Incidence and Effects of Polypharmacy on Clinical Outcome among Patients Aged 80+: A Five-Year Follow-Up Study

Abstract

ObjectivesPolypharmacy is a problem of growing interest in geriatrics with the increase in drug consumption in recent years, is defined according to the WHO criteria as the, ‘‘concurrent use of five or more different prescription medication”. We investigated the clinical characteristics of polypharmacy and identified the effects of polypharmacy on clinical outcome among patients aged 80+ admitted to Chinese PLA general hospital.MethodsOlder men aged ≥80 years (n = 1562) were included in this study. The included participants attended a structured clinical examination and an interview carried out by a geriatrician and trained nurses. A follow-up survey in 2014 was carried out on survivors in the same way as in 2009. The clinical outcome measured were adverse drug reactions, falls, frailty, disability, cognitive impairment, mortality. The association between polypharmacy and clinical outcome was assessed by logistic regression.ResultsThe mean (range) age of the included participants was 85.2 (80–104) years. Medication exposure was reported by 100% of the population. Mean number of medications reported in this population was 9.56±5.68. The prevalence of polypharmacy (≥6 medications) in the present study was 70%. At the time of the follow-up survey, an increase in the number of taken medicines had occurred among half of the survivors. The risk of different outcomes in relation to number of medications rises significantly, the odds ratios were 1.21 (95% confidence interval [CI]1.17–1.28) for adverse drug reactions, 1.18 (95% CI 1.10–1.26) for falls, 1.16 (95% CI 1.09–1.24) for disability, and 1.19 (95% CI 1.12–1.23) for mortality. There was no association between increasing number of medications and cognitive impairment.ConclusionsOur study demonstrates that polypharmacy is very common in the very old patients, and observed that number of medications was a factor associated with difference clinical outcome independently of the age, type of medications prescribed and accompanied comorbidities.

Frailty, polypharmacy, and potentially inappropriate medications in old people: findings in a representative sample of the French population

“…Anticholinergic medications can cause peripheral (dry mouth and constipation) and central (falls, dizziness, delirium, and cognitive decline) adverse effects [26] that could participate in the development of frailty through altered nutritional intake, limitation of mobility or cognitive impairment. Gnjidic et al [27] suggested the potential contribution of medicines to the development of frailty, consistently with 14 the results of previous studies showing an increased risk of incident frailty in people with polypharmacy [9,28].…”

The Association between Polypharmacy and Dementia: A Nested Case-Control Study Based on a 12-Year Longitudinal Cohort Database in South Korea

“…They noted that cases with excessive polypharmacy (≥10 drugs) exhibited significantly decreased cognitive function compared to non-polypharmacy cases (0–5 drugs) [38]. However, other studies reported a lack of association between polypharmacy and cognitive impairment in men [12, 39]. Wang et al .…”

“…However, as the definition of polypharmacy does not specify the duration of administration and the number of drugs, most commonly used criterion is the administration of five or more drugs per day for a certain period of time [7–12]. Polypharmacy and incidence of chronic diseases have increased concomitantly.…”

Pros and cons of polypharmacy in elderly patients with diabetes

“…At the same time, the authors found that the risk of adverse event increased with the number of drugs taken, regardless of the type of the drug, the age of the patient or concomitant diseases. Furthermore, a 11-year follow-up performed by American researchers from 1995 to 2005 showed that in the study population the risk of iatrogenic complication was increased by 88% in patients taking 5 or more drugs and by 45% in patients taking 3 or 4 drugs when compared to those who were administered no more than two drugs [6]. What is the optimal number of drugs, which should not be exceeded?…”

“…This may lead to unwanted duplication of drug, particularly since there are many generics available and a physician may prescribe a formulation containing the same active substance that the patients is already taking [6]. It is important problem, because elderly patients may have trouble understanding complicated medical recommendations or take the same drug several times a day due to memory dysfunction.…”