How do potentially inappropriate medications and polypharmacy affect mortality in frail and non-frail cognitively impaired older adults? A cohort study

Abstract

ObjectivesTo test whether the use of potentially inappropriate central nervous system acting medications, proton pump inhibitors (PPIs) or polypharmacy are associated with mortality in cognitively impaired older adults and whether frailer people are at greater risk of harm.SettingA cohort study nested within the Cognitive Function and Ageing Study II, a population representative cohort study of the older population in Cambridgeshire, Nottingham and Newcastle, UK.ParticipantsA total of 1154 cognitively impaired participants, aged 65 years or older.ExposuresAny use of antipsychotics, antidepressants, other anticholinergic medication, benzodiazepines or PPIs, polypharmacy (5–9) and hyperpolypharmacy (≥10 reported medications) were ascertained at baseline. Frailty was assessed using the Fried criteria.Primary outcomeMortality up to 8 years follow-up. HRs associated with potentially inappropriate medication (PIM), frailty and their interaction were estimated adjusting for covariates.ResultsWithin the sample, 44% were taking one or more PIM. Apart from antipsychotics (adjusted HR=3.24, 95% CI 1.83 to 5.73), use of specific PIM was not associated with greater subsequent mortality. Polypharmacy (HR=1.17, 95% CI 0.95 to 1.45) and hyperpolypharmacy were associated with mortality (HR=1.60, 95% CI 1.16 to 2.22). Being frail (HR=1.90, 95% CI 1.32 to 2.72) or prefrail (HR=1.56, 95% CI 1.10 to 2.20) was associated with increased mortality. There was some evidence that the HR for polypharmacy on mortality was lower among frailer individuals, but the overall polypharmacy by frailty interaction was not statistically significant (p=0.102).ConclusionsFor those with cognitive impairment, greater concern should be afforded to the number of medications than the prescription of specific classes. Frailer individuals may have a lower relative risk of mortality associated with polypharmacy than less frail individuals.

Potentially inappropriate medications for the elderly: Incidence and impact on mortality in a cohort ten-year follow-up

“…Likewise, other studies using the Beers criteria for PIM also found no association with death. This was demonstrated in Belgium with community-dwelling elderly and in the United Kingdom with elderly with frailty and elderly after hospital discharge in the United Kingdom [ 21 , 63 , 64 ]. In Brazil, a 15-year follow-up study showed that the risk of death among users of at least one PIM was 44% higher than those who did not use any PIM [ 18 ].…”

<p>The Double Burden of the COVID-19 Pandemic and Polypharmacy on Geriatric Population – Public Health Implications</p>

“…50 These viruses may lead to fatal outcomes in humans, including acute respiratory distress syndrome, multiorgan failure, and death, particularly in geriatrics patients with multiple morbidities. 4, [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36]49,53 Various studies reported that COVID-19 has a similar pathogenic potential to cause respiratory complications, disability, and death as SARS-CoV and MERS-CoV. 54,55 A recent Chinese study showed that out of 138 hospitalized COVID-19 patients with pneumonia, 26.1% geriatric patients with multiple co-morbidities were transferred to the intensive care unit (ICU) compared with younger submit your manuscript | www.dovepress.com…”

Polypharmacy and lack of joy predict physical frailty among northern Japanese community-dwellers from the ORANGE cohort study

“…33 Moreover, there is evidence that the HR for polypharmacy on mortality was high among frailer individuals in a cohort study sampling 1,154 cognitively impaired participants aged 65 years or older. 34 These results indicate polypharmacy may be a contributor to the development of frailty, and it should be noted that patients taking multiple drugs (6 or more) are at risk of frailty. In the future, it is necessary to clarify which is the cause, and the mechanism of the association of frailty and polypharmacy.…”