovakia. The original study evaluated the impact of pharmacist-led interventions on DRPs. The study was conducted over a 12-month period, from September 2021 to August 2022, and enrolled patients admitted to vascular surgery ward. Due to ethical considerations, no control group was included. The study protocol and primary results have been previously published [33,49]. Setting and participants: In the original study, hospitalized patients admitted to the vascular surgery were eligible for inclusion if they met the following criteria: use of at least three medications, diagnosis of carotid artery disease and/or lower extremity artery disease, absence of mental disorders affecting memory or comprehension and provision of written informed consent. Older adults aged 65 years or older were retrieved for the subanalysis. Data collection: Patient data, including demographic, social, and healthcare information, were collected in an online database (MIA DMS), ensuring patient anonymity. All collected variables are explained in detail elsewhere [33,49,50]. Pharmacist-led intervention: Pharmacist-led intervention consisted of medication reconciliation followed by comprehensive medication review performed both at hospital admission and discharge. Interventions were communicated directly through verbal consultation with both physicians and patients. All pharmacist-led interventions were performed by trained clinical pharmacists, as described in the original study. DRPs, pharmacist interventions, and their acceptance were classified using the PCNE classification system, version 9.00 (2019) [51]. Patients’ understanding of their pharmacotherapy was assessed via a three-point scale, evaluating knowledge of the medication name, indication, and dosage [33,52). An average comprehension score was calculated for each medication, and patients were categorized into three levels of pharmacotherapy understanding: good (2–3 points), modest (1–2 points), and poor (0–1 point) [49]. Identification of potentially inappropriate medications: This subgroup analysis focused on detecting PIMs among elderly participants (aged ≥ 65 years) at both hospital admission and discharge. PIMs were identified using the EU(7)-PIM list as a validated tool that reflects European healthcare context and prescribing practices [14] Original study was conducted and reported in accordance with the Standards for Quality Improvement Reporting Excellence (SQUIRE) guidelines [53]. Sample size: In the original cohort, the sample size was calculated using G*Power software (version 3.1), with 80% power to detect a small effect size of 0.3 using a Wilcoxon signed-rank test, resulting in a required sample size of 94 patients. To account for potential dropouts, 120 patients were recruited [33]. The present subgroup analysis included 80 older patients (≥65 years) from the original cohort. Although the original study was powered for the entire sample, this subgroup analysis was conducted to explore the prevalence and characteristics of PIMs, and DRPs specifically in the geriatric population. Outcome measures: The primary outcomes of this subgroup analysis were the prevalence and types of PIMs and DRPs in older patients. Secondary outcomes included changes in the prevalence of PIMs and DRPs between hospital admission and discharge, acceptance rates of pharmacist interventions according to intervention type, and patients’ understanding of their pharmacotherapy assessed using the three-point comprehension scale. Statistical analysis: Statistical analyses were performed using GraphPad PRISM® [54] and MIA DMS [55] were used. Continuous variables are presented as the means with standard deviations, while categorical variables are expressed as frequencies and percentages. Comparison of the number of drugs, active substances, PIMs and DRPs between hospital admission and discharge were performed using the paired Wilcoxon signed-rank test due to non-normal data distribution. Normality of the distribution was tested using the Shapiro–Wilk test. Results Patient demographic data are summarized in Table 1. The study population comprised 80 older adults with a mean age of 71.4 ± 5.0 years. The majority were male (68.8%, n=55), with females accounting for 31.3% (n=25). The mean body mass index (BMI) was 27.1 ± 4.3 kg/m². Most participants lived with family or caregivers (77.5%), while 21.3% lived alone. The vast majority were pensioners (92.5%). Educational levels varied: 17.5% (n=14) had completed elementary school, 58.8% (n=47) had secondary education, and 15.0% (n=12) had university degrees; 8.8% (n=7) did not report their educational status. The mean CCI was 4.91 ± 1.80. Most patients had a CCI score ≥ 5 (53.8%, n=43), followed by scores between 3 and 4 (41.3%, n=33), and a small group had scores < 3 (5.0%, n=4). Table 1. Baseline Characteristics of Patients (CCI, Charlson Comorbidity Index; SD, standard deviation) Population (n=80) Age (mean, SD) 71.38 ± 5 Sex Female 25 (31.25%) Male 55 (68.75%) BMI (mean, SD) 27.13 ± 4.26 Social status Lives with family/caregiver 62 (77.50%) Social service home, retirement home 1 (1.25%) Lives alone 17 (21.25%) Employment status Employed 5 (6.25%) Unemployed 1 (1.25%) Pensioners 74 (92.50%) Educational level Elementary school 14 (17.50%) High school 47 (58.75%) University 12 (15.00%) No answer 7 (8.75%) Charlson Comorbidity Index (mean, SD) 4.91 ± 1.80 Patients with CCI 5 drugs) 79 (98.75%) The study cohort exhibited a high prevalence of cardiovascular and metabolic comorbidities (Table 2.). Essential hypertension was the most frequent diagnosis, present in 88.75% of patients. Carotid artery disease and atherosclerosis were each observed in 61.25% of the population, while dyslipidaemia affected 56.25%. Type 2 diabetes mellitus was documented in 37.5% of patients. Chronic ischemic heart disease and nicotinism were present in approximately one-third of patients (31.25% and 32.5%, respectively). Additionally, transient cerebral ischemic attacks occurred in 26.25% of patients, vertebrogenic algic syndrome in 22.5%, and atrial fibrillation/flutter in 17.5%. Table 2. Most Common Diagnoses Among Patients (ICD, International Statistical Classification of Diseases and Related Health Problems) ICD-11 Diagnosis n % E11 Type 2 diabetes mellitus 30 37.50% E78 Dyslipidaemia 45 56.25% G45 Transient cerebral ischemic attacks 21 26.25% I10 Essential hypertension 71 88.75% I25 Chronic ischemic heart disease 25 31.25% I48 Atrial fibrillation and flutter 14 17.50% I65 Carotid artery disease 49 61.25% I70 Atherosclerosis 49 61.25% M53 Vertebrogenic algic syndrome 18 22.50% Z81 Nicotinism 26 32.50% In total, 301 DRPs were identified among 80 geriatric patients during the study period, corresponding to 3.76 DRPs per patient. The most frequent DRP types were related to treatment effectiveness (67.77%) and the risk of adverse drug events (16.61%). Regarding causes, the most common categories were “other” (C9), including no obvious cause and human error (C9.2, C9.3), and drug selection (C1), such as no indication for drug (C1.3) or incomplete drug treatment (C1.6). Regarding PIMs, a total of 275 PIMs were identified, corresponding to 3.44 PIMs per patient. The most frequently observed PIMs were proton pump inhibitors (PPI), present in 35.46% of patients at admission and 36.57% at discharge, followed by alpha-2-adrenoceptor agonists and imidazoline receptor agonists (Table 3.). Table 3. Most frequently observed PIMs (ATC, Anatomical Therapeutic Chemical Classification System) ATC Name of drug At admission At discharge A02BC Proton pump inhibitors 50 (35.46%) 49 (36.57%) A02BC02 Pantoprazole 46 (32.62%) 46 (34.33%) A02BC01 Omeprazole 4 (2.84%) 3 (2.24%) C02AC Imidazoline receptor agonists 10 (7.09%) 10 (7.46%) C02AC05 Moxonidine 6 (4.26%) 6 (4.48%) C02AC06 Rilmenidine 4 (2.84%) 4 (2.99%) C02CA Alpha2-adrenoreceptor agonists 14 (9.93%) 15 (11.19%) C02CA06 Urapidil 9 (6.38%) 10 (7.46%) C02CA04 Doxazosine 5 (3.55%) 5 (3.73%) N06DX02 Ginkgo biloba 8 (5.67%) 6 (4.48%) B01AF Direct factor Xa inhibitors 6 (4.26%) 5 (3.73%) B01AF02 Apixaban 4 (2.84%) 4 (2.99%) B01AF01 Rivaroxaban 2 (1.42%) 1 (0.75%) N02AJ13 Tramadol 6 (4.26%) 7 (5.22%) N05BA12 Alprazolam 5 (3.55%) 7 (5.22%) N06BX03 Piracetam 4 (2.84%) - Among the study population, the drugs most frequently associated with DRPs were atorvastatin, with a total of 35 DRPs, of which 21 were related to untreated symptoms or indications (P1.3), indicating that atorvastatin was missing from the patients’ therapy when it should have been prescribed. Pantoprazole was associated with 26 DRPs, 17 of which were classified as unnecessary drug treatment (P3.2), suggesting that the drug was prescribed without a clear indication. Naftidrofuryl accounted for 19 DRPs, 14 of which were related to the effect of drug treatment not optimal (P1.2), reflecting suboptimal therapeutic dosage (Table 4.). Both cardiovascular medications and gastrointestinal drugs were frequent contributors to DRPs, with the majority related to treatment effectiveness and untreated indications, highlighting targets for intervention in geriatric pharmacotherapy. Table 4. Drugs with the most DRPs and their most frequently associated problems (DRP, drug-related problem) ATC Active substance Total number of DRP Most frequently associated problem C10AA05 atorvastatin 35 P1.3 Untreated symptoms or indication 21 A02BC02 pantoprazol 26 P3.2 Unnecessary drug treatment 17 C04AX21 naftidrofuryl 19 P1.2 Effect of drug treatment not optimal 14 N06BX18 vinpocetine 10 P1.3 Untreated symptoms or indication 5 A10BA02 metformin 8 P2.1 Adverse drug event (possibly) occurring 4 B01AC06 acetylsalicylic acid 8 P1.2 Effect of drug treatment not optimal 5 C07AB07 bisoprolol 8 P1.2 Effect of drug treatment not optimal 5 B01AB11 sulodexid 6 P1.2 Effect of drug treatment not optimal 2 P1.3 Untreated symptoms or indication 2 C07AB02 metoprolol 6 P1.2 Effect of drug treatment not optimal 4 N05BA12 alprazolam 6 P1.3 Untreated symptoms or indication 4 C03CA01 furosemide 5 P1.2 Effect of drug treatment not optimal 2 P2.1 Adverse drug event (possibly) occurring 2 C08CA01 amlodipine 5 P1.1 No effect of drug treatment despite correct use 4 N02BB02 metamizol 5 P1.3 Untreated symptoms or indication 4 R03DA04 theophylline 5 P1.3 Untreated symptoms or indication 4 The mean number of drugs per patient decreased slightly from admission to discharge (10.78 ± 3.70 vs. 10.14 ± 3.82; p = 0.012), and the mean number of DRPs per patient was significantly reduced from 2.26 ± 2.12 at admission to 1.51 ± 1.88 at discharge (p = 0.003). No statistically significant changes were observed for the number of active substances or PIMs per patient (Table 5.). Table 5. Comparison of medication use and DRPs at admission and discharge (DRP, drug-related problem; PIM – potentially inappropriate drug; SD, standard deviation) At admission At discharge Statistical significance No. of drugs per patient (mean, SD) 10.78 ± 3.70 10.14 ± 3.82 0.012 No. of active substances per patient (mean, SD) 12.11 ± 4.31 11.53 ± 4.52 0.085 No. of DRPs per patient (mean, SD) 2.26 ± 2.12 1.51 ± 1.88 0.003 No. of PIMs per patient (mean, SD) 1.76 ± 1.32 1.68 ± 1.25 0.477 Most pharmacist interventions were accepted (Table 6.), accounting for nearly 60% of all recommendations, particularly those addressing treatment effectiveness issues (P1). In total, 38 interventions (12.6%) were not accepted, while 83 interventions (27.6%) had an unknown outcome. Interventions targeting treatment safety (P2) and other DRPs (P3) contributed to these numbers, highlighting that although the majority of recommendations were implemented, a significant proportion remained unaccepted or of unknown status, indicating opportunities for improved follow-up and clinical decision-making. Table 6. Acceptance of Pharmacist Interventions by DRP Type Intervention accepted Intervention not accepted Unknown status P1 Treatment effectiveness (no effect, not optimal effect, untreated symptom) 140 (46.51%) 26 (8.64%) 38 (12.62%) P2 Treatment safety (adverse drug event) 24 (7.97%) 2 (0.66%) 24 (7.97%) P3 Other (unnecessary treatment, other) 16 (5.32%) 10 (3.32%) 21 (6.98%) Patients demonstrated varying levels of understanding of their pharmacotherapy. The best knowledge was observed in relation to the dosage of their medications, with an average score of 0.59. This was followed by knowledge of the indication for use (mean: 0.53), while knowledge of the medication name was the lowest (mean: 0.49). These findings suggest that while patients tend to remember how to take their medications and why they were prescribed, they