1
|
O'Malley P. Frail elderly experiences of managing polypharmacy at home: adherence to drug therapy explains only a part of the story. Evid Based Nurs 2024:ebnurs-2024-104030. [PMID: 38862195 DOI: 10.1136/ebnurs-2024-104030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2024] [Indexed: 06/13/2024]
Affiliation(s)
- Patricia O'Malley
- Nursing Research, Premier Health Partners, Dayton, Ohio, USA
- Nursing, Indiana University East, Richmond, Indiana, USA
| |
Collapse
|
2
|
Buck J, Fromings Hill J, Collins R, Booth J, Fleming J. Effectiveness of non-pharmacological interventions delivered at home for urinary and faecal incontinence with homebound older people: systematic review of randomised controlled trials. Age Ageing 2024; 53:afae126. [PMID: 38941119 PMCID: PMC11212545 DOI: 10.1093/ageing/afae126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Indexed: 06/29/2024] Open
Abstract
INTRODUCTION Incontinence is a common, distressing condition, most prevalent in older people. There is an unmet need for effective interventions to support continence. This review focuses on non-pharmacological interventions to reduce incontinence among homebound older people. Aim: to identify interventions with potential to be delivered by care workers, nurses or family members in a person's home. METHODS Multiple databases were searched until 15 September 2023 for randomised controlled trials reporting home-based interventions for incontinence for older people (≥65 years) living at home. Two reviewers independently screened titles, abstracts and papers against inclusion criteria, then assessed for the Risk of Bias (RoB2). A third reviewer resolved the discrepancies. Primary data were extracted and synthesised. RESULTS A full-text review of 81 papers identified seven eligible papers (1996-2022, all USA), including n = 636 participants (561 women and 75 men). Two studies focusing on multicomponent behavioural interventions showed benefit, as did one study of transcutaneous tibial nerve stimulation self-administered through electrode-embedded socks. Three, which included cognitively impaired people, reported improvement with toileting assistance programmes, but the effects were not all significant. Results were inconclusive from a study examining the effects of fluid intake adjustments. Interventions were delivered by nurses, three in collaboration with family caregivers. No faecal incontinence interventions met the criteria. CONCLUSION There is scant evidence for continence supporting interventions delivered in older people's own homes. With an ageing population often reliant on family or social care workers well-placed to support continence promotion and policy drives for services to support older people remaining at home, this evidence gap needs addressing.
Collapse
Affiliation(s)
- Jackie Buck
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
- St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - Julia Fromings Hill
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Rachael Collins
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Joanne Booth
- Research Centre for Health, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Jane Fleming
- Cambridge Public Health Interdisciplinary Research Centre, University of Cambridge, Cambridge, UK
| |
Collapse
|
3
|
Mielke N, Barghouth MH, Fietz AK, Villain C, Bothe T, Ebert N, Schaeffner E. Effect modification of polypharmacy on incident frailty by chronic kidney disease in older adults. BMC Geriatr 2024; 24:335. [PMID: 38609867 PMCID: PMC11015642 DOI: 10.1186/s12877-024-04887-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 03/12/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Frailty and polypharmacy are common conditions in older adults, especially in those with chronic kidney disease (CKD). Therefore, we analyzed the association of polypharmacy and incident frailty and the effect modification by CKD in very old adults. METHODS In non-frail individuals within the Berlin Initiative (cohort) Study, polypharmacy (≥ 5 medications) was assessed according to multiple definitions based on the number of regular and on demand prescription and over the counter drugs, as well as vitamins and supplements. CKD was defined as an estimated glomerular filtration rate < 60 mL/min/1.73m2 and/or an albumin-creatinine ratio ≥ 30 mg/g. Incident frailty was assessed at follow-up using Fried criteria. Logistic regression was applied to assess (1) the association of different polypharmacy definitions with incident frailty and (2) effect modification by CKD. RESULTS In this cohort study, out of 757 non-frail participants (mean age 82.9 years, 52% female, 74% CKD), 298 (39%) participants reported polypharmacy. Over the observation period of 2.1 years, 105 became frail. Individuals with polypharmacy had 1.96 adjusted odds (95% confidence interval (CI): 1.20-3.19) of becoming frail compared to participants without polypharmacy. The effect of polypharmacy on incident frailty was modified by CKD on the additive scale (relative excess risk due to interaction: 1.56; 95% CI 0.01-3.12). CONCLUSIONS This study demonstrates an association of polypharmacy and incident frailty and suggests strong evidence for an effect modification of CKD on polypharmacy and incident frailty. Revision of prescriptions could be a target strategy to prevent frailty occurrence, especially in older adults with CKD.
