Frailty and polypharmacy in the community‐dwelling elderly with multiple chronic diseases

Abstract

Background Both multi‐morbidity (MM) and polypharmacy (PP) are common in the elderly and pose a challenge for health and social care systems. However, high‐quality patient‐centred care requires context‐bound understanding of the patterns and use of medications in those with MM. Therefore, the aim of this study was to investigate the prevalence of PP in community‐dwelling elderly, and the factors associated with MM, PP, excessive polypharmacy (EPP), and the types of drugs used. Methods We analysed data of 164 community‐dwelling subjects aged ≥60 years from January to December 2020 at a general hospital in a rural area of Taiwan. MM was defined as >4 diagnoses of chronic health conditions. Non‐polypharmacy (NP), PP, and EPP were defined as <5, 5–8, and >8 prescriptions, respectively. Other variables including basic activities of daily living (BADL), severity of frailty, depressive mood, screening for intellectual impairment, and nutritional status were also analysed. Results Of the 164 participants, 34.8% had >4 diagnoses, 66.5% had PP, and 26.2% had EPP. The patients with >4 diagnoses had worse performance in BADL, higher levels of frailty, and more prescriptions than those with fewer diagnoses. The EPP group had worse performance in BADL, a higher level of frailty, more comorbidities, and higher prevalences of diabetes mellitus and chronic kidney disease compared to the NP and PP groups. After adjusting for covariates, we further found a higher number of medications associated with having more comorbidities, and a higher level of frailty associated with having a greater number of medications. Conclusion We found relationships between frailty and PP, and between PP and MM, but frailty did not associate with MM. Since frailty, PP, and MM may be viewed as an inevitable trinity of ageing, reducing PP could be a method to both prevent frailty and disentangle this trinity in the elderly.

The impact of falls on activities of daily living in older adults: A retrospective cohort analysis

“…There is evidence that women are both more likely to fall [ 2 ] and to have ADL impairment [ 15 , 16 ]. Polypharmacy may be an indicator of more comorbidities, which could negatively impact older adult’s ability to perform ADLs [ 38 ], in addition to being an increased risk factor for falls [ 37 ]. There is evidence of an increased risk of disability for those living in neighborhoods with higher level of deprivation, following a critical illness [ 62 ].…”

“…Education was assessed as a covariate, as there is evidence of an inverse association between a higher level of education and risk of ADL impairment [ 51 ] and risk of falls [ 52 ]. Medication use was included as the number of prescription medications a participant was taking at each study visit and was categorized as no polypharmacy (0–4 medications) or polypharmacy (5+ medications) [ 37 , 38 ]. Polypharmacy is associated both with increased fall risk [ 37 ] and increased risk of ADL impairment [ 53 ].…”

“…NDI was included in this study, a variable that is associated with both increased fall risk and ADL impairment [32][33][34]. The design of GEMs also allowed for the inclusion of multiple covariates of interest including polypharmacy and prior hospitalizations, both of which address the health status of participants, important risk factors for falls [2,3,37,68] and ADL impairment [38,69]. The percentage of participants with ADL impairment at baseline is similar to that of a large scale study done in the United States with a comparable mean age of participants [8].…”

“…Evidence of an increased risk of long-term ADL impairment post-fall for people experiencing higher neighborhood deprivation would strengthen the argument for prioritizing funding and access to fall prevention programs in neighborhoods with lower socioeconomic status. Hospitalization [ 35 , 36 ] and polypharmacy [ 37 , 38 ] are associated with both an increased risk of falls and ADL impairment, and are therefore critical to include in an analysis of the impact of falls on ADLs.…”

Serum neurofilament light chain levels in migraine patients: a monocentric case–control study in China

“…Longer migraine course was associated with higher sNfL levels among young patients, but no such trend was observed for patients who age 45 years. The elderly population is often accompanied by various chronic diseases and frailty conditions [ 23 , 24 ], which may mask the effect of migraine course on sNfL. A recent study indicates that sNfL concentrations rose exponentially with age and at a steeper increased rate after approximately 50 years of age [ 25 ].…”