Psychotropic Polypharmacy in Adults 55 Years or Older: A Risk for Impaired Global Cognition, Executive Function, and Mobility

Loggia, Gilles; Attoh-Mensah, Elpidio; Kristell, Pothier; Morello, Rémy; Lescure, Pascale; Bocca, Marie‐Laure; Marcelli, Christian; Chavoix, Chantal

doi:10.3389/fphar.2019.01659

Cited by 18 publications

(14 citation statements)

References 50 publications

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“…The prescription of antiacids (A02) is probably due to the association of obesity with gastroesophageal reflux [ 37 ], while the use of psychotropics (N05 and N06), antidiabetics (A10), and antithrombotics (B01) may be linked to the development of pathologies related to low PA. Specifically, it is encouraging to compare our results with those of Loggia et al [ 38 ], who found an independent association between psychotropic use and physical fitness (measured with the Timed Up and Go test).…”

Section: Discussionsupporting

confidence: 80%

Fat–Fit Patterns, Drug Consumption, and Polypharmacy in Older Adults: The EXERNET Multi-Center Study

et al. 2021

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Background: Physical fitness levels and the amount of accumulated adipose tissue (fatness) relate to current and future individuals’ heath status. Nevertheless, the interrelationships of their combined patterns with polypharmacy and the types of medications consumed have not been sufficiently investigated. Methods: This cross-sectional study was carried out in six Spanish regions between 2008 and 2009 with a sample of older community-dwelling adults (≥65 years old) without dementia or cancer. Fitness was measured with one-leg balance and senior fitness tests, as well as by measuring weight and fat mass with a bioelectrical impedance analyzer. Polypharmacy was defined as the use of five or more medications. An analysis of variance was performed for comparisons between the physical fitness and fatness patterns and the medication consumed. Results: A total of 1709 elders were included in the study (72.1 ± 5.2 years). The two unfit patterns were those with the highest drug consumption. The High-Fat–Unfit pattern was the one that had the most significant consumption and had the highest percentage of polymedicated subjects. The Low-Fat–Fit pattern had a significantly lower percentage of people that did not consume any medications. The highest percentages of drug consumption in 7 of the 10 groups that were included were concentrated in the two unfit patterns. Conclusions: This study highlights the importance of fitness in older adults, as it is at least as important as the avoidance of accumulation of excess fat with respect to the consumption of a smaller number of medicines.

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Section: Discussionsupporting

confidence: 80%

Fat–Fit Patterns, Drug Consumption, and Polypharmacy in Older Adults: The EXERNET Multi-Center Study

et al. 2021

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“…This fact is extremely important as some PIM may adversely affect cognition. Such cases should be closely followed up in order to understand whether their cognitive deficits are a consequence of neurodegenerative processes or were caused (or worsened) by any PIM [ 45 , 46 , 47 ]. On the other hand, the intake of these drugs helps to control neuropsychiatric symptoms, delirium episodes, aggressive behavior, and agitation, conferring protection to both the patient and the caregiver.…”

Section: Discussionmentioning

confidence: 99%

The Prevalence of Polypharmacy and Potentially Inappropriate Medications and Its Relationship with Cognitive Status in Portuguese Institutionalized Older Adults: A Cross-Sectional Study

Caçador

Lemos

Oliveira

et al. 2022

IJERPH

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The aim of this study was to evaluate the prevalence of polypharmacy and potentially inappropriate medications (PIMs) in a population of older adults living in nursing homes. Furthermore, we also intended to assess the possible association between polypharmacy, potentially inappropriate medications and cognitive impairment in institutionalized older adults. A cross-sectional study analyzed data from 193 nursing home residents in the district of Viseu, Portugal, between September 2018 and June 2019, with a mean age of 82.4 ± 6.2 years (ranging from 65 to 95 years old); 72.5% (n = 140) were female participants. Major polypharmacy was presented in 80.8% of the study population, who took 7.6 ± 3.3 drugs per day. Using the Beers Criteria, we found that 79.3% took PIMs. There was a positive association between polypharmacy and PIM (p < 0.001), showing that higher medicines intake increased the number of PIMs. Polypharmacy was not associated with the functionality of the older adults to perform activities of daily living, but was associated with cognitive impairment. The older adults with lower scores on the Mini Mental State Examination (MMSE) took more drugs (p = 0.039) and used more PIM (p < 0.001). Moreover, patients taking five or more prescription drugs per day (major polypharmacy) consuming any psychiatric, gastrointestinal or oral antidiabetic agents (regardless of whether they were considered potentially inappropriate or not) had higher odds of displaying cognitive impairment than those who did not (p < 0.05). Older adult residents of the studied nursing homes were potentially affected by polypharmacy and inappropriate polypharmacy. This observation reveals the need to adopt and implement strategies that make drug therapy more adequate and safer for older adults.