Collapse
Affiliation(s)
- Nina Mielke
- Institute of Public Health, Charité- Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Muhammad Helmi Barghouth
- Institute of Public Health, Charité- Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Anne-Katrin Fietz
- Institute of Public Health, Charité- Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Institute of Biometry and Clinical Epidemiology, Charité- Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Cédric Villain
- Institute of Public Health, Charité- Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Service de Gériatrie, Normandie Univ UNICAEN, INSERM U1075 COMETE, CHU de Caen, Caen, France
| | - Tim Bothe
- Institute of Public Health, Charité- Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Natalie Ebert
- Institute of Public Health, Charité- Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Elke Schaeffner
- Institute of Public Health, Charité- Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| |
Collapse
|
4
|
Ma W, Wang H, Wen Z, Liu L, Zhang X. Potentially inappropriate medication and frailty in older adults: A systematic review and meta-analysis. Arch Gerontol Geriatr 2023; 114:105087. [PMID: 37311369 DOI: 10.1016/j.archger.2023.105087] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/18/2023] [Accepted: 06/03/2023] [Indexed: 06/15/2023]
Abstract
OBJECTIVES The purpose of this study was to systematically assess existing studies to demonstrate the association between potentially inappropriate medication (PIM) and frailty. DESIGN Systematic review and meta-analysis. METHODS We searched major electronic databases (PubMed, Web of Science, the Cochrane Library, Embase, CINHAL, PsycInfo, China National Knowledge Infrastructure, China Biology Medicine disk, Weipu, and Wanfang) from their inception until February 25, 2023 (data updated on May 4, 2023), for observational studies investigating PIM and frailty. I2 was used to measure the heterogeneity between studies quantitatively. A random effect model calculated pooled effect size owing to high heterogeneity. Subgroup analysis was conducted to explore sources of heterogeneity. Additionally, the studies' quality was evaluated using the Newcastle Ottawa Scale (a modified Newcastle Ottawa Scale was used to evaluate cross-sectional studies). RESULTS Twenty-four studies were included for systematic review, 14 of which were included in the meta-analysis. After pooling the effect size, the odds ratio with PIM as the dependent variable was 1.12 (95%CI: 1.01-1.25), and that with frailty as the dependent variable was 1.75 (95%CI: 1.25-2.43), indicating a bidirectional association between PIM and frailty. CONCLUSIONS PIM and frailty interact with each other and have a bidirectional association, thus providing additional information for early clinical identification and prevention of frailty, and medication safety management.
Collapse
Affiliation(s)
- Wenlian Ma
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Hongyan Wang
- Dean Office, Sichuan Nursing Vocational College, Chengdu, China
| | - Zhifei Wen
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Linfeng Liu
- Dean Office, Sichuan Nursing Vocational College, Chengdu, China
| | - Xiangeng Zhang
- Dean Office, Sichuan Nursing Vocational College, Chengdu, China.
| |
Collapse
|
5
|
Lyne S. Benefits of deprescribing for older people with frailty and polypharmacy: part one. Nurs Older People 2023; 35:35-41. [PMID: 37670533 DOI: 10.7748/nop.2023.e1441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2023] [Indexed: 09/07/2023]
Abstract
The UK population is ageing rapidly, a trend that is likely to continue due to improvements in chronic disease management and increased life expectancy. Comorbidities, including frailty, become increasingly common with age and as a result it is likely that multiple medicines will be prescribed for older people, leading to polypharmacy. This is a concern because polypharmacy is associated with various adverse effects and an increased medicine burden in this population, as well as a financial burden for the healthcare system. This article, the first of two parts, explains the physiology of ageing and frailty, and considers the adverse effects of polypharmacy on older people with frailty, using a fictional case study to illustrate this. Part two will use the case study to explore the use of medication reviews and deprescribing benefits as part of medicines optimisation.
