Long‐term trajectories of medicine use among older adults experiencing polypharmacy in Australia

Falster, Michael O.; Charrier, Rayan; Pearson, Sallie‐Anne; Buckley, Nicholas A.; Daniels, Benjamin

doi:10.1111/bcp.14504

Cited by 17 publications

(10 citation statements)

References 29 publications

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“…Our findings confirm that polypharmacy is common among older patients and increases over time, as reported in various studies [9,10,[29][30][31][32][33]. Age is an important factor driving the development of polypharmacy and the accumulation of chronic health conditions accelerates the use of multiple drugs.…”

Section: Plos Onesupporting

confidence: 91%

Fifteen-year trajectories of multimorbidity and polypharmacy in Dutch primary care—A longitudinal analysis of age and sex patterns

2022

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Objective After stratifying for age, sex and multimorbidity at baseline, our aim is to analyse time trends in incident multimorbidity and polypharmacy in the 15-year clinical trajectories of individual patients in a family medicine setting. Methods This study was carried out using data from the Registration Network Family Medicine in the South of the Netherlands. The clinical trajectories of 10037 subjects during the 15-year period (2000–2014) were analyzed in a repeated measurement of using a generalized estimating equations model as well as a multilevel random intercept model with repeated measurements to determine patterns of incident multimorbidity and polypharmacy. Hierarchical age-period-cohort models were used to generate age and cohort trajectories for comparison with prevalence trends in multimorbidity literature. Results Multimorbidity was more common in females than in males throughout the duration of the 15-year trajectory (females: 39.6%; males: 33.5%). With respective ratios of 11.7 and 5.9 between the end and the beginning of the 15-year period, the youngest female and male groups showed a substantial increase in multimorbidity prevalence. Ratios in the oldest female and male groups were 2.2 and 1.9 respectively. Females had higher levels of multimorbidity than males in the 0-24-year and 25-44-year age groups, but the levels converged to a prevalence of 92.2% in the oldest male and 90.7% in the oldest female group. Similar, albeit, moderate differences were found in polypharmacy patterns. Conclusions We sought to specify the progression of multimorbidity from an early age. As a result, our study adds to the multimorbidity literature by specifying changes in chronic disease accumulation with relation to polypharmacy, and by tracking differences in patient trajectories according to age and sex. Multimorbidity and polypharmacy are common and their prevalence is accelerating, with a relatively rapid increase in younger groups. From the point of view of family medicine, this underlines the need for a longitudinal approach and a life course perspective in patient care.

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Section: Plos Onesupporting

confidence: 91%

Fifteen-year trajectories of multimorbidity and polypharmacy in Dutch primary care—A longitudinal analysis of age and sex patterns

2022

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“…A review by Sirois and colleagues reported that more than 46 definitions of polypharmacy were retrieved from the literature [58]. Clearly, this makes exploring the prevalence of polypharmacy difficult and is one reason why such a range in prevalence has been reported [59•, 60••, [61][62][63].…”

Section: Prescribing In the Face Of Multimorbiditymentioning

confidence: 99%

An Update on Medication Use in Older Adults: a Narrative Review

Barry

Hughes

2021

Curr Epidemiol Rep

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Purpose of Review The global phenomenon of population aging is impacting the health and care needs of society. The use of medications by older adults is acknowledged to be the most common form of medical intervention for many acute and chronic conditions and prescribing in this population continues to increase. In this narrative review, we summarise the age-related factors that should be considered when prescribing for older adults, address some of the perennial challenges related to medicine use in older people, and highlight important emerging research in this area. Recent Findings A range of age-related factors should be considered when prescribing for older adults. However, the evidence base still lacks data pertaining to older adults due to their continued under-representation in clinical trials. Multimorbidity, polypharmacy, and inappropriate prescribing continue to remain prevalent among older adults, although recent research has been focused on the development and evaluation of complex interventions to address these challenges. Summary Further high-quality studies of interventions to improve and support medication use in older adults are needed, ensuring that older adults are well represented in such trials and consideration is given to the measurement of patient- and provider-focused outcomes.

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“…Multimorbidity is common in older adults leading to the concurrent use of multiple medications or polypharmacy [ 1 , 2 ]. Polypharmacy is commonly defined as the use of five or more regular medications [ 3 – 5 ] and is inherently dynamic depending on the health status of the patient [ 4 ]. A recent study in Australia found that the most commonly used types of medications in older adults with polypharmacy were medications for the cardiovascular system followed by alimentary tract and metabolism, and the nervous system [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Polypharmacy and trajectories of health-related quality of life in older adults: an Australian cohort study

2022

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Background Health-related quality of life (HRQoL) is an important outcome measure when considering medical treatment; however, the impact of polypharmacy on trajectories of HRQoL over time is unknown. This study aimed to investigate the association between polypharmacy status and trajectories of HRQoL in older adults. Methods A longitudinal cohort study of 2181 community-dwelling adults, 65 years and older, who participated in the 2013 to 2017 waves of the Household Income and Labour Dynamics in Australia (HILDA) Survey. Polypharmacy was defined as the regular use of ≥ 5 prescription medications. Polypharmacy status was categorised into no polypharmacy, in 2013 only (baseline only polypharmacy), in 2017 only (incident polypharmacy) or at both time points (persistent polypharmacy). HRQoL was assessed through the SF-36 questionnaire generating two summary scores: physical component summary (PCS) and mental component summary (MCS). Linear mixed-effects models stratified according to polypharmacy status and change in comorbidities were used to assess trajectories of HRQoL. Results Older adults with persistent polypharmacy had lowest scores for HRQoL measures from 2013 to 2017. After adjusting for all covariates, those with incident polypharmacy had the steepest annual decline in both the PCS and MCS: − 0.86 in PCS and − 0.76 in MCS for those with decreasing or stable comorbidities, and − 1.20 in PCS and − 0.75 in MCS for those with increasing comorbidities. Conclusions Polypharmacy was associated with poorer HRQoL, even after adjusting for confounders. Incident polypharmacy was found to be associated with a clinically important decline in HRQoL and this should be considered when prescribing additional medication to older adults.

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Long‐term trajectories of medicine use among older adults experiencing polypharmacy in Australia

Cited by 17 publications

References 29 publications

Fifteen-year trajectories of multimorbidity and polypharmacy in Dutch primary care—A longitudinal analysis of age and sex patterns

Fifteen-year trajectories of multimorbidity and polypharmacy in Dutch primary care—A longitudinal analysis of age and sex patterns

An Update on Medication Use in Older Adults: a Narrative Review

Polypharmacy and trajectories of health-related quality of life in older adults: an Australian cohort study

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