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“…In comparison to a sole antipsychotic prescription, antipsychotic-antidepressant-benzodiazepine combination therapy was associated with a 41% increased risk of mortality, and antipsychotic-benzodiazepine combination therapy was associated with a 119% increased risk of mortality in a registry-based sample (Nørgaard et al, 2020). Moreover, psychotropic polypharmacy has also been associated with cognitive and mobility impairment in community-dwelling adults without dementia (Loggia et al, 2020). To our knowledge, adverse effects of receiving psychotropic polypharmacy have yet to be examined in NH residents with dementia.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of psychotropic polypharmacy in nursing home residents with dementia: a meta-analysis

Jester

Molinari

Zgibor

et al. 2021

Int. Psychogeriatr.

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Objectives: Nursing home (NH) residents with dementia is exposed to high rates of psychotropic prescriptions. Our objectives were to: (1) pool the prevalence estimates of psychotropic polypharmacy from the existing literature and (2) examine potentially influential factors that are related to a higher or lower prevalence. Design: Meta-analysis of data collected from randomized trials, quasi-experimental, prospective or retrospective cohort, and cross-sectional studies. English-language searches of PubMed and PsycINFO were completed by November 2020. Included studies reported prevalence estimates of psychotropic polypharmacy (i.e. defined as either two-or-more or three-or-more medications concurrently) in NH residents with dementia. Setting and Participants: NH residents with dementia. Measurements: Random-effects models were used to pool the prevalence of psychotropic polypharmacy in NH residents with dementia across studies. Estimates were provided for both two-or-more and three-or-more concurrent medications. Heterogeneity and publication bias were measured. Meta-regression examined the influence of the percentage of the sample who were male, mean age of the sample, geographic region (continent), sample size, and study year on the prevalence of psychotropic polypharmacy. Results: Twenty-five unique articles were included comprising medications data from 92,370 NH residents with dementia in 12 countries. One-in-three (33%, [95% CI: 28%, 39%]) NH residents with dementia received two-or-more psychotropic medications concurrently. One-in-eight (13%, [95% CI: 10%, 17%]) received three-or-more psychotropic medications concurrently. Estimates were highly variable across both definitions of psychotropic polypharmacy (p < 0.001). Among study-level demographics, geographic region, sample size, or study year, only male sex was associated with greater use of two-or-more psychotropic medications (Unadjusted OR = 1.02, p = 0.006; Adjusted OR = 1.04, p = 0.07). Conclusions: Psychotropic polypharmacy is common among NH residents with dementia. Identifying the causes of utilization and the effects on resident health and well-being should be prioritized by federal entities seeking to improve NH quality.

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Psychotropic Polypharmacy in Adults 55 Years or Older: A Risk for Impaired Global Cognition, Executive Function, and Mobility

Cited by 18 publications

References 50 publications

Fat–Fit Patterns, Drug Consumption, and Polypharmacy in Older Adults: The EXERNET Multi-Center Study

Fat–Fit Patterns, Drug Consumption, and Polypharmacy in Older Adults: The EXERNET Multi-Center Study

The Prevalence of Polypharmacy and Potentially Inappropriate Medications and Its Relationship with Cognitive Status in Portuguese Institutionalized Older Adults: A Cross-Sectional Study

Prevalence of psychotropic polypharmacy in nursing home residents with dementia: a meta-analysis

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