Collapse
Affiliation(s)
- Sue Lyne
- East Sussex Healthcare NHS Trust, East Sussex, England
| |
Collapse
|
6
|
Lyne S. Benefits of deprescribing for older people with frailty and polypharmacy: part two. Nurs Older People 2023; 35:e1449. [PMID: 37726987 DOI: 10.7748/nop.2023.e1449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2023] [Indexed: 09/21/2023]
Abstract
Polypharmacy is a significant issue for many older people, including those with frailty, and it is associated with a range of adverse effects. Therefore, it is important to address polypharmacy by optimising patients' medicines use. Medication reviews are one of the main approaches to medicines optimisation, and various tools are available to support healthcare professionals with conducting these. Another approach is deprescribing, which can improve health outcomes for patients and may have financial benefits for healthcare organisations, but can also present various challenges. This article, the second of two parts, explores the benefits of medicines optimisation in the form of medication reviews and deprescribing for older people with frailty and polypharmacy.
Collapse
Affiliation(s)
- Sue Lyne
- East Sussex Healthcare NHS Trust, East Sussex, England
| |
Collapse
|
7
|
Ye L, Nieboer D, Yang-Huang J, Borrás TA, Garcés-Ferrer J, Verma A, van Grieken A, Raat H. The association between frailty and the risk of medication-related problems among community-dwelling older adults in Europe. J Am Geriatr Soc 2023. [PMID: 36965170 DOI: 10.1111/jgs.18343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 02/17/2023] [Accepted: 02/27/2023] [Indexed: 03/27/2023]
Abstract
BACKGROUND Studies revealed unidirectional associations between frailty and medication-related problems (MRPs) among older adults. Less is known about the association between frailty and the risk of MRPs. We aimed to assess the bi-directional association between frailty and the risk of MRPs in community-dwelling older adults in five European countries. METHODS Participants were 1785 older adults in the population-based Urban Health Centres Europe project. Repeated assessments were collected at baseline and one-year follow-up, including frailty, the risk of MRPs, and covariates. Linear regression analyses were conducted to examine the unidirectional associations. A cross-lagged panel modeling was used to assess bi-directional associations. RESULTS The unidirectional association between frailty at baseline and the risk of MRPs at follow-up remained statistically significant after adjusting for covariates (β = 0.10, 95%CI:0.08, 0.13). The association between the risk of MRPs at baseline and frailty at follow-up shows similar trends. The bi-directional association was comparable with reported unidirectional associations, with a stronger effect from frailty at baseline to the risk of MRPs at follow-up than reversed path (Wald test for comparing lagged effects: p < 0.05). CONCLUSION This longitudinal study suggests that a cycle may exist where older adults with higher frailty levels are more likely to have a higher risk of MRPs, which in turn contributes to developing a higher level of frailty. Further research is needed to validate our findings and explore underlying pathways.
Collapse
Affiliation(s)
- Lizhen Ye
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Daan Nieboer
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Junwen Yang-Huang
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - Jorge Garcés-Ferrer
- Polibienestar Research Institute - Universitat de València ES, Valencia, Spain
| | - Arpana Verma
- Epidemiology and Public Health Group, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK
| | - Amy van Grieken
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Hein Raat
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| |
Collapse
|
8
|
Mohammed MA, Harrison J, Milosavljevic A, Chan AHY. Attitude towards deprescribing and its association with frailty and complexity of medication regimen: A survey of older inpatients in a district health board in New Zealand. BMC Geriatr 2023; 23:166. [PMID: 36959598 PMCID: PMC10035261 DOI: 10.1186/s12877-023-03878-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 03/08/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Older inpatients, particularly those with frailty, have increased exposure to complex medication regimens. It is not known whether frailty and complexity of medication regimens influence attitudes toward deprescribing. This study aimed to investigate (1) older inpatients' attitudes toward deprescribing; (2) if frailty and complexity of medication regimen influence attitudes and willingness to deprescribe - a relationship that has not been investigated in previous studies. METHODS In this cross-sectional study, older adults (≥ 65 years) recruited from general medicine and geriatric services in a New Zealand hospital completed the revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire. Hospital frailty risk score (HFRS) was calculated using diagnostic codes and other relevant information present at the time of index hospital admission; higher scores indicate higher frailty risk. Medication regimen complexity was quantified using the medication regimen complexity index (MRCI); higher scores indicate greater complexity. Logistic regression analysis was used to identify predictors of attitudes and willingness to deprescribe. RESULTS A total of 222 patients were included in the study, the median age was 83 years and 63% were female. One in two patients reported feeling they were taking too many medications, and 1 in 5 considered their medications burdensome. Almost 3 in 4 (73%) wanted to be involved in decision-making about their medications, and 4 in 5 (84%) were willing to stop one or more of their medications if their prescriber said it was possible. Patients with higher MRCI had increased self-reported medication burden (adjusted odds ratio (AOR) 2.6, 95% CI 1.29, 5.29) and were more interested in being involved in decision-making about their medications (AOR 1.8, CI 0.99, 3.42) than those with lower MRCI. Patients with moderate HFRS had lower odds of willingness to deprescribe (AOR 0.45, CI 0.22,0.92) compared to the low-risk group. Female patients had a lower desire to be involved in decision-making. The oldest old age group( > 80 years) had lower self-reported medication burden and were less likely to want to try stopping their medications. CONCLUSION Most older inpatients wanted to be involved in decision-making about their medications and were willing to stop one or more medications if proposed by their prescriber. Medication complexity and frailty status influence patients' attitudes toward deprescribing and thus should be taken into consideration when making deprescribing decisions. Further research is needed to investigate the relationship between frailty and the complexity of medication regimens.
