The relation between using inappropriate medications and quality of life among the elderly living in Kerman

century. Aging is a biological process that all living creatures, including human beings experience. The advances in medical knowledge and technologies in today’s world have increased life expectancy and the number of elderly people. Abstract Background: Disability induced by severe diseases reduces life quality among elders, and leads to increased use of medications and increase in drug misuse. This study was done to determine the relation between the number of inappropriate medications used and life quality of elderly people living in Kerman during 2014. Methods: This cross-sectional study was conducted on 107 elderly people in Kerman, Iran. The participants were selected by simple random sampling. The elderly health assessment questionnaire and Beers Criteria were used for data collection. Data were analyzed using SPSS (version 16) and running 2  test, Fischer’s Exact test, and logistic regression. The model fitness was evaluated by the Hosmer and Lemeshow Test. Results: The risk of low life quality in elders using 3 to 4 inappropriate medications was 9.98 times more than elders using no unauthorized medication. The most frequent inappropriate medications were Aspirin and Alprazolam. A significant relation was observed between low life quality and number of inappropriate medications used by elders; that is, taking a higher number of inappropriate medications was associated with lower life quality. Conclusions: Many elderly people use inappropriate medications, which can have a serious adverse impact on their quality of life

Currently, the rapid increase of the aged population has highlighted issues related to this age group. Generally, with increase in age, the likelihood of illnesses and incapability increases.
These negative effects increase the elderlies need for help, affect their independence and reduce their Quality of Life (QoL) (2). Today, for the first time in history, most people can expect to live into their sixties and beyond. By 2050, the world's population aged 60 years and older is expected to reach 2 billion. Now, 125 million people are aged 80 years or older. By 2050, there will be almost this many (120 million) living in China alone, and 434 million people in this age group worldwide. By 2050, 80% of all older people will live in low-and middle-income countries (1). Currently, the elderly population of Iran is 8.2% of the total population (3,4).
According to international estimates, in the coming years the elderly population of Iran will have a faster growth than the rest of the world and even the world average; and by 2045, Iran will overtake the average global population growth rate for the elderly and five years later will also surpass that of Asia (3). By the middle of the century many countries for e.g. Chile, China, the Islamic Republic of Iran and the Russian Elderly people suffer from more illness and disability and consume more drugs in comparison with young people (8). The

Results
The demographic characteristics of participants have been shown in Table 1. 150 elderly people participated, 77 persons were women and 73 were men. The mean age of the participants was 72.8 ± 8.04 years (Additional file 3: Table S3). The frequency of the components of total QoL in the elderly according to participants' demographic characteristics is showed in Table2.
According to Table 2, physical mobility in the elderly had a significant relation with gender, age, and marital status. Desirable physical mobility was more in men than women (P= 0.03).
Moreover, it had the highest frequency among elderly who were between 60-70 years old than others (P=0.001). It was also more frequent among married ones (P <0.001).
Moreover, there was a significant relation between the relative frequency of pain and age (P = 0.006) and marital status (P = 0.04). With increase in age, the frequency of unfavorable pain increased (p <0.001). Furthermore, the severity of pain in older people whose spouses had died was higher than the elderly who lived with their spouses (p = 0.04).
As seen in As table 2 shows, social isolation was more remarkable in women (P=0.02), those aged> 80 years (P <0.001), the elderly whose spouse had died (P<0.001), and the elderly who were housekeepers (P=0.02). There was a significant relation between emotional reactions and educational level (P = 0.05) and job (P = 0.03).
That is, the prevalence of undesirable emotional reactions was significantly higher among illiterate people than people with elementary education. More unemployed elderly had unfavorable emotional reactions.
In general, a significant relation was found between QoL and gender (P = 0.03), age (P = 0.001), and marital status (P <0.001). In other words, QoL was lower in females and those who were older. The prevalence of unfavorable QoL was significantly higher among the elderly whose spouses had died than the elderly living with their spouses.
The frequency of the elderlies' life quality in terms of the number, and the severity and possible complications of inappropriate drugs is reported in Table 3. Table 3, a significant relation was observed between QoL and the number of inappropriately consumed drugs among the elderly. The elderly who consumed 3 to 4 inappropriate drugs had more unfavorable QoL than those who took none or one inappropriate medication.

