Polypharmacy and frailty: prevalence, relationship, and impact on mortality in a French sample of 2350 old people

Herr, Marie; Robine, Jean‐Marie; Pinot, Juliette; Arvieu, Jean-Jacques; Ankri, Joël

doi:10.1002/pds.3772

Cited by 172 publications

(155 citation statements)

References 55 publications

(106 reference statements)

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“…Our results confirm the previously reported association between excessive polypharmacy and frailty [7], and extend to the general population the results of Moulis et al [25] who showed that medications with anticholinergic properties were associated with frailty in people attending a frailty clinic in France, after adjustment for polypharmacy. 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.…”

Section: Polypharmacy Anticholinergic Medications and Frailtysupporting

confidence: 92%

“…Our estimates of the prevalence of polypharmacy and PIMs are relatively high compared to previous estimates [7,9,11,23], which was expected considering our methodology. Indeed, the prevalence of polypharmacy should be considered with regard to our definition that encompasses all the medications prescribed over 3-month periods.…”

Section: Prevalence Of Polypharmacy and Pimssupporting

confidence: 62%

“…We estimated the number of medications used during the year 2012 by calculating the mean of the total number of medications used per 3-month periods. Polypharmacy was defined as five or more and excessive polypharmacy as 10 medications or more [7]. It included both regular and as required medications.…”

Section: Polypharmacy and Potentially Inappropriate Medicationsmentioning

confidence: 99%

“…Epidemiological studies have shown that frail people are more likely to receive polypharmacy compared to non-frail individuals [7][8][9][10][11]. Polypharmacy exposes old people to various risks [12], notably adverse drugs events [13], falls [14], increased use of healthcare services, and mortality [15,16].…”

Section: Introductionmentioning

confidence: 99%

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

Herr

Sirven

Grondin

et al. 2017

Eur J Clin Pharmacol

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Results: The study population was composed of 1003 women and 887 men, of mean age 74.7 +/-7.4 years. Polypharmacy (5 to 9 drugs) and excessive polypharmacy (≥10 drugs) were reported in 42.9% and 27.4% of the study population respectively, while 46.7% of the study population received at least one PIM during the year 2012. Polypharmacy and PIMs were both associated with the number of frailty criteria in models adjusted for socio-demographic and health characteristics of the participants. The prescription of anticholinergic medications was the only PIM that remained significantly associated with the number of frailty criteria after adjustment for polypharmacy.Conclusions: Polypharmacy and use of anticholinergic medications are independently associated with frailty in old people.3

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Section: Polypharmacy Anticholinergic Medications and Frailtysupporting

confidence: 92%

Section: Prevalence Of Polypharmacy and Pimssupporting

confidence: 62%

Section: Polypharmacy and Potentially Inappropriate Medicationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Herr

Sirven

Grondin

et al. 2017

Eur J Clin Pharmacol

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“…13 Indeed, this French study showed that frail people using 10 or more regular medicines were six times more likely to die than non-frail people not using polypharmacy. 13 Clegg and colleagues' work in developing the electronic frailty index (eFI) is key to such screening.…”

Section: Identifying Frailtymentioning

confidence: 92%

Factoring in frailty when optimising medication

Krska¹

2018

Prescriber

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Evaluation of Time to Benefit of Statins for the Primary Prevention of Cardiovascular Events in Adults Aged 50 to 75 Years

et al. 2021

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IMPORTANCE Guidelines recommend targeting preventive interventions toward older adults whose life expectancy is greater than the intervention's time to benefit (TTB). The TTB for statin therapy is unknown.OBJECTIVE To conduct a survival meta-analysis of randomized clinical trials of statins to determine the TTB for prevention of a first major adverse cardiovascular event (MACE) in adults aged 50 to 75 years.DATA SOURCES Studies were identified from previously published systematic reviews (Cochrane Database of Systematic Reviews and US Preventive Services Task Force) and a search of MEDLINE and Google Scholar for subsequently published studies until February 1, 2020.STUDY SELECTION Randomized clinical trials of statins for primary prevention focusing on older adults (mean age >55 years).DATA EXTRACTION AND SYNTHESIS Two authors independently abstracted survival data for the control and intervention groups. Weibull survival curves were fit, and a random-effects model was used to estimate pooled absolute risk reductions (ARRs) between control and intervention groups each year. Markov chain Monte Carlo methods were applied to determine time to ARR thresholds. MAIN OUTCOMES AND MEASURESThe primary outcome was time to ARR thresholds (0.002, 0.005, and 0.010) for a first MACE, as defined by each trial. There were broad similarities in the definition of MACE across trials, with all trials including myocardial infarction and cardiovascular mortality.RESULTS Eight trials randomizing 65 383 adults (66.3% men) were identified. The mean age ranged from 55 to 69 years old and the mean length of follow-up ranged from 2 to 6 years. Only 1 of 8 studies showed that statins decreased all-cause mortality. The meta-analysis results suggested that 2.5 (95% CI, 1.7-3.4) years were needed to avoid 1 MACE for 100 patients treated with a statin. To prevent 1 MACE for 200 patients treated (ARR = 0.005), the TTB was 1.3 (95% CI, 1.0-1.7) years, whereas the TTB to avoid 1 MACE for 500 patients treated (ARR = 0.002) was 0.8 (95% CI, 0.5-1.0) years.CONCLUSIONS AND RELEVANCE These findings suggest that treating 100 adults (aged 50-75 years) without known cardiovascular disease with a statin for 2.5 years prevented 1 MACE in 1 adult. Statins may help to prevent a first MACE in adults aged 50 to 75 years old if they have a life expectancy of at least 2.5 years. There is no evidence of a mortality benefit.

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Polypharmacy and frailty: prevalence, relationship, and impact on mortality in a French sample of 2350 old people

Abstract: By showing the independent and combined effects of polypharmacy and frailty on mortality risk, this study should reinforce the awareness of clinicians with regard to these factors, rather prevalent in old people.

Cited by 172 publications

References 55 publications

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

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

Factoring in frailty when optimising medication

Evaluation of Time to Benefit of Statins for the Primary Prevention of Cardiovascular Events in Adults Aged 50 to 75 Years

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