are less familiar with the actual names of the drugs. When evaluating overall pharmacotherapy knowledge, patients were categorized into three levels based on their total scores. A total of 25.00% of patients scored below 1, indicating a poor understanding of their treatment. Another 26.25% scored between 1 and 2, representing a moderate level of understanding. Notably, 48.75% of patients achieved scores above 2, reflecting a very good understanding of their pharmacotherapy. Among the 80 patients included in the study, the vast majority - 69 individuals (86.25%) - reported that they personally prepare and are responsible for managing their medications. A smaller subset of patients (13.75%, n=11) rely on caregivers, typically family members, to assist with medication management. Despite this high level of self-management, only 30 patients (47.5%) use a drug organizer to aid in adherence and proper administration. Concomitant use of OTC medications alongside prescribed drugs was common, with 65% of patients (52 out of 80) reporting regular use of OTC products. Interestingly, most patients (88.75%, n=71) avoided commonly cautioned herbal supplements such as teas or OTC products containing Hypericum perforatum, which is known for potential interactions with numerous medications. However, a notable proportion - 35% (28 patients) -consumed grapefruit or pomelo, substances that can also significantly affect the metabolism of various drugs through cytochrome P450 enzyme inhibition. Discussion Older adults represent a particularly vulnerable patient population due to age-related physiological changes, increased frailty, and reduced functional reserve [56]. Polymorbidity was highly prevalent in this population, with more than half of the patients presenting a Charlson Comorbidity Index greater than five, reflecting a substantial burden of chronic disease. Polymorbidity itself represents an independent risk factor for adverse outcomes in older adults and often necessitates complex pharmacotherapy, thereby further increasing the risk of DRPs [27,57]. The most frequently observed comorbidities included hypertension, hyperlipidaemia, and type 2 diabetes mellitus, along with conditions commonly associated with these diseases. Optimal management of these chronic conditions is essential to achieve favorable clinical outcomes, particularly in elderly patients; however, treatment regimens often require multiple medications. While appropriately managed pharmacotherapy may provide significant therapeutic benefit, it simultaneously represents a major source of potential harm when drug regimens are complex or inadequately optimized [27,57,58]. In addition, hospitalization itself constitutes a critical period associated with an increased frequency of DRPs due to therapy modifications, transitions of care, and the introduction of new medications [20,25–27]. In view of the considerable polymorbidity among these patients, the widespread occurrence of polypharmacy is to be expected. Polypharmacy poses significant clinical challenges, as inappropriate pharmacotherapy may lead to serious adverse outcomes with potentially severe consequences [5,23,58,59]. In our study population, the mean age was 71.38 ± 5 years, and nearly all patients (98.75%) were exposed to polypharmacy. Furthermore, the mean number of medications at hospital admission exceeded ten, indicating the presence of hyper-polypharmacy, which has been associated with more various adverse health outcomes [60]. DRPs are highly prevalent among older adults [10], particularly in hospitalized patients [25,27], due to age-related physiological changes, polypharmacy, polymorbidity, and frequent modifications of pharmacotherapy during hospitalization [56]. In our study, the mean number of DRPs per patient was 2.26 ± 2.12. The mean number of DRPs per patient in our study (2.26) is very similar to that reported by Czech colleagues [61], but higher to that reported in Spain [34]. However, in similar studies overall, the number and types of DRPs vary considerably, largely due to differences in classification and assessment methods. The clinical consequences of DRPs vary widely, ranging from mild and transient complications to severe adverse outcomes, including adverse drug reactions, increased risk of rehospitalization, prolonged hospital stay, and, in some cases, mortality The most frequently identified DRP categories in our cohort were related to treatment effectiveness (67.77%) and the risk of adverse drug events (16.61%), underscoring the dual challenge of achieving optimal therapeutic outcomes while minimizing harm in older patients. Age-related physiological changes significantly alter pharmacokinetics and pharmacodynamics in older adults, thereby influencing both the effectiveness and safety of pharmacotherapy [56]. As a result, several active substances are classified as PIMs for use in this population [14,16,17]. Multiple explicit criteria and PIM lists have been developed to support safer prescribing; among these, the EU-PIM(7) list is one of the most widely accepted and validated tools used in European clinical practice [14]. The use of PIMs is associated with numerous adverse outcomes, including an increased risk of adverse drug reactions, functional decline, falls, hospitalization, and mortality [62]. In our study population, the mean number of PIMs per patient at hospital admission was 1.76 ± 1.32. Pharmacist-led interventions did not result in a statistically significant reduction in the number of PIMs per patient. However, the identification, continuous monitoring, and regular reassessment of the clinical appropriateness and ongoing necessity of these medications remain crucial, as some PIMs may be temporarily justified under specific clinical circumstances. Therefore, PIM management in older adults should focus not only on deprescribing but also on individualized risk–benefit evaluation and timely reassessment throughout the course of treatment. With regard to the active substances most frequently involved in DRPs, atorvastatin was associated with the highest number of identified DRPs, predominantly at the time of hospital admission. Statins, and lipid-lowering agents in general, play a central role in the management of cardiovascular patients by reducing cardiovascular risk and preventing the progression of associated comorbidities [63]. Despite robust evidence supporting their efficacy and safety, statins are frequently omitted from patients’ pharmacotherapy [64,65]. In contrast, PPIs were also commonly associated with DRPs, primarily due to their widespread initiation during hospitalization to reduce the risk of stress-related gastrointestinal complications [66–68]. However, PPIs are often continued beyond the period of clinical indication, contributing to their well-documented overuse across all age groups. Although PPIs are characterized by a favorable pharmacokinetic profile, long-term use has been associated with several adverse outcomes, including impaired absorption of electrolytes and micronutrients, as well as an increased risk of Clostridioides difficile infection [66–68]. These findings highlight both underuse of evidence-based therapies, such as statins, and overuse of preventive medications, such as PPIs, as important and contrasting contributors to DRPs in older hospitalized patients. With regard to PIMs, PPIs were the most frequently identified PIMs in our study population. In older adults, long-term PPI use is associated with reduced calcium absorption—particularly calcium carbonate—and an increased risk of hip, vertebral, and wrist fractures [69,70]. Except for patients with clear indications, such as chronic nonsteroidal anti-inflammatory drug use, Barrett’s esophagus, or erosive esophagitis, PPI therapy beyond eight weeks is generally considered inappropriate in older adults [69]. Another commonly identified PIM group consisted of centrally acting antihypertensive agents, particularly imidazoline receptor agonists and alpha-2 adrenoreceptor agonists. These drugs exert centrally mediated sympathetic inhibition and are associated with sedation, cognitive impairment, bradycardia, and orthostatic hypotension, thereby substantially increasing fall risk in the geriatric population [71]. Additionally, the use of tramadol and alprazolam was observed; both agents are associated with a high risk of central nervous system depression, cognitive impairment, delirium, sedation, falls, and fractures [72,73]. Tramadol further carries the potential for serotonergic toxicity and respiratory depression [72]. Taken together, these findings underscore the importance of regular medication review, individualized risk–benefit assessment, and targeted deprescribing strategies to minimize medication-related harm in older patients. Numerous strategies have been proposed to reduce the occurrence of DRPs and PIMs in older patients, including systematic medication review, obtaining the best possible medication history, medication reconciliation during transitions of care, and regular reassessment of pharmacotherapy [74–78]. Pharmacists are key healthcare professionals involved in delivering these activities. Across Europe and worldwide, various models of pharmacist-led clinical services have been implemented. Despite differences in organisation, there is broad consensus that pharmacists are becoming integral members of interdisciplinary healthcare teams, particularly in the management of cardiovascular diseases [47,48,79], chronic kidney disease [44–46], and other complex conditions [39–43,80]. Consistent with findings from previous hospital-based studies, pharmacist-led interventions in our study resulted in a statistically significant reduction in the number of DRPs. In addition, a significant decrease in the total number of medications per patient was observed, although the number of active substances remained unchanged. This finding may be attributed to pharmacotherapy optimization strategies, including the recommendation of fixed-dose combination products (polypills), which reduce pill burden while maintaining therapeutic coverage and may contribute to improved medication adherence. A growing body of evidence demonstrates that pharmacist–physician collaboration can optimize pharmacotherapy, reduce medication-related complications and adverse drug reactions, decrease hospital readmissions, prevent patient harm, and lower healthcare costs [74–78]. Nevertheless, the implementation and integration of pharmacist-led clinical activities vary considerably across healthcare systems, and professional trust develops at different rates. This variability is reflected in our findings, as not all pharmacist-proposed interventions were accepted by physicians. Importantly, the acceptance rate observed in our study suggests that interdisciplinary cooperation is established but not yet optimal, highlighting opportunities for further improvement. Increasing evidence also indicates that the inclusion of pharmacists in clinical decision-making related to pharmacotherapy may help address workforce shortages in healthcare systems, particularly the growing shortage of physicians [81]. Following the optimization of pharmacotherapy, patient-related factors represent a key determinant of therapeutic success [82,83]. Numerous studies have demonstrated that medication adherence is influenced by multiple variables, including sex, age, educational level, and, importantly, the patient’s understanding of their treatment regimen [31,82,83]. There is substantial evidence indicating a strong association between patients’ understanding of pharmacotherapy, medication adherence, and clinical outcomes [31,82]. In our study, patient understanding was assessed using a recently optimized three-point scale, which revealed that nearly half of the patients (48.75%) demonstrated good understanding of their pharmacotherapy. However, a considerable proportion of patients (25%) exhibited low levels of understanding, highlighting the need for targeted educational interventions. Education led by healthcare professionals has the potential to positively influence patient attitudes, improve adherence, and enhance treatment outcomes. In this context, pharmacist-led educational interventions have proven particularly effective across various therapeutic areas, including anticoagulant therapy, immunosuppressive treatment, chronic kidney disease management, and oncology, demonstrating significant improvements in medication safety and adherence [84,85]. Our findings indicate that the vast majority of geriatric patients in this cohort manage