Discussion
In the present study, the mean score of QoL in the elderly was 47.36 ± 23.53 from 100, and the QoL score of the elderly was generally favorable in Kerman. Regression analysis of the results indicated that QoL of the elderly had a significant relation with their age, gender, and marital status.
In other words, with increase of age, the elderly had more unfavorable QoL. In similar studies about the effect of age on QoL, significant and inverse relations were found between age and QoL (18). Results of the current study are in line results of other studies that reported total quality of life is lower among the older seniors than the other age groups. A study in Australia showed that the elderly under 70 years of age had better health and QoL than those who were more than 70 years old (19). Obviously, the incidence of physical inability and moving limitations are more pronounced in older people, and this affects their QoL.
Moreover, a greater percentage of female elderly had undesirable QoL than males. Elderly women experience more functional disability compared to older men. Health statistics show more high physical inability and more use of health services among women. The reason for better physical activity status among elderly men compared to the elderly women seems to be the fact that women are more likely to suffer from articular and bone diseases than men, and therefore have more difficulty in doing their daily activities and exercises (20). In examining the relation between gender and life quality of the elderly, the results of similar studies indicate higher QoL scores for elderly men in all aspects of life quality (19,(21)(22)(23)(24)(25). Some studies have shown a significant statistical difference for life quality, only in physical dimensions and social function which was more among men than women (24,26,27).
However, in our study, in all aspects, the life quality scores of the elderly men were higher than those of the elderly women, which can be due to cultural and social factors of the community.
According to the results of this study, undesirable life quality was more prevalent among elderly people whose spouse had died and was significantly higher than the elderly who lived with their spouses. One of the social factors affecting QoL is partner support and the social networks people interact with them. The absence of this factor in the elderly whose spouse has passed away or those who live alone can affect their health and quality of life. Therefore, social and support networks should be created for the elderly people. They should also be empowered adequately to face the complications caused by lack of these supportive networks. Anderson (2006), and Owens (1990) showed that spouses have a decisive role in improving the satisfaction in elderly life (28,29). Furthermore, other studies have emphasized on the positive role of marriage in the quality of life of individuals (18,19).

However, this relation was not confirmed in
Lehman's study in 1995 (30). and are more satisfied with their lives (34). In this regard, we can argue that social isolation can lower the function of the body's immune system and increase the activity of the endocrine and cardiovascular systems (35). A study from Finland reported that more than one-third of the elderly suffered from loneliness (36).
In the relation between the elderlies' level of education and their quality of life, significant differences were observed; and the elderly with higher educations had higher average scores than the elderly with lower education levels. This confirms the findings that think education is an effective factor in creating a dynamic elderly life (19,(21)(22)(23)(24)37).  (37,38).
In the current study, a significant relation was found between undesirable life quality and the number of inappropriate medications taken by elders, so that elders who used 3 to4 inappropriate medications had a much more undesirable life quality than elders who used no or 1 inappropriate medication.
A study on the demographic factors of the elderly discharged from the hospitals of Tehran showed that gender and income were associated with consumption of inappropriate drugs among the elderly. The findings indicated that the elderly women (21.5%) more than men (11.8%) and the elderly without income (26.4%) more than the individuals with income (13.2%) used inappropriate drugs. The elderly who took more drugs, consumed more inappropriate medicines (28.6% vs. 12.2%). However, factors such as age, gender, marital status, occupation, and etc., did not have any relation with inappropriate use of drugs (7,37).
In another study, drug consumption was reported higher among the low-educated or illiterate older In a study conducted by Laroche, it was found that women used inappropriate medications more than men; in addition, he found that old elderly people with low education took more inappropriate medications (39). In another research on the relevant factors associated with prescription of inappropriate medications in elders, it was found that patients with myocardial infarction or heart failure used inappropriate medications more than others. Men, individuals with health insurance, and the elderly over eighty-five years used less inappropriate medications (40).
In a study conducted on the elderly admitted to Slovakia hospitals, the use of various medications, depression, lack of mobility, and heart failure were recognized as factors associated with increased prescription of inappropriate medications; moreover, it was found that the prescription of inappropriate medications was less in elders over 74 years (11) . In a study performed in Italy, the rate of