Inappropriate medications and physical function: a systematic review

Abstract

Background and aims: Inappropriate medication prescription is highly prevalent in older adults and is associated with adverse health outcomes. The aim of this study was to examine the associations between potentially inappropriate medications (PIMS) and potential prescribing omissions with physical function in older adults situated in diverse environments. Methods: A systematic search was completed using the following databases: MEDLINE, CINAHL, PsycINFO, EMBASE and COCHRANE. Results were extracted from the included studies. Results: In total, 55 studies reported on 2,767,594 participants with a mean age of 77.1 years (63.5% women). Study designs comprised 26 retrospective cohort studies, 21 prospective cohort studies and 8 cross-sectional studies. Inappropriate medications in community and hospital settings were significantly associated with higher risk of falls (21 out of 30 studies), higher risk of fractures (7 out of 9 studies), impaired activities of daily living (ADL; 8 out of 10 studies) and impaired instrumental ADL (IADL) score (4 out of 6 studies). Five out of seven studies also showed that PIMs were associated with poorer physical performance comprising the Timed Up and Go test, walking speed, grip strength, time to functional recovery, functional independence and scale of functioning. Many medication classes were implicated as PIMs in falls, fractures and impairment in physical performance including antipsychotic, sedative, anti-anxiety, anticholinergic, antidiabetic, opioid and antihypertensive medications. For patients not receiving musculoskeletal medications, such as calcium, vitamin D and bisphosphonates, older adults were found to be at risk of a hospital admission for a fall or fracture. Conclusion: Inappropriate medication prescriptions are associated with impaired physical function across longitudinal and cross-sectional studies in older adults situated in diverse settings. It is important to support older people to reduce their use of inappropriate medications and prevent prescribing omissions. Plain language summary Inappropriate medications and physical function Background and aims: The use of inappropriate medications is very common in older adults and is associated with harmful health problems. The aim was to examine associations between potentially inappropriate medications and potential prescribing omissions with physical function in older adults situated in diverse environments. Methods: Library databases were examined for possible studies to include and a systematic search was completed. Relevant information was obtained from the included studies. Results: In total, 55 studies reported on 2,767,594 participants who were an average age of 77.1 years and about 6 out of 10 were women. A variety of different study designs were used. Inappropriate medication prescriptions in community and hospital settings were significantly associated with higher risk of falls (21 out of 30 studies), higher risk of fractures (7 out of 9 studies), problems with activities of daily living (ADL), such as eating, bathing, dressing, grooming, walking and toileting (8 out of 10 studies) and problems with instrumental ADL such as managing medications, house cleaning and shopping (4 out of 6 studies). Five out of seven studies also showed that inappropriate medications were associated with poorer physical performance involving the Timed Up and Go test, walking speed, grip strength, time to functional recovery, functional independence and scale of functioning. Many types of medication classes were shown to be associated with a risk of falls, fractures and problems with physical performance. Omitted medications were also associated with falls and fractures. Conclusion: Inappropriate medication prescriptions are associated with problems relating to physical function. It is important to support older people to reduce their use of inappropriate medications and prevent prescribing omissions.

Higher FORTA (Fit fOR The Aged) scores are associated with poor functional outcomes, dementia, and mortality in older people

“…Our findings show significant correlations between medication quality and functional status in community-dwelling older adults. Although weak according to Leclezio et al [ 43 ], these correlations are in line with our previous findings from the VALFORTA trial [ 16 , 25 ] and with those reported in the literature [ 11 ]. While ADL and IADL were negatively correlated with the FORTA score both longitudinally as well as in the multivariate analysis thus matching with those studies cited, they were positively correlated with the number of medications and diseases.…”

“…Consequently, as the prevalence of multimorbidity (having two or more chronic diseases) and associated polypharmacy (use of five or more medications by most definitions) is generally high in this group [3][4][5], these issues are expected to become even more relevant over the coming decades. Polypharmacy often leads to inappropriate drug treatment and this frequently results in preventable adverse clinical outcomes [2,[6][7][8][9][10][11][12][13][14][15][16]. Inappropriate prescribing is often the result of an "evidence-biased" pharmacotherapy in older adults [17].…”

Motor- and cognition-related safety of pimavanserin in patients with Parkinson's disease psychosis

“…Off-label use of antipsychotics and other medication in older adults is significantly associated with impaired activities of daily living and health-related quality of life ( 18 ). Motor-related AEs are of particular concern in patients with PD, for whom motor control is already compromised, and comorbid disease- and age-related impairments are common ( 32 ).…”

“…Parkinsonism (extrapyramidal symptoms) and worsening motor function are commonly reported AEs with antipsychotic use that may be particularly important in this context ( 11 , 13 , 16 , 17 ). Motor impairment associated with off-label use of antipsychotics in older adults has a negative impact on activities of daily living, such as bathing, dressing, and walking, and on instrumental activities of daily living, such as managing medication, house cleaning, and shopping ( 18 ). In addition to motor impairments, off-label antipsychotics have also been shown to exacerbate cognitive function decline in patients with dementias ( 13 , 19 ).…”

The Sex-Specific Impact of the FORTA (Fit-fOR-The-Aged) List on Medication Quality and Clinical Endpoints in Older Hospitalized Patients: Secondary Analysis of a Randomized Controlled Trial

“…This is the first analysis of sex differences for the clinical effects of a listing approach that is focused on older patients (patient-in-focus listing approach, PILA) [ 22 ]. The use of PIMs is associated with a decline in functional aspects and worse outcomes regarding activities of daily living (ADLs) [ 30 , 31 ]. It was shown that the equivalent improvement of the FORTA score in both sexes is accompanied by an equivalent improvement of the BI.…”