their medications independently, highlighting a high degree of autonomy in daily pharmacotherapy. However, despite this self-management, less than half of the patients utilize medication aids such as drug organizers, which are known to improve adherence and reduce errors [86]. This gap suggests a potential vulnerability in this population, as advanced age, polypharmacy, and age-related cognitive or sensory changes may increase the risk of missed doses, incorrect administration, or adverse drug events [86–88]. The relatively small proportion of patients relying on caregivers further underscores the importance of interventions that support safe self-management, including education, simplified regimens, and the use of adherence tools. These findings align with previous studies emphasizing that self-reliance in medication management does not necessarily equate to safe or optimal adherence in older adults. The high prevalence of OTC medication use in this cohort—reported by 65% of patients—highlights an important, yet often underrecognized, source of potential DRPs in older adults [89,90]. While most patients avoided high-risk herbal products such as Hypericum perforatum [91], a significant proportion consumed grapefruit or pomelo, which are known to inhibit cytochrome P450 enzymes and potentially alter the metabolism of multiple prescription drugs [92]. Such practices increase the risk of adverse drug reactions, therapeutic failure, or potentiation of pharmacologic effects, particularly when combined with potentially inappropriate medications [91,92]. These findings underscore the need for comprehensive medication reconciliation that includes both prescribed and OTC products, with active patient engagement and counseling. Pharmacists in community and hospital settings are ideally positioned to facilitate this process, ensuring a complete medication history is obtained, identifying potential interactions, and providing guidance on safe and effective use of all medications, including OTC products. Conclusions Older hospitalized adults with polymorbidity and polypharmacy represent a population at particularly high risk of drug-related problems and suboptimal therapeutic outcomes. Our findings confirm that pharmacotherapy in this group is frequently complex, associated with both underuse of evidence-based treatments and overuse or prolonged use of potentially inappropriate medications. These challenges are further amplified during hospitalization, when frequent therapy changes and transitions of care increase the likelihood of medication-related harm. Pharmacist-led clinical activities proved to be an effective strategy for addressing these risks. The integration of pharmacists into the multidisciplinary team resulted in a significant reduction in the number of DRPs and contributed to optimisation of pharmacotherapy through medication review, reconciliation, deprescribing where appropriate, and regimen simplification. Beyond improving safety and treatment effectiveness, pharmacist involvement also supported better patient understanding of therapy and promoted adherence, both of which are essential determinants of long-term clinical outcomes in older adults. Importantly, the expanding clinical role of pharmacists has implications that extend beyond medication safety. In the context of increasing demand for healthcare services and a persistent shortage of healthcare professionals - particularly physicians - pharmacists represent a highly qualified and underutilised resource. By assuming responsibility for structured medication management, patient education, and ongoing pharmacotherapy monitoring, pharmacists can alleviate part of the workload traditionally borne by physicians. This collaborative model enables more efficient use of available healthcare capacity, supports continuity of care, and helps maintain high-quality pharmacotherapy even in resource-constrained settings. Overall, our findings reinforce the value of pharmacist–physician collaboration as a key component of modern hospital care. Systematic involvement of clinical pharmacists in the care of older patients has the potential not only to optimize pharmacotherapy and reduce medication-related harm, but also to strengthen healthcare systems by mitigating workforce shortages and improving the efficiency of interdisciplinary care. Wider implementation of pharmacist-led clinical services should therefore be considered an essential strategy for improving patient outcomes and ensuring sustainable healthcare delivery in ageing populations. Limitations: This study has several limitations. First, it was conducted at a single tertiary-care center, which may limit the generalizability of findings to other settings or populations. Although the original cohort included 120 patients, this sub-analysis focused on 80 older adults, potentially reducing statistical power. The lack of a control group limits causal inference regarding the impact of pharmacist-led interventions, although ethical considerations informed this design. Patients’ understanding of pharmacotherapy was assessed using a simple three-point scale, which may be subject to recall bias or interviewer influence. Lastly, data on OTC and herbal product use relied on self-reporting and may have been underreported. Abbreviations BMI - Body Mass Index CCI - Charlson Comorbidity Index DRP - Drug-Related Problem OTC - Over The Counter Drug PCNE - Pharmaceutical Care Network Europe PIM - Potentially Inappropriate Drug PPI - Proton Pump Inhibitor SD – standard deviaton Declarations Competing Interests The study was conducted without external funding and received approval from the Ethics Committee of the National Institute of Cardiovascular Diseases. Acknowledgements: Not applicable Author's contribution: All authors contributed equally to the study conception and design. All authors read and approved the final manuscript. TT is responsible for the overall content as the guarantor. Data availability: Access to all patient data was limited exlusively to the investigators at the National Institute of Cardiovascular Diseases. The research team maintained a detailed and accurate registry of all study participants, including the alphanumeric identification codes assigned to each individual, as documented in the “Participant Identification Sheet.” Both the completed identification sheets and all study-related data were stored securely. Only anonymized personal data were entered into the case report form within the online database MIA DMS, and access was limited to the investigators. The datasets used and analyzed during the study are available from the corresponding author upon reasonable request. Declarations: The study was approved by the Ethics Committee of the National Institute of Cardiovascular Diseases (Approval Number 1625/21, dated 26th May 2021) and registered at ClinicalTrials.gov (Trial Registration Number NCT04930302, dated 16th June 2021). 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CMAJ Can Med Assoc J. 2013;185(4):309-316; https://doi.org/10.1503/cmaj.120951 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 09 Apr, 2026 Reviews received at journal 08 Apr, 2026 Reviewers agreed at journal 29 Mar, 2026 Reviewers invited by journal 27 Mar, 2026 Editor assigned by journal 09 Mar, 2026 Submission checks completed at journal 09 Mar, 2026 First submitted to journal 08 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9063248","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":613954251,"identity":"bd277a17-dc39-4891-a921-3a30c6b04db6","order_by":0,"name":"Kristína Szmicseková","email":"","orcid":"","institution":"National Institute of Cardiovascular Diseases","correspondingAuthor":false,"prefix":"","firstName":"Kristína","middleName":"","lastName":"Szmicseková","suffix":""},{"id":613954252,"identity":"64a3fa90-eb18-410a-b2ec-a9409f3efa06","order_by":1,"name":"Slávka Porubcová","email":"","orcid":"","institution":"National Institute of Cardiovascular Diseases","correspondingAuthor":false,"prefix":"","firstName":"Slávka","middleName":"","lastName":"Porubcová","suffix":""},{"id":613954254,"identity":"b50904c6-36fd-4711-b276-725b842e9af8","order_by":2,"name":"Veronika Slezáková","email":"","orcid":"","institution":"National Institute of Cardiovascular Diseases","correspondingAuthor":false,"prefix":"","firstName":"Veronika","middleName":"","lastName":"Slezáková","suffix":""},{"id":613954256,"identity":"f17eaf90-295a-4140-9923-5a83f0050a63","order_by":3,"name":"Kristína Lajtmanová","email":"","orcid":"","institution":"National Institute of Cardiovascular Diseases","correspondingAuthor":false,"prefix":"","firstName":"Kristína","middleName":"","lastName":"Lajtmanová","suffix":""},{"id":613954257,"identity":"ac086607-9896-48c6-9a01-aca86ff1704e","order_by":4,"name":"Ján Tomka","email":"","orcid":"","institution":"National Institute of Cardiovascular Diseases","correspondingAuthor":false,"prefix":"","firstName":"Ján","middleName":"","lastName":"Tomka","suffix":""},{"id":613954259,"identity":"90cfcdc4-bedf-4837-b261-d6a8992718fd","order_by":5,"name":"Ľubica Lehocká","email":"","orcid":"","institution":"Faculty of Pharmacy, Comenius University","correspondingAuthor":false,"prefix":"","firstName":"Ľubica","middleName":"","lastName":"Lehocká","suffix":""},{"id":613954260,"identity":"584fc748-0161-4e4d-9450-8bbd02525df7","order_by":6,"name":"Zuzana Koblišková","email":"","orcid":"","institution":"Faculty of Pharmacy, Comenius University","correspondingAuthor":false,"prefix":"","firstName":"Zuzana","middleName":"","lastName":"Koblišková","suffix":""},{"id":613954261,"identity":"d18c8822-435a-41ab-9501-8ff493815b77","order_by":7,"name":"Lucia Masaryková","email":"","orcid":"","institution":"Faculty of Pharmacy, Comenius University","correspondingAuthor":false,"prefix":"","firstName":"Lucia","middleName":"","lastName":"Masaryková","suffix":""},{"id":613954262,"identity":"cf0c6547-06b9-4b07-a13f-1dfeb014a9c8","order_by":8,"name":"Tomáš Tesař","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5ElEQVRIiWNgGAWjYNCCCjkGAyiTB8RgbMCjmAdMnjEmVQtjG0ILA0Et9uztDz9XzjPIM2c/+3QDY9sdGXP2A8wfZ+CzheeMseTZbQbFlj3pZjcY257xWPYksEluwKdFIodBsnHbn8QNB9LYgFoO8xgcSGBjfIBPi/zzxz8b5xgkbjj/DKrl/APmj3i1SDCYSTY2ALXcgNlyI4EBv8PO5JhZNhwzKDa4AbQl4dxhHssZD9sk8Xmfvf3445sNNQZ5BueBtnwoO2xvzp98+GMPHi0wkIBE4o0VdC2jYBSMglEwCrABAHoEUQvPYW5ZAAAAAElFTkSuQmCC","orcid":"","institution":"Faculty of Pharmacy, Comenius University","correspondingAuthor":true,"prefix":"","firstName":"Tomáš","middleName":"","lastName":"Tesař","suffix":""}],"badges":[],"createdAt":"2026-03-08 09:38:43","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9063248/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9063248/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":105744664,"identity":"ff210095-c23d-450f-a20b-9d7118edbcc8","added_by":"auto","created_at":"2026-03-30 13:59:06","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1403864,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9063248/v1/f275d909-6479-456c-a4ed-614981245729.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Drug-related problems in geriatric cardiovascular patients – a hospital setting","fulltext":[{"header":"Background","content":"\u003cp\u003eThe World Health Organization defines polypharmacy as \"the concurrent use of multiple medications\" [1]. While there is no universally accepted threshold, polypharmacy is frequently characterized by the regular use of five or more medications, including prescription drugs, over-the-counter (OTC) products, and traditional or complementary medicines [2,3]. Although widely used, the term \"polypharmacy\" lacks precision, and its definition remains a topic of ongoing debate. Reported prevalence varies widely depending on the patient population, healthcare setting, geographical region, and definitional criteria applied [3,4].\u003c/p\u003e \u003cp\u003ePolypharmacy in older adults has been consistently linked to a range of adverse clinical outcomes, such as frailty, increased risk of hospitalization, medication non-adherence, cognitive impairment, falls, and even mortality [5–10]. Geriatric pharmacotherapy, when not appropriately managed, further increases the likelihood of such events due to age-associated changes in pharmacokinetics and pharmacodynamics [11–13].\u003c/p\u003e \u003cp\u003eThe complexity of prescribing in older adults has led to various tools to assess medication appropriateness. Notably, the EU-PIM list, along with the Beers Criteria, STOPP/START criteria, and FORTA list, are commonly used to identify potentially inappropriate medications (PIMs) in the geriatric population, which are associated with preventable adverse outcomes [14–17].