Collapse
Affiliation(s)
- Mohammed A Mohammed
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
| | - Jeff Harrison
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Aleksandra Milosavljevic
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Amy Hai Yan Chan
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| |
Collapse
|
9
|
Herrera-Añazco P, Mougenot B, Benites-Meza JK, Barturén-Alvarado LC, Zumarán-Nuñez CJ, Boyd-Gamarra MA, Runzer-Colmenares FM, Benites-Zapata VA. Self-Medication Practices, Use of Brand-Name, and Over-the-Counter Medicines by Peruvian Older Adults. Can Geriatr J 2023; 26:187-199. [PMID: 36865404 PMCID: PMC9953501 DOI: 10.5770/cgj.26.631] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
Background Older adults are a particularly vulnerable group to drug use and self-medication. The aim of the study was to evaluate self-medication as a factor associated with the purchase of brand-name and over-the-counter (OTC) drugs in older adults in Peru. Methods A secondary analysis was performed using an analytical cross-sectional design of data from a nationally representative survey from 2014 to 2016. The exposure variable was self-medication, defined as the purchase of medicines without a prescription. The dependent variables were purchases of brand-name and OTC drugs, both as a dichotomous response (yes/no). Information of sociodemographic variables, health insurance, and the types of drugs purchased by the participants was collected. Crude prevalence ratios (PR) were calculated and adjusted using generalized linear models of the Poisson family, considering the complex sample of the survey. Results In this study, 1,115 respondents were evaluated, with a mean age of 63.8 years and a male proportion of 48.2%. The prevalence of self-medication was 66.6%, while the proportions of purchases of brand-name and OTC drugs were 62.4% and 23.6%, respectively. The adjusted Poisson regression analysis revealed an association between self-medication and the purchase of brand-name drugs (adjusted PR [aPR]=1.09; 95% confidence interval [CI]: 1.01-1.19). Likewise, self-medication was associated with the purchase of OTC medications (aPR=1.97; 95%CI: 1.55-2.51). Conclusions This study evidenced a high prevalence of self-medication in Peruvian older adults. Two-thirds of the surveyed people bought brand-name drugs, whereas one-quarter bought OTC drugs. Self-medication was associated with a greater likelihood of buying brand-name and OTC drugs.
