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Prevalence and association of continuous polypharmacy and frailty among older women: A longitudinal analysis over 15 years

  • Kaeshaelya Thiruchelvam
    Correspondence
    Corresponding author.
    Affiliations
    University of Newcastle, University Drive, Callaghan, New South Wales 2308, Australia

    International Medical University, 126 Jalan Jalil Perkasa 19, Bukit Jalil, 57000 Kuala Lumpur, Malaysia
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  • Julie Byles
    Affiliations
    University of Newcastle, University Drive, Callaghan, New South Wales 2308, Australia

    Priority Research Centre for Generational Health and Ageing, Hunter Medical Research Institute, New Lambton Heights, New South Wales 2305, Australia
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  • Syed Shahzad Hasan
    Affiliations
    University of Newcastle, University Drive, Callaghan, New South Wales 2308, Australia

    University of Huddersfield, Queensgate, Huddersfield HD1 3DH, United Kingdom
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  • Nicholas Egan
    Affiliations
    University of Newcastle, University Drive, Callaghan, New South Wales 2308, Australia

    Priority Research Centre for Generational Health and Ageing, Hunter Medical Research Institute, New Lambton Heights, New South Wales 2305, Australia
    Search for articles by this author
  • Therese Kairuz
    Affiliations
    University of Newcastle, University Drive, Callaghan, New South Wales 2308, Australia

    International Medical University, 126 Jalan Jalil Perkasa 19, Bukit Jalil, 57000 Kuala Lumpur, Malaysia
    Search for articles by this author

      Highlights

      • Frailty and polypharmacy commonly co-occur among oldest old women.
      • Prevalence of continuous polypharmacy could be a consequence of long-term use of preventive medications.
      • Longitudinal data on polypharmacy and frailty provides an advantage over cross-sectional data at a single time point.
      • Frailty should be considered as an important indicator of health outcomes during the medication review process.

      Abstract

      Objectives

      This study aimed to determine the prevalence of continuous polypharmacy and hyperpolypharmacy, determine medications that contribute to continuous polypharmacy, and examine the association between frailty and continuous polypharmacy.

      Study design

      A prospective study using data from the Australian Longitudinal Study on Women’s Health. Women aged 77–82 years in 2003, and 91–96 years in 2017 were analysed, linking the Pharmaceutical Benefits Scheme data to participants’ survey data.

      Main outcome measures

      The association between frailty and continuous polypharmacy was determined using generalised estimating equations for log binomial regressions, controlling for confounding variables. Descriptive statistics were used to determine the proportion of women with polypharmacy, and medications that contributed to polypharmacy.

      Results

      The proportion of women with continuous polypharmacy increased over time as they aged. Among participants who were frail (n = 833) in 2017, 35.9 % had continuous polypharmacy and 1.32 % had hyperpolypharmacy. Among those who were non-frail (n = 1966), 28.2 % had continuous polypharmacy, and 1.42 % had hyperpolypharmacy. Analgesics (e.g. paracetamol) and cardiovascular medications (e.g. furosemide and statins) commonly contributed to continuous polypharmacy among frail and non-frail women. Accounting for time and other characteristics, frail women had an 8% increased risk of continuous polypharmacy (RR 1.08; 95 % CI 1.05, 1.11) compared to non-frail women.

      Conclusions

      Combined, polypharmacy and frailty are key clinical and public health challenges. Given that one-third of women had continuous polypharmacy, monitoring and review of medication use among older women are important, and particularly among women who are frail.

      Keywords

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