\u003c/p\u003e \u003cp\u003eAccording to the Pharmaceutical Care Network Europe, a drug-related problem (DRP) is defined as \u003cem\u003e“an event or circumstance involving drug therapy that actually or potentially interferes with desired health outcomes”\u003c/em\u003e [18]. DRPs are highly prevalent in both inpatient and outpatient settings, especially among patients with polypharmacy, polymorbidity, and those of advanced age. Certain comorbidities, such as cardiovascular disease and chronic kidney disease, further increase the likelihood of DRPs [10,19–22]. Recent estimates indicate that the prevalence of polypharmacy among older adults was approximately 37% as of 2022 [23]. While well-managed polypharmacy can be clinically appropriate, it remains a significant risk factor for DRPs and medication-related harm [24–26].\u003c/p\u003e \u003cp\u003eHospitalization is a critical period during which older adults are particularly vulnerable to DRPs [20,25–27]. Additionally, transitions of care—such as admission to or discharge from hospital—represent high-risk periods for medication discrepancies, adverse drug events, and therapeutic failures [28,29). These problems frequently lead to longer hospital stays, increased healthcare costs, suboptimal pharmacotherapy, and adverse clinical outcomes [24–26].\u003c/p\u003e \u003cp\u003eGiven these risks, several strategies have been proposed to reduce the incidence of DRPs. One of the most effective is the integration of pharmacists into multidisciplinary care teams [30–32]. Pharmacist-led interventions—including medication reconciliation, medication history taking, clinical medication reviews, use of prescribing support tools, and active participation in ward rounds—have demonstrated significant benefits. Studies have shown that pharmacists can reduce the number of PIMs, minimize drug interactions, and improve overall pharmacotherapy safety [18,33–37]. For example, a systematic review by Mekonnen et al. (2016) found that pharmacist-led medication reconciliation reduced medication discrepancies by up to 67% [35]. Collaboration between pharmacists, physicians, and nurses has been shown to improve clinical outcomes, particularly in vulnerable populations such as the elderly, patients with chronic diseases (e.g., cardiovascular conditions, chronic kidney disease, oncology patients, and those admitted to intensive care units [33,38–48].\u003c/p\u003e \u003cp\u003eThe high rate of potentially inappropriate prescribing in older adults, combined with the rapid growth of the aging population, presents serious challenges—mainly due to polypharmacy and the increased risk of drug-related problems. Giving pharmacists a clearer and more consistent role in hospital care for older patients could help tackle these issues by improving medication safety, adherence, and overall treatment outcomes. In the initial PHAROS study, we found that vascular surgery patients experience a substantial number of DRPs. In the present subgroup analysis, we focus specifically on patients aged ≥ 65 years, as this population is particularly vulnerable to inappropriate prescribing and its consequences.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis study represents a post hoc subgroup analysis of data derived from a single-center, prospective, uncontrolled study conducted at the National Institute of Cardiovascular Diseases in Bratislava, Slovakia. The original study evaluated the impact of pharmacist-led interventions on DRPs. The study was conducted over a 12-month period, from September 2021 to August 2022, and enrolled patients admitted to vascular surgery ward. Due to ethical considerations, no control group was included. The study protocol and primary results have been previously published [33,49].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSetting and participants:\u003c/strong\u003e In the original study, hospitalized patients admitted to the vascular surgery were eligible for inclusion if they met the following criteria: use of at least three medications, diagnosis of carotid artery disease and/or lower extremity artery disease, absence of mental disorders affecting memory or comprehension and provision of written informed consent. Older adults aged 65 years or older were retrieved for the subanalysis.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection:\u003c/strong\u003e Patient data, including demographic, social, and healthcare information, were collected in an online database (MIA DMS), ensuring patient anonymity. All collected variables are explained in detail elsewhere [33,49,50].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePharmacist-led intervention:\u003c/strong\u003e Pharmacist-led intervention consisted of medication reconciliation followed by comprehensive medication review performed both at hospital admission and discharge. Interventions were communicated directly through verbal consultation with both physicians and patients. All pharmacist-led interventions were performed by trained clinical pharmacists, as described in the original study. DRPs, pharmacist interventions, and their acceptance were classified using the PCNE classification system, version 9.00 (2019) [51].\u0026nbsp;Patients’ understanding of their pharmacotherapy was assessed via a three-point scale, evaluating knowledge of the medication name, indication, and dosage\u0026nbsp;[33,52). An average comprehension score was calculated for each medication, and patients were categorized into three levels of pharmacotherapy understanding: good (2–3 points), modest (1–2 points), and poor (0–1 point)\u0026nbsp;[49].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIdentification of potentially inappropriate medications:\u003c/strong\u003e This subgroup analysis focused on detecting PIMs among elderly participants (aged ≥ 65 years) at both hospital admission and discharge. PIMs were identified using the EU(7)-PIM list as a validated tool that reflects European healthcare context and prescribing practices [14]\u003c/p\u003e\n\u003cp\u003eOriginal study was conducted and reported in accordance with the Standards for Quality Improvement Reporting Excellence (SQUIRE) guidelines [53].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample size:\u003c/strong\u003e In the original cohort, the sample size was calculated using G*Power software (version 3.1), with 80% power to detect a small effect size of 0.3 using a Wilcoxon signed-rank test, resulting in a required sample size of 94 patients. To account for potential dropouts, 120 patients were recruited [33]. The present subgroup analysis included 80 older patients (≥65 years) from the original cohort. Although the original study was powered for the entire sample, this subgroup analysis was conducted to explore the prevalence and characteristics of PIMs, and DRPs specifically in the geriatric population.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOutcome measures:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe primary outcomes of this subgroup analysis were the prevalence and types of PIMs and DRPs in older patients. Secondary outcomes included changes in the prevalence of PIMs and DRPs between hospital admission and discharge, acceptance rates of pharmacist interventions according to intervention type, and patients’ understanding of their pharmacotherapy assessed using the three-point comprehension scale.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis:\u003c/strong\u003e Statistical analyses were performed using GraphPad PRISM® [54] and MIA DMS [55] were used. Continuous variables are presented as the means with standard deviations, while categorical variables are expressed as frequencies and percentages. Comparison of the number of drugs, active substances, PIMs and DRPs between hospital admission and discharge were performed using the paired Wilcoxon signed-rank test due to non-normal data distribution. Normality of the distribution was tested using the Shapiro–Wilk test.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003ePatient demographic data are summarized in Table 1. The study population comprised 80 older adults with a mean age of 71.4 \u0026plusmn; 5.0 years. The majority were male (68.8%, n=55), with females accounting for 31.3% (n=25). The mean body mass index (BMI) was 27.1 \u0026plusmn; 4.3 kg/m\u0026sup2;. Most participants lived with family or caregivers (77.5%), while 21.3% lived alone. The vast majority were pensioners (92.5%). Educational levels varied: 17.5% (n=14) had completed elementary school, 58.8% (n=47) had secondary education, and 15.0% (n=12) had university degrees; 8.8% (n=7) did not report their educational status. The mean CCI was 4.91 \u0026plusmn; 1.80. Most patients had a CCI score \u0026ge; 5 (53.8%, n=43), followed by scores between 3 and 4 (41.3%, n=33), and a small group had scores \u0026lt; 3 (5.0%, n=4).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1. Baseline Characteristics of Patients (CCI, Charlson Comorbidity Index; SD, standard deviation)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"602\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 349px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 253px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePopulation (n=80)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 349px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (mean, SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 253px;\"\u003e\n \u003cp\u003e71.38 \u0026plusmn; 5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 349px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 253px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 349px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 253px;\"\u003e\n \u003cp\u003e25 (31.25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 349px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 253px;\"\u003e\n \u003cp\u003e55 (68.75%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 349px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBMI (mean, SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 253px;\"\u003e\n \u003cp\u003e27.13 \u0026plusmn; 4.26\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 349px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSocial status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 253px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 349px;\"\u003e\n \u003cp\u003eLives with family/caregiver\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 253px;\"\u003e\n \u003cp\u003e62 (77.50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 349px;\"\u003e\n \u003cp\u003eSocial service home, retirement home\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 253px;\"\u003e\n \u003cp\u003e1 (1.25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 349px;\"\u003e\n \u003cp\u003eLives alone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 253px;\"\u003e\n \u003cp\u003e17 (21.25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 349px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEmployment status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 253px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 349px;\"\u003e\n \u003cp\u003eEmployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 253px;\"\u003e\n \u003cp\u003e5 (6.25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 349px;\"\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 253px;\"\u003e\n \u003cp\u003e1 (1.25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 349px;\"\u003e\n \u003cp\u003ePensioners\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 253px;\"\u003e\n \u003cp\u003e74 (92.50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 349px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducational level\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 253px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 349px;\"\u003e\n \u003cp\u003eElementary school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 253px;\"\u003e\n \u003cp\u003e14 (17.50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 349px;\"\u003e\n \u003cp\u003eHigh school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 253px;\"\u003e\n \u003cp\u003e47 (58.75%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 349px;\"\u003e\n \u003cp\u003eUniversity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 253px;\"\u003e\n \u003cp\u003e12 (15.