Collapse
Affiliation(s)
- Percy Herrera-Añazco
- Facultad de Ciencias de la Salud, Universidad Privada del Norte, Trujillo, Peru,Red Internacional en Salud Colectiva y Salud Intercultural, Mexico City, Mexico
| | - Benoit Mougenot
- Facultad de Ciencias Empresariales, Universidad San Ignacio de Loyola, Lima, Peru,Centro de Excelencia en Investigaciones Económicas y Sociales en Salud, Universidad San Ignacio de Loyola, Lima, Peru
| | - Jerry K. Benites-Meza
- Sociedad Científica de Estudiantes de Medicina de la Universidad Nacional de Trujillo, Trujillo, Peru,Grupo Peruano de Investigación Epidemiológica, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru
| | - Luz C. Barturén-Alvarado
- Escuela Profesional de Medicina Humana de la Universidad Señor de Sipán, Chiclayo, Peru,Asociación Científica de Estudiantes de Medicina de la Universidad Señor de Sipán, Chiclayo, Peru
| | - Carlos J. Zumarán-Nuñez
- Grupo Peruano de Investigación Epidemiológica, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru,Asociación Científica de Estudiantes de Medicina de la Universidad Señor de Sipán, Chiclayo, Peru
| | - Maria A. Boyd-Gamarra
- Escuela Profesional de Medicina Humana de la Universidad Señor de Sipán, Chiclayo, Peru,Asociación Científica de Estudiantes de Medicina de la Universidad Señor de Sipán, Chiclayo, Peru
| | - Fernando M. Runzer-Colmenares
- Universidad Científica del Sur, Facultad de Ciencias de la Salud, Carrera de Medicina Humana, CHANGE Research Working Group, Lima, Peru
| | - Vicente A. Benites-Zapata
- Red Internacional en Salud Colectiva y Salud Intercultural, Mexico City, Mexico,Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru
| |
Collapse
|
10
|
An Overview of Systematic Reviews and Meta-Analyses on the Effect of Medication Interventions Targeting Polypharmacy for Frail Older Adults. J Clin Med 2023; 12:jcm12041379. [PMID: 36835915 PMCID: PMC9960328 DOI: 10.3390/jcm12041379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/31/2023] [Accepted: 02/04/2023] [Indexed: 02/12/2023] Open
Abstract
Frailty refers to the lack of resilience and a reduction in a person's ability to recover following a health problem, and it is increasingly becoming a challenging aspect of ageing populations. Many older adults are exposed to polypharmacy; i.e., they continue to be on medications without timely re-evaluation. Medication reviews have proven successful in managing polypharmacy in the general population, but there is uncertainty regarding their effect among frail older adults. This overview of published systematic reviews assesses the impact of medication reviews on polypharmacy in frail older adults. Embase was searched from its inception to January 2021 and 28 systematic reviews were identified, out of which 10 were included in the overview. Medication reviews were the most common intervention in 8 out of 10 systematic reviews. The frailty score was reported as an outcome in one systematic review that found no evidence for fundamental pharmacological effects on frailty. Six systematic reviews reported a statistically significant reduction in the number of inappropriately prescribed medications. Four systematic reviews reported on hospital admissions, with two of them reporting a decrease in hospitalisations. The quality assessment was moderate in six and critically low in four of the systematic reviews. We conclude that medication reviews help in reducing the use of inappropriate medications in frail older adults, but that there is insufficient evidence in terms of frailty score and hospital admissions.
Collapse
|
11
|
Ekram ARMS, Woods RL, Ryan J, Espinoza SE, Gilmartin-Thomas JF, Shah RC, Mehta R, Kochar B, Lowthian JA, Lockery J, Orchard S, Nelson M, Fravel MA, Liew D, Ernst ME. The association between polypharmacy, frailty and disability-free survival in community-dwelling healthy older individuals. Arch Gerontol Geriatr 2022; 101:104694. [PMID: 35349875 PMCID: PMC9437977 DOI: 10.1016/j.archger.2022.104694] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/11/2022] [Accepted: 03/22/2022] [Indexed: 01/02/2023]
Abstract
OBJECTIVES Polypharmacy and frailty are two common geriatric conditions. In community-dwelling healthy older adults, we examined whether polypharmacy is associated with frailty and affects disability-free survival (DFS), assessed as a composite of death, dementia, or persistent physical disability. METHODS We included 19,114 participants (median age 74.0 years, IQR: 6.1 years) from ASPirin in Reducing Events in the Elderly (ASPREE) clinical trial. Frailty was assessed by a modified Fried phenotype and a deficit accumulation Frailty Index (FI). Polypharmacy was defined as concomitant use of five or more prescription medications. Multinomial logistic regression was used to examine the cross-sectional association between polypharmacy and frailty at base line, and Cox regression to determine the effect of polypharmacy and frailty on DFS over five years. RESULTS Individuals with polypharmacy (vs. <5 medications) were 55% more likely to be pre-frail (Relative Risk Ratio or RRR: 1.55; 95%Confidence Interval or CI:1.44, 1.68) and three times more likely to be frail (RRR: 3.34; 95%CI:2.64, 4.22) according to Fried phenotype. Frailty alone was associated with double risk of the composite outcome (Hazard ratio or HR: 2.16; 95%CI: 1.56, 2.99), but frail individuals using polypharmacy had a four-fold risk (HR: 4.24; 95%CI: 3.28, 5.47). Effect sizes were larger when frailty was assessed using the FI. CONCLUSION Polypharmacy was significantly associated with pre-frailty and frailty at baseline. Polypharmacy-exposed frailty increased the risk of reducing disability-free survival among older adults. Addressing polypharmacy in older people could ameliorate the impact of frailty on individuals' functional status, cognition and survival.
