Association of Polypharmacy and Potentially Inappropriate Medications With Physical Functional Impairments in Older Adults With Cancer

Abstract

Background: Polypharmacy and potentially inappropriate medications (PIMs) are prevalent in older adults with cancer, but their associations with physical function are not often studied. This study examined the associations of polypharmacy and PIMs with physical function in older adults with cancer, and determined the optimal cutoff value for the number of medications most strongly associated with physical functional impairment. Methods: This cross-sectional analysis used baseline data from a randomized study enrolling patients aged ≥70 years with advanced cancer starting a new systemic cancer treatment. We categorized PIM using 2015 American Geriatrics Society Beers Criteria. Three validated physical function measures were used to assess patient-reported impairments: activities of daily living (ADL) scale, instrumental activities of daily living (IADL) scale, and the Older Americans Resources and Services Physical Health (OARS PH) survey. Optimal cutoff value for number of medications was determined by the Youden index. Separate multivariate logistic regressions were then performed to examine associations of polypharmacy and PIMs with physical function measures. Results: Among 439 patients (mean age, 76.9 years), the Youden index identified ≥8 medications as the optimal cutoff value for polypharmacy; 43% were taking ≥8 medications and 62% were taking ≥1 PIMs. On multivariate analysis, taking ≥8 medications was associated with impairment in ADL (adjusted odds ratio [aOR], 1.64; 95% CI, 1.01–2.58) and OARS PH (aOR, 1.73; 95% CI, 1.01–2.98). PIMs were associated with impairments in IADL (aOR, 1.72; 95% CI, 1.09–2.73) and OARS PH (aOR, 1.97; 95% CI, 1.15–3.37). A cutoff of 5 medications was not associated with any of the physical function measures. Conclusions: Physical function, an important component of outcomes for older adults with cancer, is cross-sectionally associated with polypharmacy (defined as ≥8 medications) and with PIMs. Future studies should evaluate the association of polypharmacy with functional outcomes in this population in a longitudinal fashion.

Inappropriate medications and physical function: a systematic review

“…Of the 10 studies involved in the examination of inappropriate medication use and measures of functional independence, 9 demonstrated that inappropriate medication use was significantly associated with increased impediment with functional independence. 35 , 41 – 48 PIM use was associated significantly with a decrease in the Health-Related Quality-of-Life Score. 42 In one study, a lowering in the number of PIMs was associated with a significant increase in the Functional Independence Measure.…”

“…A total of 10 studies examined associations between inappropriate medication use and ADL, 34 – 37 , 52 , 54 , 58 , 59 , 62 , 65 while 6 studies examined associations between inappropriate medication use and IADL ( Table 2 ). 35 , 38 , 52 , 58 , 63 , 64 Of the 10 studies focusing on ADLs, 8 showed that inappropriate medication use was associated with ADL impairment, 34 , 36 , 37 , 52 , 54 , 59 , 62 , 65 while 4 studies involving IADLs showed that inappropriate medication use was associated with IADL impairment.…”

“…A total of 10 studies examined associations between inappropriate medication use and ADL, 34 – 37 , 52 , 54 , 58 , 59 , 62 , 65 while 6 studies examined associations between inappropriate medication use and IADL ( Table 2 ). 35 , 38 , 52 , 58 , 63 , 64 Of the 10 studies focusing on ADLs, 8 showed that inappropriate medication use was associated with ADL impairment, 34 , 36 , 37 , 52 , 54 , 59 , 62 , 65 while 4 studies involving IADLs showed that inappropriate medication use was associated with IADL impairment. 35 , 38 , 52 , 64 In the one study involving anticholinergic burden and ADLs, patients who were prescribed any anticholinergic medication had a mean Bartel Index of 83.5 (95% CI 81.9–85.0), while those who were not prescribed any anticholinergic medication had a mean Bartel Index of 86.3 (95% CI 84.4–88.1, p = 0.03).…”

“… 35 , 38 , 52 , 58 , 63 , 64 Of the 10 studies focusing on ADLs, 8 showed that inappropriate medication use was associated with ADL impairment, 34 , 36 , 37 , 52 , 54 , 59 , 62 , 65 while 4 studies involving IADLs showed that inappropriate medication use was associated with IADL impairment. 35 , 38 , 52 , 64 In the one study involving anticholinergic burden and ADLs, patients who were prescribed any anticholinergic medication had a mean Bartel Index of 83.5 (95% CI 81.9–85.0), while those who were not prescribed any anticholinergic medication had a mean Bartel Index of 86.3 (95% CI 84.4–88.1, p = 0.03). 65 In the study by Tosato et al ., there were variations in results depending on the type of tool used for inappropriate medication use.…”

Thirty‐day hospital readmission rate, reasons, and risk factors after acute inpatient cancer rehabilitation

“… 28 These risk factors may not be modifiable but they may identify patients who may benefit from intensive interventions during the transition of care period. 28 Since polypharmacy (≥8 medications) has been associated with physical function impairment in older adults with cancer, 35 patients with these characteristics may benefit from closer follow‐up assessments and in ensuring access to palliative care to apply patient‐centered care.…”