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 349px;\"\u003e\n \u003cp\u003eNo answer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 253px;\"\u003e\n \u003cp\u003e7 (8.75%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 349px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharlson Comorbidity Index (mean, SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 253px;\"\u003e\n \u003cp\u003e4.91 \u0026plusmn; 1.80\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 349px;\"\u003e\n \u003cp\u003ePatients with CCI \u0026lt; 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 253px;\"\u003e\n \u003cp\u003e4 (5.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 349px;\"\u003e\n \u003cp\u003ePatients with CCI 3 to 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 253px;\"\u003e\n \u003cp\u003e33 (41.25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 349px;\"\u003e\n \u003cp\u003ePatients with CCI \u0026ge; 5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 253px;\"\u003e\n \u003cp\u003e43 (53.75%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 349px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePolypharmacy (\u0026gt;5 drugs)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 253px;\"\u003e\n \u003cp\u003e79 (98.75%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThe study cohort exhibited a high prevalence of cardiovascular and metabolic comorbidities (Table 2.). Essential hypertension was the most frequent diagnosis, present in 88.75% of patients. Carotid artery disease and atherosclerosis were each observed in 61.25% of the population, while dyslipidaemia affected 56.25%. Type 2 diabetes mellitus was documented in 37.5% of patients. Chronic ischemic heart disease and nicotinism were present in approximately one-third of patients (31.25% and 32.5%, respectively). Additionally, transient cerebral ischemic attacks occurred in 26.25% of patients, vertebrogenic algic syndrome in 22.5%, and atrial fibrillation/flutter in 17.5%.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. Most Common Diagnoses Among Patients (ICD, International Statistical Classification of Diseases and Related Health Problems)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"482\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eICD-11\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiagnosis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003eE11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 198px;\"\u003e\n \u003cp\u003eType 2 diabetes mellitus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e37.50%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003eE78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 198px;\"\u003e\n \u003cp\u003eDyslipidaemia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e56.25%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003eG45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 198px;\"\u003e\n \u003cp\u003eTransient cerebral ischemic attacks\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e26.25%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003eI10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 198px;\"\u003e\n \u003cp\u003eEssential hypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e88.75%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003eI25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 198px;\"\u003e\n \u003cp\u003eChronic ischemic heart disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e31.25%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003eI48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 198px;\"\u003e\n \u003cp\u003eAtrial fibrillation and flutter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e17.50%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003eI65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 198px;\"\u003e\n \u003cp\u003eCarotid artery disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e61.25%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003eI70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 198px;\"\u003e\n \u003cp\u003eAtherosclerosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e61.25%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003eM53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 198px;\"\u003e\n \u003cp\u003eVertebrogenic algic syndrome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e22.50%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003eZ81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 198px;\"\u003e\n \u003cp\u003eNicotinism\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e32.50%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eIn total, 301 DRPs were identified among 80 geriatric patients during the study period, corresponding to 3.76 DRPs per patient. The most frequent DRP types were related to treatment effectiveness (67.77%) and the risk of adverse drug events (16.61%). Regarding causes, the most common categories were \u0026ldquo;other\u0026rdquo; (C9), including no obvious cause and human error (C9.2, C9.3), and drug selection (C1), such as no indication for drug (C1.3) or incomplete drug treatment (C1.6).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRegarding PIMs, a total of 275 PIMs were identified, corresponding to 3.44 PIMs per patient. The most frequently observed PIMs were proton pump inhibitors (PPI), present in 35.46% of patients at admission and 36.57% at discharge, followed by alpha-2-adrenoceptor agonists and imidazoline receptor agonists (Table 3.).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3. Most frequently observed PIMs (ATC, Anatomical Therapeutic Chemical Classification System)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"605\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eATC\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 92px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 231px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eName of drug\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAt admission\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAt discharge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eA02BC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 92px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 231px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProton pump inhibitors\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e50 (35.46%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e49 (36.57%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 94px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003eA02BC02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 231px;\"\u003e\n \u003cp\u003ePantoprazole\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e46 (32.62%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e46 (34.33%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 94px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003eA02BC01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 231px;\"\u003e\n \u003cp\u003eOmeprazole\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e4 (2.84%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e3 (2.24%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eC02AC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 92px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 231px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eImidazoline receptor agonists\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e10 (7.09%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e10 (7.46%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 94px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003eC02AC05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 231px;\"\u003e\n \u003cp\u003eMoxonidine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e6 (4.26%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e6 (4.48%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 94px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003eC02AC06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 231px;\"\u003e\n \u003cp\u003eRilmenidine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e4 (2.84%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e4 (2.99%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eC02CA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 92px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 231px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAlpha2-adrenoreceptor agonists\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e14 (9.93%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e15 (11.19%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 94px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003eC02CA06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 231px;\"\u003e\n \u003cp\u003eUrapidil\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e9 (6.38%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e10 (7.46%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 94px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003eC02CA04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 231px;\"\u003e\n \u003cp\u003eDoxazosine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e5 (3.55%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e5 (3.73%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN06DX02\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 92px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 231px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGinkgo biloba\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e8 (5.67%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e6 (4.48%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eB01AF\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 92px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 231px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDirect factor Xa inhibitors\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e6 (4.26%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e5 (3.73%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 94px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003eB01AF02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 231px;\"\u003e\n \u003cp\u003eApixaban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e4 (2.84%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e4 (2.99%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 94px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003eB01AF01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 231px;\"\u003e\n \u003cp\u003eRivaroxaban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e2 (1.42%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e1 (0.75%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN02AJ13\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 92px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 231px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTramadol\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e6 (4.26%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e7 (5.22%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN05BA12\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 92px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 231px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAlprazolam\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e5 (3.55%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e7 (5.22%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN06BX03\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 92px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 231px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePiracetam\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4 (2.84%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAmong the study population, the drugs most frequently associated with DRPs were atorvastatin, with a total of 35 DRPs, of which 21 were related to untreated symptoms or indications (P1.3), indicating that atorvastatin was missing from the patients\u0026rsquo; therapy when it should have been prescribed. Pantoprazole was associated with 26 DRPs, 17 of which were classified as unnecessary drug treatment (P3.2), suggesting that the drug was prescribed without a clear indication. Naftidrofuryl accounted for 19 DRPs, 14 of which were related to the effect of drug treatment not optimal (P1.2), reflecting suboptimal therapeutic dosage (Table 4.).