Collapse
|
12
|
Randles MA, O'Mahony D, Gallagher PF. Frailty and Potentially Inappropriate Prescribing in Older People with Polypharmacy: A Bi-Directional Relationship? Drugs Aging 2022; 39:597-606. [PMID: 35764865 PMCID: PMC9355920 DOI: 10.1007/s40266-022-00952-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2022] [Indexed: 01/10/2023]
Abstract
Frail older adults commonly experience multiple co-morbid illnesses and other risk factors for potentially inappropriate prescribing. However, determination of frailty varies depending on the frailty instrument used. Older people’s degree of frailty often influences their care and treatment priorities. Research investigating the association between frailty and potentially inappropriate prescribing is hindered by a wide variety of frailty definitions and measurement tools. We undertook a narrative review of selected articles of PubMed and Google Scholar databases. Articles were selected on the basis of relevance to the core themes of frailty and potentially inappropriate prescribing. We identified observational studies that clearly link potentially inappropriate prescribing, potential prescribing omissions, and adverse drug reactions with frailty in older adults. Equally, the literature illustrates that measured frailty in older adults predisposes to inappropriate polypharmacy and associated adverse drug reactions and events. In essence, there is a bi-directional relationship between frailty and potentially inappropriate prescribing, the underlying substrates being multimorbidity and inappropriate polypharmacy. We conclude that there is a need for consensus on rapid and accurate identification of frailty in older people using appropriate and user-friendly methods for routine clinical practice as a means of identifying older multimorbid patients at risk of potentially inappropriate prescribing. Detection of frailty should, we contend, lead to structured screening for inappropriate prescribing in this high-risk population. Of equal importance, detection of potentially inappropriate prescribing in older people should trigger screening for frailty. All clinicians undertaking a medication review of multimorbid patients with associated polypharmacy should take account of the important interaction between frailty and potentially inappropriate prescribing in the interest of minimizing patient harm.
Collapse
Affiliation(s)
- Mary A Randles
- Department of Geriatric Medicine, Cork University Hospital, Wilton, Cork, T12DC4A, Ireland. .,Department of Medicine, University College Cork, Cork, Ireland.
| | - Denis O'Mahony
- Department of Geriatric Medicine, Cork University Hospital, Wilton, Cork, T12DC4A, Ireland.,Department of Medicine, University College Cork, Cork, Ireland
| | - Paul F Gallagher
- Department of Medicine, University College Cork, Cork, Ireland.,Department of Geriatric Medicine, Bon Secours Hospital, Cork, Ireland
| |
Collapse
|
13
|
van Dam CS, Labuschagne HA, van Keulen K, Kramers C, Kleipool EE, Hoogendijk EO, Knol W, Nanayakkara PWB, Muller M, Trappenburg MC, Peters MJL. Polypharmacy, comorbidity and frailty: a complex interplay in older patients at the emergency department. Eur Geriatr Med 2022; 13:849-857. [PMID: 35723840 PMCID: PMC9378326 DOI: 10.1007/s41999-022-00664-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/22/2022] [Indexed: 11/30/2022]
Abstract
Aim To investigate the association of polypharmacy with adverse health outcomes, in relation to comorbidity and frailty. Findings Excessive polypharmacy (≥ 10 medications) is highly prevalent in older adults at the emergency department and associated with falls, mortality and readmission. Frailty and comorbidity partly drive the association of polypharmacy with adverse health outcomes. Message Trials that target polypharmacy and inappropriate prescribing are needed to answer the lingering question of causality in the observed polypharmacy–mortality association and to evaluate whether medication review improves health outcomes in older patients at the ED. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-022-00664-y. Purpose Older adults at the emergency department (ED) with polypharmacy, comorbidity, and frailty are at risk of adverse health outcomes. We investigated the association of polypharmacy with adverse health outcomes, in relation to comorbidity and frailty. Methods This is a prospective cohort study in ED patients ≥ 70 years. Non-polypharmacy was defined as 0–4 medications, polypharmacy 5–9 and excessive polypharmacy ≥ 10. Comorbidity was classified by the Charlson comorbidity index (CCI). Frailty was defined by the Identification of Seniors At Risk—Hospitalized Patients (ISAR-HP) score. The primary outcome was 3-month mortality. Secondary outcomes were readmission to an ED/hospital ward and a self-reported fall < 3 months. The association between polypharmacy, comorbidity and frailty was analyzed by logistic regression. Results 881 patients were included. 