Polypharmacy Is Associated With Higher Frailty Risk in Older People: An 8-Year Longitudinal Cohort Study

Veronese, Nicola; Stubbs, Brendon; Noale, Marianna; Solmi, Marco; Pilotto, Alberto; Vaona, Alberto; Demurtas, Jacopo; Mueller, Christoph; Huntley, Jonathan; Crepaldi, Gaetano; Maggi, Stefania

doi:10.1016/j.jamda.2017.02.009

Cited by 147 publications

(148 citation statements)

References 37 publications

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“…139 Likewise, in a cohort study of community-dwelling people aged between 50 and 75 years, Saum et al observed a dose-response association, with an OR of 2.30 for polypharmacy (95% CI 1.60-3.31) and 4.97 for hyperpolypharmacy (95% CI 2.97-8.32). 141 These observational studies provide evidence that polypharmacy is a risk factor for frailty. Over the follow-up period, participants taking four to six medications were more likely to become frail than those taking zero to three medications were, and this likelihood was even higher in those taking seven or more medications.…”

Section: Explanationmentioning

confidence: 97%

Chapter 4 Frailty and specific diseases

Sugimoto

Rakugi

Kojima

et al. 2020

Geriatrics Gerontology Int

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CQ18: What is the relationship of frailty with orthostatic hypotension and orthostatic intolerance? Summary • Orthostatic hypotension and orthostatic intolerance are more prevalent among frail individuals than non-frail individuals, and these conditions worsen frailty outcomes (evidence level: E-2). ExplanationOrthostatic hypotension and orthostatic intolerance, both of which are risk factors for falls, are reported to be associated with frailty. O'Connell et al. examined the relationship between orthostatic hypotension, orthostatic intolerance and frailty using data from 5692 individuals aged ≥50 years who participated in the Irish Longitudinal Study on Aging (TILDA). Of these participants, 6.1% had orthostatic hypotension, 6.7% had orthostatic intolerance and 4.3% were identified as frail, and 34.5% participants were identified as pre-frail under the Cardiovascular Health Study (CHS) criteria. Both orthostatic hypotension and orthostatic intolerance were more prevalent in frail participants (8.9% and 14.3%) than they were in robust participants (5.0% and 5.7%). In a multivariate analysis, orthostatic intolerance was found to be independently associated with frailty (odds ratio [OR] 1.80, 95% CI 1.13-2.87), although orthostatic hypotension was not. 1 Similarly, Freud et al. examined associations between orthostatic hypotension and mortality using data of patients who were regularly assessed in the outpatient Comprehensive Geriatric Assessment Unit. These patients were aged ≥65 years (mean age 83.7 years), and 32.1% were diagnosed with orthostatic hypotension. They found that orthostatic hypotension was associated with increased mortality (over the follow-up period, 30.2% and 22.3% of those with and without orthostatic hypotension died, respectively), but a multivariate analysis did not show orthostatic hypotension to be independently associated with increased mortality. 2 These studies suggest that orthostatic hypotension and orthostatic intolerance are more prevalent in frail individuals, and that they worsen frailty outcomes.Romero-Ortuno et al. analyzed a sample of older individuals (average age of 72, 6.1% with orthostatic hypotension, 6.7% with orthostatic intolerance) who did not have dementia or risk factors for autonomic neuropathy. They arranged the participants into non-frail, pre-frail and frail groups, and found that the baseline heart rate decreased across the groups in that order. They also found that the delta heart rate (maximum heart rate within 30 s after standing minus baseline heart rate) increased across the groups in that order. It was reported that 30 s after standing, 98% of the non-frail participants, 95% of the pre-frail participants and 92% of the frail participants recovered to their baseline heart rate. 3 These findings suggest that frailty worsens hypostatic problems that occur when standing.CQ19: What is the relationship of frailty with antihypertensive treatment? Summary • Antihypertensive treatment prevents cardiovascular events whether or not the patient is frail. Intensive anti...

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Section: Explanationmentioning

confidence: 97%

Chapter 4 Frailty and specific diseases

Sugimoto

Rakugi

Kojima

et al. 2020

Geriatrics Gerontology Int

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“…These results may have limited generalizability to the US population because US‐based frailty research showed that prevalence varies by race, socioeconomic status, and geographic area . To our knowledge, only one US‐based cohort, the Osteoarthritis Initiative, examined this association . However, it measured frailty using the Study of Osteoporotic Fracture index, which limits comparisons with studies that use more common frailty measures.…”

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confidence: 99%

“…Results from longitudinal analyses of polypharmacy and frailty were reported; however, these studies were primarily conducted in non‐US regions including Australia, China, and Europe . These results may have limited generalizability to the US population because US‐based frailty research showed that prevalence varies by race, socioeconomic status, and geographic area .…”

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confidence: 99%

Polypharmacy and Incident Frailty in a Longitudinal Community‐Based Cohort Study

Shmuel

Lund

Álvarez

et al. 2019

J American Geriatrics Society

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OBJECTIVES Polypharmacy may affect frailty, a common and costly condition among older adults. Frailty prevalence is elevated among racial/ethnic minorities and persons living in the US South, and research is needed to inform future pharmacologic interventions in these populations. Our aim was to quantify the prevalence of frailty and polypharmacy, and to estimate the association between polypharmacy and incident frailty. DESIGN Prospective cohort study. SETTING A community‐based cohort study of adults residing in Johnston County, North Carolina. PARTICIPANTS White and African American adults aged 50 to 95 years (n=1697). MEASUREMENTS At each study visit, all prescription and over‐the‐counter medications were recorded. We calculated annual polypharmacy (5‐9 medications) and excessive polypharmacy (≥10 medications) prevalence at the 2006‐2010 visit (n = 1697) and operationalized the Fried frailty phenotype to describe prevalent and incident frailty at two consecutive visits (2006‐2010 and 2013‐2015). We estimated risk ratios (RRs) and 95% confidence intervals (CIs) for the association between polypharmacy and incident frailty using weighted log‐binomial regression to account for measured confounding and attrition using inverse probability of treatment and attrition weights, respectively. RESULTS At the 2006‐2010 visit, 678 (41%) and 260 (16%) participants were exposed to polypharmacy and excessive polypharmacy, respectively. Overall, 353 (21%) participants and 180 (21%) participants were frail at the 2006‐2010 and 2013‐2015 visits, respectively. Frailty was more common among participants identifying as white, women, and having less educational attainment relative to those without these characteristics. Incident frailty at the 2013‐2015 visit was 15% (mean follow‐up = 5.5 years). Our results suggest that polypharmacy is positively associated with incident frailty (weighted RR = 1.4; 95% CI = .9‐2.0), yet estimates are imprecise and should be interpreted with caution. CONCLUSION Consistent with the current weight of evidence, our results suggest an association between polypharmacy and incident frailty. Prospective studies evaluating deprescribing interventions are needed to clarify whether reducing polypharmacy decreases frailty incidence. J Am Geriatr Soc 67:2482–2489, 2019

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“…The rapid development of biological drugs will require the geriatrician to be an expert on these emerging drugs and their side-effects, e.g., antibodies against myostatin or activin receptors to treat sarcopenia (8). Geriatricians are already aware of the problems produced by polypharmacy and inappropriate drug use in older persons (9)(10)(11)(12)(13)(14)(15)(16)(17), and this will only become worse with the interactions with biologics which will only become obvious after many years of use. All of this will drive geriatricians to become prime users of personalized (P4) medicine (i.e., predictive, preventive, personalized and participatory), assisted by computers (18).…”

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confidence: 99%