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBoth cardiovascular medications and gastrointestinal drugs were frequent contributors to DRPs, with the majority related to treatment effectiveness and untreated indications, highlighting targets for intervention in geriatric pharmacotherapy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4. Drugs with the most DRPs and their most frequently associated problems (DRP, drug-related problem)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"601\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eATC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eActive substance\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal number of DRP\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" colspan=\"2\" valign=\"top\" style=\"width: 365px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMost frequently associated problem\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003eC10AA05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003eatorvastatin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 300px;\"\u003e\n \u003cp\u003eP1.3 Untreated symptoms or indication\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003eA02BC02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003epantoprazol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 300px;\"\u003e\n \u003cp\u003eP3.2 Unnecessary drug treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003eC04AX21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003enaftidrofuryl\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 300px;\"\u003e\n \u003cp\u003eP1.2 Effect of drug treatment not optimal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003eN06BX18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003evinpocetine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 300px;\"\u003e\n \u003cp\u003eP1.3 Untreated symptoms or indication\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003eA10BA02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003emetformin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 300px;\"\u003e\n \u003cp\u003eP2.1 Adverse drug event (possibly) occurring\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003eB01AC06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003eacetylsalicylic acid\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 300px;\"\u003e\n \u003cp\u003eP1.2 Effect of drug treatment not optimal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003eC07AB07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003ebisoprolol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 300px;\"\u003e\n \u003cp\u003eP1.2 Effect of drug treatment not optimal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" rowspan=\"2\" valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003eB01AB11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" rowspan=\"2\" valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003esulodexid\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 300px;\"\u003e\n \u003cp\u003eP1.2 Effect of drug treatment not optimal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 300px;\"\u003e\n \u003cp\u003eP1.3 Untreated symptoms or indication\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003eC07AB02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003emetoprolol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 300px;\"\u003e\n \u003cp\u003eP1.2 Effect of drug treatment not optimal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003eN05BA12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003ealprazolam\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 300px;\"\u003e\n \u003cp\u003eP1.3 Untreated symptoms or indication\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" rowspan=\"2\" valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003eC03CA01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" rowspan=\"2\" valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003efurosemide\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 300px;\"\u003e\n \u003cp\u003eP1.2 Effect of drug treatment not optimal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 300px;\"\u003e\n \u003cp\u003eP2.1 Adverse drug event (possibly) occurring\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003eC08CA01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003eamlodipine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 300px;\"\u003e\n \u003cp\u003eP1.1 No effect of drug treatment despite correct use\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003eN02BB02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003emetamizol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 300px;\"\u003e\n \u003cp\u003eP1.3 Untreated symptoms or indication\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003eR03DA04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003etheophylline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 300px;\"\u003e\n \u003cp\u003eP1.3 Untreated symptoms or indication\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThe mean number of drugs per patient decreased slightly from admission to discharge (10.78 \u0026plusmn; 3.70 vs. 10.14 \u0026plusmn; 3.82; p = 0.012), and the mean number of DRPs per patient was significantly reduced from 2.26 \u0026plusmn; 2.12 at admission to 1.51 \u0026plusmn; 1.88 at discharge (p = 0.003). No statistically significant changes were observed for the number of active substances or PIMs per patient (Table 5.).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5. Comparison of medication use and DRPs at admission and discharge (DRP, drug-related problem; PIM \u0026ndash; potentially inappropriate drug; SD, standard deviation)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAt admission\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAt discharge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStatistical significance\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo. of drugs per patient (mean, SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e10.78 \u0026plusmn; 3.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e10.14 \u0026plusmn; 3.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e0.012\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo. of active substances per patient (mean, SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e12.11 \u0026plusmn; 4.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e11.53 \u0026plusmn; 4.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e0.085\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo. of DRPs per patient (mean, SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e2.26 \u0026plusmn; 2.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e1.51 \u0026plusmn; 1.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo. of PIMs per patient (mean, SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e1.76 \u0026plusmn; 1.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e1.68 \u0026plusmn; 1.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e0.477\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eMost pharmacist interventions were accepted (Table 6.), accounting for nearly 60% of all recommendations, particularly those addressing treatment effectiveness issues (P1). In total, 38 interventions (12.6%) were not accepted, while 83 interventions (27.6%) had an unknown outcome. Interventions targeting treatment safety (P2) and other DRPs (P3) contributed to these numbers, highlighting that although the majority of recommendations were implemented, a significant proportion remained unaccepted or of unknown status, indicating opportunities for improved follow-up and clinical decision-making.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 6. Acceptance of Pharmacist Interventions by DRP Type\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"595\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIntervention accepted\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIntervention not accepted\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUnknown status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP1 Treatment effectiveness (no effect, not optimal effect, untreated symptom)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e140 (46.51%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e26 (8.64%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e38 (12.62%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP2 Treatment safety (adverse drug event)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e24 (7.97%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e2 (0.66%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e24 (7.97%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP3 Other (unnecessary treatment, other)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e16 (5.32%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e10 (3.32%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e21 (6.98%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003ePatients demonstrated varying levels of understanding of their pharmacotherapy. The best knowledge was observed in relation to the dosage of their medications, with an average score of 0.59. This was followed by knowledge of the indication for use (mean: 0.53), while knowledge of the medication name was the lowest (mean: 0.49). These findings suggest that while patients tend to remember how to take their medications and why they were prescribed, they are less familiar with the actual names of the drugs.\u003c/p\u003e\n\u003cp\u003eWhen evaluating overall pharmacotherapy knowledge, patients were categorized into three levels based on their total scores. A total of 25.00% of patients scored below 1, indicating a poor understanding of their treatment. Another 26.25% scored between 1 and 2, representing a moderate level of understanding. Notably, 48.75% of patients achieved scores above 2, reflecting a very good understanding of their pharmacotherapy.\u003c/p\u003e\n\u003cp\u003eAmong the 80 patients included in the study, the vast majority - 69 individuals (86.25%) - reported that they personally prepare and are responsible for managing their medications. A smaller subset of patients (13.75%, n=11) rely on caregivers, typically family members, to assist with medication management. Despite this high level of self-management, only 30 patients (47.5%) use a drug organizer to aid in adherence and proper administration.\u003c/p\u003e\n\u003cp\u003eConcomitant use of OTC medications alongside prescribed drugs was common, with 65% of patients (52 out of 80) reporting regular use of OTC products. Interestingly, most patients (88.75%, n=71) avoided commonly cautioned herbal supplements such as teas or OTC products containing Hypericum perforatum, which is known for potential interactions with numerous medications. However, a notable proportion - 35% (28 patients) -consumed grapefruit or pomelo, substances that can also significantly affect the metabolism of various drugs through cytochrome P450 enzyme inhibition.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOlder adults represent a particularly vulnerable patient population due to age-related physiological changes, increased frailty, and reduced functional reserve [56]. Polymorbidity was highly prevalent in this population, with more than half of the patients presenting a Charlson Comorbidity Index greater than five, reflecting a substantial burden of chronic disease. Polymorbidity itself represents an independent risk factor for adverse outcomes in older adults and often necessitates complex pharmacotherapy, thereby further increasing the risk of DRPs [27,57]. The most frequently observed comorbidities included hypertension, hyperlipidaemia, and type 2 diabetes mellitus, along with conditions commonly associated with these diseases. Optimal management of these chronic conditions is essential to achieve favorable clinical outcomes, particularly in elderly patients; however, treatment regimens often require multiple medications. While appropriately managed pharmacotherapy may provide significant therapeutic benefit, it simultaneously represents a major source of potential harm when drug regimens are complex or inadequately optimized [27,57,58]. In addition, hospitalization itself constitutes a critical period associated with an increased frequency of DRPs due to therapy modifications, transitions of care, and the introduction of new medications [20,25\u0026ndash;27].\u003c/p\u003e \u003cp\u003eIn view of the considerable polymorbidity among these patients, the widespread occurrence of polypharmacy is to be expected. Polypharmacy poses significant clinical challenges, as inappropriate pharmacotherapy may lead to serious adverse outcomes with potentially severe consequences [5,23,58,59]. In our study population, the mean age was 71.38\u0026thinsp;\u0026plusmn;\u0026thinsp;5 years, and nearly all patients (98.75%) were exposed to polypharmacy. Furthermore, the mean number of medications at hospital admission exceeded ten, indicating the presence of hyper-polypharmacy, which has been associated with more various adverse health outcomes [60].