43% had polypharmacy and 18% had excessive polypharmacy. After 3 months, 9% died, 30% were readmitted, and 21% reported a fall. Compared with non-polypharmacy, the odds ratio (OR) for mortality ranged from 2.62 (95% CI 1.39–4.93) in patients with polypharmacy to 3.92 (95% CI 1.95–7.90) in excessive polypharmacy. The OR weakened after adjustment for comorbidity: 1.80 (95% CI 0.92–3.52) and 2.32 (95% CI 1.10–4.90). After adjusting for frailty, the OR weakened to 2.10 (95% CI 1.10–4.00) and OR 2.40 (95% CI 1.15–5.02). No significant association was found for readmission or self-reported fall. Conclusions Polypharmacy is common in older patients at the ED. Polypharmacy, and especially excessive polypharmacy, is associated with an increased risk of mortality. The observed association is complex given the confounding effect of comorbidity and frailty. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-022-00664-y.
Collapse
Affiliation(s)
- Carmen S van Dam
- Department of Internal Medicine and Geriatrics, Amsterdam UMC, Location VUmc, Amsterdam, the Netherlands.
| | - Helena A Labuschagne
- Department of Internal Medicine and Geriatrics, Amsterdam UMC, Location VUmc, Amsterdam, the Netherlands
| | - Kris van Keulen
- Department of Pharmacy, Amstelland Hospital, Amstelveen, the Netherlands
| | - Cornelis Kramers
- Department of Pharmacology-Toxicology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Emma E Kleipool
- Department of Internal Medicine and Geriatrics, Amsterdam UMC, Location VUmc, Amsterdam, the Netherlands
| | - Emiel O Hoogendijk
- Department of Epidemiology and Data Science, Amsterdam UMC, Location VUmc, Amsterdam, the Netherlands
| | - Wilma Knol
- Department of Geriatric Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Prabath W B Nanayakkara
- Section General and Acute Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, Location VUmc, Amsterdam, the Netherlands
| | - Majon Muller
- Department of Internal Medicine and Geriatrics, Amsterdam UMC, Location VUmc, Amsterdam, the Netherlands
| | - Marijke C Trappenburg
- Department of Internal Medicine and Geriatrics, Amsterdam UMC, Location VUmc, Amsterdam, the Netherlands.,Department of Pharmacy, Amstelland Hospital, Amstelveen, the Netherlands
| | - Mike J L Peters
- Department of Internal Medicine and Geriatrics, Amsterdam UMC, Location VUmc, Amsterdam, the Netherlands.,Department of Geriatric Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| |
Collapse
|
14
|
Teixeira-Gomes A, Laffon B, Valdiglesias V, Gostner JM, Felder T, Costa C, Madureira J, Fuchs D, Teixeira JP, Costa S. Exploring Early Detection of Frailty Syndrome in Older Adults: Evaluation of Oxi-Immune Markers, Clinical Parameters and Modifiable Risk Factors. Antioxidants (Basel) 2021; 10:antiox10121975. [PMID: 34943076 PMCID: PMC8750623 DOI: 10.3390/antiox10121975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/22/2021] [Accepted: 12/02/2021] [Indexed: 12/15/2022] Open
Abstract
Ageing is accompanied with a decline in several physiological systems. Frailty is an age-related syndrome correlated to the loss of homeostasis and increased vulnerability to stressors, which is associated with increase in the risk of disability, comorbidity, hospitalisation, and death in older adults. The aim of this study was to understand the relationship between frailty syndrome, immune activation, and oxidative stress. Serum concentrations of vitamins A and E were also evaluated, as well as inflammatory biomarkers (CRP and IL-6) and oxidative DNA levels. A group of Portuguese older adults (≥65 years old) was engaged in this study and classified according to Fried’s frailty phenotype. Significant increases in the inflammatory mediators (CRP and IL-6), neopterin levels, kynurenine to tryptophan ratio (Kyn/Trp), and phenylalanine to tyrosine ratio (Phe/Tyr), and significant decreases in Trp and Tyr concentrations were observed in the presence of frailty. IL-6, neopterin, and Kyn/Trp showed potential as predictable biomarkers of frailty syndrome. Several clinical parameters such as nutrition, dependency scales, and polypharmacy were related to frailty and, consequently, may influence the associations observed. Results obtained show a progressive immune activation and production of pro-inflammatory molecules in the presence of frailty, agreeing with the inflammageing model. Future research should include different dimensions of frailty, including psychological, social, biological, and environmental factors.
