The relationship between frailty and polypharmacy in older people: A systematic review

Gutiérrez-Valencia, Marta; Izquierdo, Mikel; Cesari, Matteo; Casas‐Herrero, Álvaro; Inzitari, Marco; Martínez‐Velilla, Nicolás

doi:10.1111/bcp.13590

Cited by 304 publications

(282 citation statements)

References 62 publications

(168 reference statements)

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“…Our longitudinal analyses of specific drug use categories contribute drug‐specific evidence to the emerging longitudinal evidence regarding polypharmacy and frailty risk . The additional contribution of this study is to provide estimates of the effect size and ranking of frailty risks of analgesic and sedative prescription drug use.…”

Section: Discussionmentioning

confidence: 99%

“…Four of seven longitudinal analyses reported significant associations of polypharmacy with frailty . A subsequent report provides evidence for a dose‐response relationship between polypharmacy and frailty .…”

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confidence: 80%

“…A subsequent report provides evidence for a dose‐response relationship between polypharmacy and frailty . However, increased drug use among frail individuals suggests a complex bidirectional relationship, most apparent in cross‐sectional analyses . Although clinical practice guidelines discourage co‐prescribing opioids and benzodiazepines due to the risks of dizziness, falls, dependence, respiratory depression, and death, this combination is often co‐prescribed and co‐used in the United States .…”

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confidence: 99%

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Self‐Reported Prescription Drug Use for Pain and for Sleep and Incident Frailty

Cil

Park

Bergen

2019

J American Geriatrics Society

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OBJECTIVES We aimed to estimate incident frailty risks of prescription drugs for pain and for sleep in older US adults. DESIGN Longitudinal cohort. SETTING Health and Retirement Study. PARTICIPANTS Community‐living respondents aged 65 years and older, excluding individuals who received recent treatment for cancer (N = 14 208). Our longitudinal analysis sample included respondents who were not frail at baseline and had at least one follow‐up wave with complete information on both prescription drug use and frailty, or date of death (N = 7201). MEASUREMENTS Prescription drug use for pain and sleep, sociodemographics, other drug and substance use, and Burden frailty model components. Multivariable drug use stratified hazard models with death as a competing risk evaluated frailty risks associated with co‐use and single use of prescription drugs for pain and for sleep. RESULTS Proportions endorsing prescription drug use were 22.1% for pain only, 6.8% for sleep only, and 7.7% for both indications. Burden frailty model prevalence was 41.0% and varied significantly by drug use. Among non‐frail individuals at baseline, proportions endorsing prescription drug use were 14.9%, 5.6%, and 2.2% for the three indications. Prescription drug use was associated with increased risk of frailty (co‐use adjusted subhazard ratio [sHR] = 1.95; 95% confidence interval [CI] = 1.6‐2.4; pain only adjusted sHR = 1.58; CI = 1.4‐1.8; sleep‐only adjusted sHR = 1.35; CI = 1.1‐1.6; no use = reference group). Cumulative incidence of frailty over 8 years for the four groups was 60.6%, 50.9%, 45.8%, and 34.1%. Sensitivity analyses controlling for chronic diseases associated with persistent pain resulted in minor risk reductions. CONCLUSION Prescription pain and sleep drug use is significantly associated with increased incidence of frailty. Research to estimate effects of pain and sleep indications and of drug class–specific dosage and duration on incident frailty is indicated before advocating deprescribing based on these findings. J Am Geriatr Soc 67:2474–2481, 2019

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Section: Discussionmentioning

confidence: 99%

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confidence: 80%

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confidence: 99%

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Self‐Reported Prescription Drug Use for Pain and for Sleep and Incident Frailty

Cil

Park

Bergen

2019

J American Geriatrics Society

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“…Proposed interventions to reduce the burden of frailty on individuals and society include exercise, nutrition, and pharmacologic interventions . The interplay between polypharmacy (ie, concurrent use of five or more medications) and frailty is an emerging area of interest because polypharmacy is a potentially modifiable risk factor for mortality among older adults . We hypothesize that polypharmacy may lead to frailty development through increased risk of decline in functional and cognitive status, dangerous drug‐drug interactions, and serious adverse drug events (eg, falls) .…”

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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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“…In contrast, Cil et al 5 measured only drug therapy prescribed for pain or sleep. This lack of consistency in the measures of both frailty and drug therapy is not unique to these studies and creates challenges …”

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confidence: 99%