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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References
- What is polypharmacy? A systematic review of definitions.BMC Geriatr. 2017; 17: 230https://doi.org/10.1186/s12877-017-0621-2
- Polypharmacy cutoff and outcomes: five or more medicines were used to identify community-dwelling older men at risk of different adverse outcomes.J. Clin. Epidemiol. 2012; 65: 989-995https://doi.org/10.1016/j.jclinepi.2012.02.018
- Increased risk of hip fracture in the elderly associated with prochlorperazine: is a prescribing cascade contributing?.Pharmacoepidemiol. Drug Saf. 2010; 19: 977-982https://doi.org/10.1002/pds.2009
- Associations between polypharmacy and cognitive and physical capability: a British birth cohort study.J. Am. Geriatr. Soc. 2018; 66: 916-923https://doi.org/10.1111/jgs.15317
- Frailty in older adults: evidence for a phenotype.J. Gerontol. A Biol. Sci. Med. Sci. 2001; 56: M146-M156https://doi.org/10.1093/gerona/56.3.m146
- Use of health resources and healthcare costs associated with frailty: the FRADEA study.J. Nutr. Health Aging. 2017; 21: 207-214https://doi.org/10.1007/s12603-016-0727-9
- Prevalence of frailty in community-dwelling older persons: a systematic review.J. Am. Geriatr. Soc. 2012; 60: 1487-1492https://doi.org/10.1111/j.1532-5415.2012.04054.x
- Women’s Health Australia: on the progress of the main cohort studies.J. Womens Health Gend. Med. 1999; 8: 681-688https://doi.org/10.1089/jwh.1.1999.8.681
- Cohort profile update: australian longitudinal study on women’s health.Int. J. Epidemiol. 2015; 44 (1547-1547f)https://doi.org/10.1093/ije/dyv110
- World Health Organization, Anatomical Therapeutic Chemical (ATC) Classification.2020 (accessed 18 April 2020)
- Polypharmacy among older Australians, 2006–2017: a population‐based study.Med. J. Aust. 2019; 211: 71-75https://doi.org/10.5694/mja2.50244
- Validation of the frail scale in a cohort of older Australian women.J. Am. Geriatr. Soc. 2012; 60: 171-173https://doi.org/10.1111/j.1532-5415.2011.03746.x
- The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection.Med. Care. 1992; 30: 473-483
- Uptake, prevalence and predictors of first-time use for the 75+ Health Assessment Scheme.Aust. J. Prim. Health. 2017; 23: 476-481https://doi.org/10.1071/PY16108
- Obesity: Preventing and Managing the Global Epidemic.2000: 267
- Updated AGS Beers Criteria® for potentially inappropriate medication use in older adults.J. Am. Geriatr. Soc. 2019; 67: 674-694https://doi.org/10.1111/jgs.15767
- High-risk prescribing and incidence of frailty among older community-dwelling men.Clin. Pharmacol. Ther. 2012; 91: 521-528https://doi.org/10.1038/clpt.2011.258
- Frailty, polypharmacy, and health outcomes in older adults: the frailty and dependence in Albacete Study.J. Am. Med. Dir. Assoc. 2018; 19: 46-52https://doi.org/10.1016/j.jamda.2017.07.008
- Beginner’s Guide to Using Pharmaceutical Benefits Scheme Data: Tips and Pitfalls.2012 (accessed 20 April 2020)
- Variation of polypharmacy in older primary care attenders occurs at prescriber level.BMC Geriatr. 2018; 18: 59https://doi.org/10.1186/s12877-018-0750-2
- Aging-associated cardiovascular changes and their relationship to heart failure.Heart Fail. Clin. 2012; 8: 143-164https://doi.org/10.1016/j.hfc.2011.08.011
- Prevalence, risk factors and health outcomes associated with polypharmacy among urban community-dwelling older adults in multi-ethnic Malaysia.PLoS One. 2017; 12 (e0173466)https://doi.org/10.1371/journal.pone.0173466
- Polypharmacy and frailty: prevalence, relationship, and impact on mortality in a French sample of 2350 old people.Pharmacoepidemiol. Drug Saf. 2015; 24: 637-646https://doi.org/10.1002/pds.3772
- Pharmaceutical Society of Australia, Guidelines for Pharmacists Providing Home Medicines Review (HMR) Services.2011 (accessed 10 March 2020)
- MedsCheck- Public Information - Ministry of Health and Long-term Care.2020 (accessed 10 March 2020)
- Medicines Management: Definition, Levels, Competence Framework.2019 (accessed 12 February 2020)
- Deprescribing in older people.Maturitas. 2016; 91: 115-134https://doi.org/10.1016/j.maturitas.2016.06.006
- Undiagnosing to prevent overprescribing.Maturitas. 2019; 123: 67-72https://doi.org/10.1016/j.maturitas.2019.02.010
- Medication prescribing in frail older people.Eur. J. Clin. Pharmacol. 2013; 69: 319-326https://doi.org/10.1007/s00228-012-1387-2
- Use of goal attainment scaling in measuring clinically important change in cognitive rehabilitation patients.J. Clin. Epidemiol. 1997; 50: 581-588https://doi.org/10.1016/s0895-4356(97)00014-0
- Use of medications by persons 65 and over: data from the established populations for epidemiologic studies of the elderly.J. Gerontol. 1992; 47 (M137-M14)https://doi.org/10.1093/geronj/47.5.m1
Article info
Publication history
Published online: January 27, 2021
Accepted:
January 22,
2021
Received in revised form:
November 1,
2020
Received:
July 15,
2020
Identification
Copyright
© 2021 Elsevier B.V. All rights reserved.