\u003c/p\u003e \u003cp\u003eDRPs are highly prevalent among older adults [10], particularly in hospitalized patients [25,27], due to age-related physiological changes, polypharmacy, polymorbidity, and frequent modifications of pharmacotherapy during hospitalization [56]. In our study, the mean number of DRPs per patient was 2.26\u0026thinsp;\u0026plusmn;\u0026thinsp;2.12. The mean number of DRPs per patient in our study (2.26) is very similar to that reported by Czech colleagues [61], but higher to that reported in Spain [34]. However, in similar studies overall, the number and types of DRPs vary considerably, largely due to differences in classification and assessment methods. The clinical consequences of DRPs vary widely, ranging from mild and transient complications to severe adverse outcomes, including adverse drug reactions, increased risk of rehospitalization, prolonged hospital stay, and, in some cases, mortality\u003c/p\u003e \u003cp\u003eThe most frequently identified DRP categories in our cohort were related to treatment effectiveness (67.77%) and the risk of adverse drug events (16.61%), underscoring the dual challenge of achieving optimal therapeutic outcomes while minimizing harm in older patients. Age-related physiological changes significantly alter pharmacokinetics and pharmacodynamics in older adults, thereby influencing both the effectiveness and safety of pharmacotherapy [56]. As a result, several active substances are classified as PIMs for use in this population [14,16,17]. Multiple explicit criteria and PIM lists have been developed to support safer prescribing; among these, the EU-PIM(7) list is one of the most widely accepted and validated tools used in European clinical practice [14]. The use of PIMs is associated with numerous adverse outcomes, including an increased risk of adverse drug reactions, functional decline, falls, hospitalization, and mortality [62]. In our study population, the mean number of PIMs per patient at hospital admission was 1.76\u0026thinsp;\u0026plusmn;\u0026thinsp;1.32. Pharmacist-led interventions did not result in a statistically significant reduction in the number of PIMs per patient. However, the identification, continuous monitoring, and regular reassessment of the clinical appropriateness and ongoing necessity of these medications remain crucial, as some PIMs may be temporarily justified under specific clinical circumstances. Therefore, PIM management in older adults should focus not only on deprescribing but also on individualized risk\u0026ndash;benefit evaluation and timely reassessment throughout the course of treatment.\u003c/p\u003e \u003cp\u003eWith regard to the active substances most frequently involved in DRPs, atorvastatin was associated with the highest number of identified DRPs, predominantly at the time of hospital admission. Statins, and lipid-lowering agents in general, play a central role in the management of cardiovascular patients by reducing cardiovascular risk and preventing the progression of associated comorbidities [63]. Despite robust evidence supporting their efficacy and safety, statins are frequently omitted from patients\u0026rsquo; pharmacotherapy [64,65].\u003c/p\u003e \u003cp\u003eIn contrast, PPIs were also commonly associated with DRPs, primarily due to their widespread initiation during hospitalization to reduce the risk of stress-related gastrointestinal complications [66\u0026ndash;68]. However, PPIs are often continued beyond the period of clinical indication, contributing to their well-documented overuse across all age groups. Although PPIs are characterized by a favorable pharmacokinetic profile, long-term use has been associated with several adverse outcomes, including impaired absorption of electrolytes and micronutrients, as well as an increased risk of \u003cem\u003eClostridioides difficile\u003c/em\u003e infection [66\u0026ndash;68]. These findings highlight both underuse of evidence-based therapies, such as statins, and overuse of preventive medications, such as PPIs, as important and contrasting contributors to DRPs in older hospitalized patients.\u003c/p\u003e \u003cp\u003eWith regard to PIMs, PPIs were the most frequently identified PIMs in our study population. In older adults, long-term PPI use is associated with reduced calcium absorption\u0026mdash;particularly calcium carbonate\u0026mdash;and an increased risk of hip, vertebral, and wrist fractures [69,70]. Except for patients with clear indications, such as chronic nonsteroidal anti-inflammatory drug use, Barrett\u0026rsquo;s esophagus, or erosive esophagitis, PPI therapy beyond eight weeks is generally considered inappropriate in older adults [69]. Another commonly identified PIM group consisted of centrally acting antihypertensive agents, particularly imidazoline receptor agonists and alpha-2 adrenoreceptor agonists. These drugs exert centrally mediated sympathetic inhibition and are associated with sedation, cognitive impairment, bradycardia, and orthostatic hypotension, thereby substantially increasing fall risk in the geriatric population [71]. Additionally, the use of tramadol and alprazolam was observed; both agents are associated with a high risk of central nervous system depression, cognitive impairment, delirium, sedation, falls, and fractures [72,73]. Tramadol further carries the potential for serotonergic toxicity and respiratory depression [72]. Taken together, these findings underscore the importance of regular medication review, individualized risk\u0026ndash;benefit assessment, and targeted deprescribing strategies to minimize medication-related harm in older patients.\u003c/p\u003e \u003cp\u003eNumerous strategies have been proposed to reduce the occurrence of DRPs and PIMs in older patients, including systematic medication review, obtaining the best possible medication history, medication reconciliation during transitions of care, and regular reassessment of pharmacotherapy [74\u0026ndash;78]. Pharmacists are key healthcare professionals involved in delivering these activities. Across Europe and worldwide, various models of pharmacist-led clinical services have been implemented. Despite differences in organisation, there is broad consensus that pharmacists are becoming integral members of interdisciplinary healthcare teams, particularly in the management of cardiovascular diseases [47,48,79], chronic kidney disease [44\u0026ndash;46], and other complex conditions [39\u0026ndash;43,80].\u003c/p\u003e \u003cp\u003eConsistent with findings from previous hospital-based studies, pharmacist-led interventions in our study resulted in a statistically significant reduction in the number of DRPs. In addition, a significant decrease in the total number of medications per patient was observed, although the number of active substances remained unchanged. This finding may be attributed to pharmacotherapy optimization strategies, including the recommendation of fixed-dose combination products (polypills), which reduce pill burden while maintaining therapeutic coverage and may contribute to improved medication adherence.\u003c/p\u003e \u003cp\u003eA growing body of evidence demonstrates that pharmacist\u0026ndash;physician collaboration can optimize pharmacotherapy, reduce medication-related complications and adverse drug reactions, decrease hospital readmissions, prevent patient harm, and lower healthcare costs [74\u0026ndash;78]. Nevertheless, the implementation and integration of pharmacist-led clinical activities vary considerably across healthcare systems, and professional trust develops at different rates. This variability is reflected in our findings, as not all pharmacist-proposed interventions were accepted by physicians. Importantly, the acceptance rate observed in our study suggests that interdisciplinary cooperation is established but not yet optimal, highlighting opportunities for further improvement.\u003c/p\u003e \u003cp\u003eIncreasing evidence also indicates that the inclusion of pharmacists in clinical decision-making related to pharmacotherapy may help address workforce shortages in healthcare systems, particularly the growing shortage of physicians [81].\u003c/p\u003e \u003cp\u003eFollowing the optimization of pharmacotherapy, patient-related factors represent a key determinant of therapeutic success [82,83]. Numerous studies have demonstrated that medication adherence is influenced by multiple variables, including sex, age, educational level, and, importantly, the patient\u0026rsquo;s understanding of their treatment regimen [31,82,83]. There is substantial evidence indicating a strong association between patients\u0026rsquo; understanding of pharmacotherapy, medication adherence, and clinical outcomes [31,82]. In our study, patient understanding was assessed using a recently optimized three-point scale, which revealed that nearly half of the patients (48.75%) demonstrated good understanding of their pharmacotherapy. However, a considerable proportion of patients (25%) exhibited low levels of understanding, highlighting the need for targeted educational interventions. Education led by healthcare professionals has the potential to positively influence patient attitudes, improve adherence, and enhance treatment outcomes. In this context, pharmacist-led educational interventions have proven particularly effective across various therapeutic areas, including anticoagulant therapy, immunosuppressive treatment, chronic kidney disease management, and oncology, demonstrating significant improvements in medication safety and adherence [84,85].\u003c/p\u003e \u003cp\u003eOur findings indicate that the vast majority of geriatric patients in this cohort manage their medications independently, highlighting a high degree of autonomy in daily pharmacotherapy. However, despite this self-management, less than half of the patients utilize medication aids such as drug organizers, which are known to improve adherence and reduce errors [86]. This gap suggests a potential vulnerability in this population, as advanced age, polypharmacy, and age-related cognitive or sensory changes may increase the risk of missed doses, incorrect administration, or adverse drug events [86\u0026ndash;88]. The relatively small proportion of patients relying on caregivers further underscores the importance of interventions that support safe self-management, including education, simplified regimens, and the use of adherence tools. These findings align with previous studies emphasizing that self-reliance in medication management does not necessarily equate to safe or optimal adherence in older adults.\u003c/p\u003e \u003cp\u003eThe high prevalence of OTC medication use in this cohort\u0026mdash;reported by 65% of patients\u0026mdash;highlights an important, yet often underrecognized, source of potential DRPs in older adults [89,90]. While most patients avoided high-risk herbal products such as Hypericum perforatum [91], a significant proportion consumed grapefruit or pomelo, which are known to inhibit cytochrome P450 enzymes and potentially alter the metabolism of multiple prescription drugs [92]. Such practices increase the risk of adverse drug reactions, therapeutic failure, or potentiation of pharmacologic effects, particularly when combined with potentially inappropriate medications [91,92]. These findings underscore the need for comprehensive medication reconciliation that includes both prescribed and OTC products, with active patient engagement and counseling. Pharmacists in community and hospital settings are ideally positioned to facilitate this process, ensuring a complete medication history is obtained, identifying potential interactions, and providing guidance on safe and effective use of all medications, including OTC products.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eOlder hospitalized adults with polymorbidity and polypharmacy represent a population at particularly high risk of drug-related problems and suboptimal therapeutic outcomes. Our findings confirm that pharmacotherapy in this group is frequently complex, associated with both underuse of evidence-based treatments and overuse or prolonged use of potentially inappropriate medications. These challenges are further amplified during hospitalization, when frequent therapy changes and transitions of care increase the likelihood of medication-related harm.