Collapse
Affiliation(s)
- Armanda Teixeira-Gomes
- EPIUnit—Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas 135, 4050-600 Porto, Portugal; (A.T.-G.); (C.C.); (J.M.); (S.C.)
- Environmental Health Department, National Institute of Health Doutor Ricardo Jorge, Rua Alexandre Herculano 321, 4000-055 Porto, Portugal
- School of Medicine and Biomedical Sciences (ICBAS), University of Porto, Rua de Jorge Viterbo Ferreira 228, 4050-313 Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), Rua das Taipas 135, 4050-600 Porto, Portugal
| | - Blanca Laffon
- Centro de Investigaciones Científicas Avanzadas (CICA), Grupo DICOMOSA, Departamento de Psicología, Facultad de Ciencias de la Educación, Campus Elviña s/n, Universidade da Coruña, 15071 A Coruña, Spain;
- Instituto de Investigación Biomédica de A Coruña (INIBIC), AE CICA-INIBIC. Oza, 15071 A Coruña, Spain;
| | - Vanessa Valdiglesias
- Instituto de Investigación Biomédica de A Coruña (INIBIC), AE CICA-INIBIC. Oza, 15071 A Coruña, Spain;
- Centro de Investigaciones Científicas Avanzadas (CICA), Grupo NanoToxGen, Departamento de Biología, Facultad de Ciencias, Campus A Zapateira s/n, Universidade da Coruña, 15071 A Coruña, Spain
| | - Johanna M. Gostner
- Institute of Medical Biochemistry, Biocenter, Medical University of Innsbruck, 6020 Innsbruck, Austria;
| | - Thomas Felder
- Department of Laboratory Medicine, Paracelsus Medical University, 5020 Salzburg, Austria;
| | - Carla Costa
- EPIUnit—Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas 135, 4050-600 Porto, Portugal; (A.T.-G.); (C.C.); (J.M.); (S.C.)
- Environmental Health Department, National Institute of Health Doutor Ricardo Jorge, Rua Alexandre Herculano 321, 4000-055 Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), Rua das Taipas 135, 4050-600 Porto, Portugal
| | - Joana Madureira
- EPIUnit—Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas 135, 4050-600 Porto, Portugal; (A.T.-G.); (C.C.); (J.M.); (S.C.)
- Environmental Health Department, National Institute of Health Doutor Ricardo Jorge, Rua Alexandre Herculano 321, 4000-055 Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), Rua das Taipas 135, 4050-600 Porto, Portugal
| | - Dietmar Fuchs
- Institute of Biological Chemistry, Biocenter, Medical University of Innsbruck, 6020 Innsbruck, Austria;
| | - João Paulo Teixeira
- EPIUnit—Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas 135, 4050-600 Porto, Portugal; (A.T.-G.); (C.C.); (J.M.); (S.C.)
- Environmental Health Department, National Institute of Health Doutor Ricardo Jorge, Rua Alexandre Herculano 321, 4000-055 Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), Rua das Taipas 135, 4050-600 Porto, Portugal
- Correspondence: or
| | - Solange Costa
- EPIUnit—Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas 135, 4050-600 Porto, Portugal; (A.T.-G.); (C.C.); (J.M.); (S.C.)
- Environmental Health Department, National Institute of Health Doutor Ricardo Jorge, Rua Alexandre Herculano 321, 4000-055 Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), Rua das Taipas 135, 4050-600 Porto, Portugal
| |
Collapse
|