Polypharmacy Is Associated With Higher Frailty Risk in Older People: An 8-Year Longitudinal Cohort Study

Veronese, N; Stubbs, B; Noale, M; Solmi, M; Pilotto, A; Vaona, A; Demurtas, J; Mueller, C; Huntley, J; Crepaldi, G; Maggi, S

doi:10.1016/j.jamda.2017.02.009

Objective To investigate whether polypharmacy is associated with a higher incidence of frailty in a large cohort of North Americans during 8 years of follow-up. Design Longitudinal study, follow-up of 8 years. Participants A total of 4402 individuals at high risk or having knee osteoarthritis free from frailty at baseline. Measurements Details regarding medication prescription were captured and categorized as 0–3, 4–6, and ≥7. Frailty was defined using the Study of Osteoporotic Fracture index as the presence of ≥2 out of (1) weight loss ≥5% between baseline and the subsequent follow-up visit; (2) inability to do 5 chair stands; and (3) low energy level according to the Study of Osteoporotic Fracture definition. Cox's regression models calculating a hazard ratio (HR) with 95% confidence intervals (CIs), adjusted for potential confounders, were undertaken. Results During the 8-year follow-up, from 4402 participants at baseline, 361 became frail. Compared with participants taking 0–3 medications, the incidence of frailty was approximately double in those taking 4–6 medications and 6 times higher in people taking ≥7 medications. After adjusting for 11 potential baseline confounders, participants using 4–6 medications had a higher risk of frailty of 55% (HR = 1.55; 95% CI 1.22–1.96; P <.0001), whereas those using more than 7 drugs were at approximately 147% (HR = 2.47; 95% CI 1.78–3.43; P <.0001). Each additional drug used at the baseline increased the risk of frailty at the follow-up of 11% (HR = 1.11; 95% CI 1.07–1.15; P <.0001). Conclusions Polypharmacy is associated with a higher incidence of frailty over 8-year follow-up period. Our data suggest evidence of a dose response relationship. Future research is required to confirm our findings and explore underlying mechanisms. © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine

Veronese, N., Stubbs, B., Noale, M., Solmi, M., Pilotto, A., Vaona, A., et al. (2017). Polypharmacy Is Associated With Higher Frailty Risk in Older People: An 8-Year Longitudinal Cohort Study. JOURNAL OF THE AMERICAN MEDICAL DIRECTORS ASSOCIATION, 18(7), 624-628.

Data di pubblicazione:	2017
Titolo:	Polypharmacy Is Associated With Higher Frailty Risk in Older People: An 8-Year Longitudinal Cohort Study
Autori:	Veronese, Nicola Stubbs, B. Noale, M. Solmi, M. Pilotto, A. Vaona, A. Demurtas, J. Mueller, C. Huntley, J. Crepaldi, G. Maggi, S. mostra contributor esterni nascondi contributor esterni
Citazione:	Veronese, N., Stubbs, B., Noale, M., Solmi, M., Pilotto, A., Vaona, A., et al. (2017). Polypharmacy Is Associated With Higher Frailty Risk in Older People: An 8-Year Longitudinal Cohort Study. JOURNAL OF THE AMERICAN MEDICAL DIRECTORS ASSOCIATION, 18(7), 624-628.
Rivista:	JOURNAL OF THE AMERICAN MEDICAL DIRECTORS ASSOCIATION
Digital Object Identifier (DOI):	http://dx.doi.org/10.1016/j.jamda.2017.02.009
Abstract:	Objective To investigate whether polypharmacy is associated with a higher incidence of frailty in a large cohort of North Americans during 8 years of follow-up. Design Longitudinal study, follow-up of 8 years. Participants A total of 4402 individuals at high risk or having knee osteoarthritis free from frailty at baseline. Measurements Details regarding medication prescription were captured and categorized as 0–3, 4–6, and ≥7. Frailty was defined using the Study of Osteoporotic Fracture index as the presence of ≥2 out of (1) weight loss ≥5% between baseline and the subsequent follow-up visit; (2) inability to do 5 chair stands; and (3) low energy level according to the Study of Osteoporotic Fracture definition. Cox's regression models calculating a hazard ratio (HR) with 95% confidence intervals (CIs), adjusted for potential confounders, were undertaken. Results During the 8-year follow-up, from 4402 participants at baseline, 361 became frail. Compared with participants taking 0–3 medications, the incidence of frailty was approximately double in those taking 4–6 medications and 6 times higher in people taking ≥7 medications. After adjusting for 11 potential baseline confounders, participants using 4–6 medications had a higher risk of frailty of 55% (HR = 1.55; 95% CI 1.22–1.96; P <.0001), whereas those using more than 7 drugs were at approximately 147% (HR = 2.47; 95% CI 1.78–3.43; P <.0001). Each additional drug used at the baseline increased the risk of frailty at the follow-up of 11% (HR = 1.11; 95% CI 1.07–1.15; P <.0001). Conclusions Polypharmacy is associated with a higher incidence of frailty over 8-year follow-up period. Our data suggest evidence of a dose response relationship. Future research is required to confirm our findings and explore underlying mechanisms. © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine
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