Association of polypharmacy and hyperpolypharmacy with frailty states: a systematic review and meta-analysis

Abstract

Purpose To investigate: (1) the cross-sectional association between polypharmacy, hyperpolypharmacy and presence of prefrailty or frailty; (2) the risk of incident prefrailty or frailty in persons with polypharmacy, and vice versa. Methods A systematic review and meta-analysis was performed according to PRISMA guidelines. We searched PubMed, Web of Science, and Embase from 01/01/1998 to 5/2/2018. Pooled estimates were obtained through random effect models and Mantel-Haenszel weighting. Homogeneity was assessed with the I 2 statistic and publication bias with Egger's and Begg's tests. Results Thirty-seven studies were included. The pooled proportion of polypharmacy in persons with prefrailty and frailty was 47% (95% CI 33-61) and 59% (95% CI 42-76), respectively. Increased odds ratio of polypharmacy were seen for prefrail (pooled OR = 1.52; 95% CI 1.32-1.79) and frail persons (pooled OR = 2.62, 95% CI 1.81-3.79). Hyperpolypharmacy was also increased in prefrail (OR = 1.95; 95% CI 1.41-2.70) and frail (OR = 6.57; 95% CI 9.57-10.48) persons compared to robust persons. Only seven longitudinal studies reported data on the risk of either incident prefrailty or frailty in persons with baseline polypharmacy. A significant higher odds of developing prefrailty was found in robust persons with polypharmacy (pooled OR = 1.30; 95% CI 1.12-1.51). We found no papers investigating polypharmacy incidence in persons with prefrailty/frailty. Conclusions Polypharmacy is common in prefrail and frail persons, and these individuals are also more likely to be on extreme drug regimens, i.e. hyperpolypharmacy, than robust older persons. More research is needed to investigate the causal relationship between polypharmacy and frailty syndromes, thereby identifying ways to jointly reduce drug burden and prefrailty/frailty in these individuals. Prospero registration number CRD42018104756.

Physical Frailty: ICFSR International Clinical Practice Guidelines for Identification and Management

“…A 2019 meta-analysis of 37 studies by Palmer and colleagues reported that 59% of older people with frailty are medicated with five or more medications (polypharmacy) (110). Medication management is recommended as part of a comprehensive management plan for frailty by the ICFSR task force.…”

<p>Polypharmacy Is Associated with Frailty, Nutritional Risk and Chronic Disease in Chilean Older Adults: Remarks from PIEI-ES Study</p>

“…20 SABE study stated a much fewer percentage in Brazilian older (36%). 21 Notwithstanding the novelty of the idea regarding the relationship between polypharmacy and frailty, there is a lot of conclusive evidence that support it, as can be seen in Palmer et al 22 On the other hand, in Chilean reality, there is a lack of information regarding this topic. This study aims to analyze the relationship between polypharmacy and variables as frailty and other chronic comorbidities in Chilean older adults.…”

Integrated care for the management of ageing-related non-communicable diseases: current gaps and future directions

“…In conjunction with this population ageing, it is expected that there will be an increase in absolute numbers of noncommunicable diseases (NCD), especially those that are age-related such as dementia disorders as well as cardio-and cerebrovascular diseases. NCDs are often associated with frailty [2][3][4][5][6][7] leading to numerous negative outcomes including unplanned hospitalization, disability, decreased quality of life, polypharmacy, and mortality [8][9][10]. In addition, as a person ages, there is an increased risk of having more than one comorbid condition, which is usually referred to as "multimorbidity".…”