\u003c/p\u003e \u003cp\u003ePharmacist-led clinical activities proved to be an effective strategy for addressing these risks. The integration of pharmacists into the multidisciplinary team resulted in a significant reduction in the number of DRPs and contributed to optimisation of pharmacotherapy through medication review, reconciliation, deprescribing where appropriate, and regimen simplification. Beyond improving safety and treatment effectiveness, pharmacist involvement also supported better patient understanding of therapy and promoted adherence, both of which are essential determinants of long-term clinical outcomes in older adults.\u003c/p\u003e \u003cp\u003eImportantly, the expanding clinical role of pharmacists has implications that extend beyond medication safety. In the context of increasing demand for healthcare services and a persistent shortage of healthcare professionals - particularly physicians - pharmacists represent a highly qualified and underutilised resource. By assuming responsibility for structured medication management, patient education, and ongoing pharmacotherapy monitoring, pharmacists can alleviate part of the workload traditionally borne by physicians. This collaborative model enables more efficient use of available healthcare capacity, supports continuity of care, and helps maintain high-quality pharmacotherapy even in resource-constrained settings.\u003c/p\u003e \u003cp\u003eOverall, our findings reinforce the value of pharmacist\u0026ndash;physician collaboration as a key component of modern hospital care. Systematic involvement of clinical pharmacists in the care of older patients has the potential not only to optimize pharmacotherapy and reduce medication-related harm, but also to strengthen healthcare systems by mitigating workforce shortages and improving the efficiency of interdisciplinary care. Wider implementation of pharmacist-led clinical services should therefore be considered an essential strategy for improving patient outcomes and ensuring sustainable healthcare delivery in ageing populations.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eLimitations:\u003c/strong\u003e This study has several limitations. First, it was conducted at a single tertiary-care center, which may limit the generalizability of findings to other settings or populations. Although the original cohort included 120 patients, this sub-analysis focused on 80 older adults, potentially reducing statistical power. The lack of a control group limits causal inference regarding the impact of pharmacist-led interventions, although ethical considerations informed this design. Patients’ understanding of pharmacotherapy was assessed using a simple three-point scale, which may be subject to recall bias or interviewer influence. Lastly, data on OTC and herbal product use relied on self-reporting and may have been underreported.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eBMI - Body Mass Index\u003c/p\u003e\n\u003cp\u003eCCI - \u0026nbsp;Charlson Comorbidity Index\u003c/p\u003e\n\u003cp\u003eDRP - Drug-Related Problem\u003c/p\u003e\n\u003cp\u003eOTC - Over The Counter Drug\u003c/p\u003e\n\u003cp\u003ePCNE - Pharmaceutical Care Network Europe\u003c/p\u003e\n\u003cp\u003ePIM - Potentially Inappropriate Drug\u003c/p\u003e\n\u003cp\u003ePPI - Proton Pump Inhibitor\u003c/p\u003e\n\u003cp\u003eSD \u0026ndash; standard deviaton\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted without external funding and received approval from the Ethics Committee of the National Institute of Cardiovascular Diseases.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e Not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor's contribution:\u0026nbsp;\u003c/strong\u003eAll authors contributed equally to the study conception and design. All authors read and approved the final manuscript. TT is responsible for the overall content as the guarantor.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability:\u003c/strong\u003e Access to all patient data was limited exlusively to the investigators at the National Institute of Cardiovascular Diseases. The research team maintained a detailed and accurate registry of all study participants, including the alphanumeric identification codes assigned to each individual, as documented in the “Participant Identification Sheet.” Both the completed identification sheets and all study-related data were stored securely. Only anonymized personal data were entered into the case report form within the online database MIA DMS, and access was limited to the investigators.\u003c/p\u003e\n\u003cp\u003eThe datasets used and analyzed during the study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclarations:\u003c/strong\u003e The study was approved by the Ethics Committee of the National Institute of Cardiovascular Diseases (Approval Number 1625/21, dated 26th May 2021) and registered at ClinicalTrials.gov (Trial Registration Number NCT04930302, dated 16th June 2021). All study procedures were conducted in accordance with the ethical principles set by the institutional and/or national research committees, as well as the 1964 Declaration of Helsinki and its subsequent amendments, or comparable ethical standards. Written informed consent was obtained from all participants prior to the initiation of any research-related activities. The consent form, which was approved by the Ethics Committee, was provided in the Slovak language to ensure full comprehension by all participants.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWorld Health Organization. Medication Safety in Polypharmacy: a technical report. 2019 https://www.who.int/publications/i/item/medication-safety-in-polypharmacy-technical-report. \u003c/li\u003e\n\u003cli\u003eGuillot J, Maumus-Robert S, Bezin J. Polypharmacy: A general review of definitions, descriptions and determinants. Therapie. 2020;75(5):407-416; https://doi.org/10.1016/j.therap.2019.10.001\u003c/li\u003e\n\u003cli\u003eMasnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. What is polypharmacy? A systematic review of definitions. BMC Geriatr. 2017;17(1):230; https://doi.org/10.1186/s12877-017-0621-2\u003c/li\u003e\n\u003cli\u003ePazan F, Wehling M. Polypharmacy in older adults: a narrative review of definitions, epidemiology and consequences. 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Age-related changes in pharmacokinetics and pharmacodynamics: basic principles and practical applications. Br J Clin Pharmacol. 2004;57(1):6-14; https://doi.org/10.1046/j.1365-2125.2003.02007.x\u003c/li\u003e\n\u003cli\u003eNgcobo NN. Influence of Ageing on the Pharmacodynamics and Pharmacokinetics of Chronically Administered Medicines in Geriatric Patients: A Review. Clin Pharmacokinet. 2025;64(3):335-367; https://doi.org/10.1007/s40262-024-01466-0\u003c/li\u003e\n\u003cli\u003eRenom-Guiteras A, Meyer G, Th\u0026uuml;rmann PA. The EU(7)-PIM list: a list of potentially inappropriate medications for older people consented by experts from seven European countries. Eur J Clin Pharmacol. 2015;71(7):861-875; https://doi.org/10.1007/s00228-015-1860-9\u003c/li\u003e\n\u003cli\u003eO\u0026rsquo;Mahony D, Cherubini A, Guiteras AR, et al. STOPP/START criteria for potentially inappropriate prescribing in older people: version 3. 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Int J Clin Pharm. 2020;42(2):786-795; https://doi.org/10.1007/s11096-020-00984-8\u003c/li\u003e\n\u003cli\u003eEickhoff C, H\u0026auml;mmerlein A, Griese N, Schulz M. Nature and frequency of drug-related problems in self-medication (over-the-counter drugs) in daily community pharmacy practice in Germany. Pharmacoepidemiol Drug Saf. 2012;21(3):254-260; https://doi.org/10.1002/pds.2241\u003c/li\u003e\n\u003cli\u003eHenderson L, Yue QY, Bergquist C, Gerden B, Arlett P. St John\u0026rsquo;s wort (Hypericum perforatum): drug interactions and clinical outcomes. Br J Clin Pharmacol. 2002;54(4):349-356; https://doi.org/10.1046/j.1365-2125.2002.01683.x\u003c/li\u003e\n\u003cli\u003eBailey DG, Dresser G, Arnold JMO. Grapefruit\u0026ndash;medication interactions: Forbidden fruit or avoidable consequences? CMAJ Can Med Assoc J. 2013;185(4):309-316; https://doi.org/10.1503/cmaj.120951\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bratislava-medical-journal","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Bratislava Medical Journal](https://link.springer.com/journal/44411)","snPcode":"44411","submissionUrl":"https://submission.springernature.com/new-submission/44411/3","title":"Bratislava Medical Journal","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"drug-related problems, pharmaceutical care, older patients, surgery patients","lastPublishedDoi":"10.21203/rs.3.rs-9063248/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9063248/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eOlder patients with cardiovascular diseases frequently experience polypharmacy and its associated complications, including drug-related problems (DRPs) and potentially inappropriate medications (PIMs). Hospitalization and therapy modifications may further complicate therapy. Structured pharmacotherapy review conducted collaboratively by pharmacists and physicians may enhance medication safety in this population.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis subgroup analysis included 80 patients aged\u0026thinsp;\u0026ge;\u0026thinsp;65 years hospitalized at the Vascular Surgery Department of the National Institute of Cardiovascular Diseases in Bratislava, Slovakia. Medication reconciliation and comprehensive medication review were performed at admission and discharge by trained pharmacists in collaboration with treating physicians. DRPs were classified using the Pharmaceutical Care Network Europe v9.00 system and PIMs identified using the EU(7)-PIM list. Patients\u0026rsquo; understanding of pharmacotherapy was assessed using a three-point comprehension scale. Admission and discharge data were compared using the paired Wilcoxon signed-rank test.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe mean age was 71.4\u0026thinsp;\u0026plusmn;\u0026thinsp;5.0 years, and polypharmacy was highly present. Pharmacist intervention was associated with a significant reduction in DRPs at discharge (p\u0026thinsp;=\u0026thinsp;0.003) and a modest decrease in the number of medications (p\u0026thinsp;=\u0026thinsp;0.01), but not PIMs. DRPs were most frequently associated with statins and proton pump inhibitors. Most pharmacist recommendations addressed prescribing-related issues, with an overall physician acceptance rate of 59.8%. Although nearly half of patients demonstrated good understanding of their pharmacotherapy, important knowledge gaps persisted.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003e A pharmacist-led, structured pharmacotherapy review conducted collaboratively with physicians was associated with fewer DRPs at discharge in older cardiovascular patients, supporting its role in improving medication safety in complex clinical settings.\u003c/p\u003e","manuscriptTitle":"Drug-related problems in geriatric cardiovascular patients – a hospital setting","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-30 13:58:44","doi":"10.21203/rs.3.rs-9063248/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-09T05:58:52+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-08T19:04:10+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"201363882001298021739237264365728892744","date":"2026-03-29T07:16:29+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-27T06:59:49+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-09T11:30:29+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-09T11:30:25+00:00","index":"","fulltext":""},{"type":"submitted","content":"Bratislava Medical Journal","date":"2026-03-08T09:31:37+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bratislava-medical-journal","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Bratislava Medical Journal](https://link.springer.com/journal/44411)","snPcode":"44411","submissionUrl":"https://submission.springernature.com/new-submission/44411/3","title":"Bratislava Medical Journal","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"a965626b-c057-4c10-abfa-6ecb4053d4a7","owner":[],"postedDate":"March 30th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-22T09:42:03+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-30 13:58:44","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9063248","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9063248","identity":"rs-9063248","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}