Polypharmacy and Cognition Function Among Rural Adults

Abstract

Background: Polypharmacy (using≥5 medications) is associated with poor health outcomes. Mixed results from past studies surrounding chronic medication use, control of chronic conditions, and their effects on cognitive performance warrant further attention. Objective: Investigate a link between polypharmacy and cognition function in rural-dwelling adults in Texas, USA. Methods: Project FRONTIER (Facing Rural Obstacles to Healthcare Now Through Intervention, Education & Research) is a cross-sectional epidemiological study using community-based participatory research in three counties of Texas. Residents age > 40 were eligible for inclusion. The primary outcome is cognitive impairment, and exposures of interest are polypharmacy; comorbidities; and diabetes, hypertension, and depression medication. Logistic regression was used to assess association. Results: Six hundred eighty-nine individuals participated; the mean age was 61, and the majority were female (68.7%).The median number of medications taken by participants was 3.3 (IQR: 0–5); the rate of polypharmacy was 29.6%. Anti-hypertensive agents were the most common medications (15%) used. Polypharmacy users were 2.84 times more likely to have cognitive impairment [OR: 2.84, 95%CI (1.32–6.09)] than those using < 5 medications. Participants on hypertensive medications had 1.85 times higher odds [OR: 1.85, 95%CI (1.14–3.01)] of having cognitive impairment than those who did not have cognitive impairment. Conclusion: Polypharmacy increases the odds of cognitive impairment. The odds of presenting with cognitive impairment increased as the number of medications increased. Additionally, we identified a large, concerning number of participants with pharmacotherapy and poor chronic disease management. A larger study should examine medication adherence among rural elders to manage chronic disease and any healthcare barriers to adherence.

Polypharmacy and Its Association with Dysphagia and Malnutrition among Stroke Patients with Sarcopenia

“…We suggest that polypharmacy may contribute to dysphagia in post-stroke patients with sarcopenia, in addition to the effects of the stroke itself, the loss of muscle mass, and muscle strength due to sarcopenia. Polypharmacy is associated with xerostomia [ 23 ] and cognitive decline, [ 50 ] and may also affect swallowing function. In polypharmacy, anticholinergic load is associated with dysphagia [ 26 , 27 ], cognitive decline [ 51 ], and poor oral health [ 52 ].…”

Impact of Pneumonia on Cognitive Aging: A Longitudinal Propensity-Matched Cohort Study

“…Finally, the change in medication regimens occurring after a hospitalization episode, along with the increase in polypharmacy, might further partially explain the poorer cognitive performance observed in individuals experiencing pneumonia. It is well known that complex pharmacological regimens are associated with a higher anticholinergic burden and several side effects that may impact cognition ( 50 , 51 ).…”

Polypharmacy in Older Adults with Alzheimer’s Disease

“…Several reports have examined the association between polypharmacy and cognitive dysfunction, where polypharmacy is defined as the use of five or more drugs that are commonly used in clinical practice [ 9 , 17 ]. In a cross-sectional study on the association between polypharmacy and cognitive function and related comorbidities (depression, hypertension, and/or diabetes) in rural America, older adults afflicted with polypharmacy had 3.71 times higher odds of having cognitive impairment than older adults who were not [ 49 ]. In addition, even after adjusting for confounding factors using multivariate analysis, the odds of cognitive impairment were 2.86 times higher in patients with polypharmacy, whereas there was no significant association between comorbidities and cognitive impairment.…”