Is Polypharmacy Associated with Frailty in Older People? Results From the ESTHER Cohort Study

Abstract

OBJECTIVES: To investigate the relationship between polypharmacy and frailty. DESIGN: Longitudinal, observational cohort study. SETTING: Saarland, Germany. PARTICIPANTS: 3,058 community-dwelling adults aged between 57 and 84 years. MEASUREMENTS: Frailty was assessed according to the frailty phenotype, described by Fried et al. Polypharmacy and hyperpolypharmacy were defined as the concomitant use of five or more and 10 or more drugs, respectively. We assessed associations between polypharmacy and prevalent and incident frailty within 3 years of follow-up by logistic regression models controlled for multiple potential confounders including comorbidity. Additionally, cubic splines were used to assess dose-response associations. RESULTS: Polypharmacy was reported in 39.1% (n = 1,194), and hyperpolypharmacy in 8.9% (n = 273) of participants. Prevalent frailty was present in 271 (8.9%) participants; 186 (9.3%) of 1,998 non-frail participants with follow-up data became frail within 3 years. After adjustment, polypharmacy and hyperpolypharmacy were associated with prevalent frailty with adjusted odds ratios (95% confidence interval) of 2.30 (1.60-3.31) and 4.97 (2.97-8.32), respectively. Polypharmacy (odds ratio (OR) 1.51 (1.05-2.16)) and hyperpolypharmacy (OR 1.90 (1.10-3.28)) were also independent predictors of incident frailty. Furthermore, there was a moderate exposure-response relationship between the number of medicines and prevalent as well as incident frailty.CONCLUSION: Our study showed that polypharmacy is associated with frailty. Further research should address the potential benefit of reducing of inappropriate polypharmacy and better pharmacotherapeutic management for preventing medication-associated frailty. J Am Geriatr Soc 65:e27-e32, 2017.

Frailty, polypharmacy, and potentially inappropriate medications in old people: findings in a representative sample of the French population

“…Our estimates of the prevalence of polypharmacy and PIMs are relatively high compared to previous estimates [7,9,11,23], which was expected considering our methodology. Indeed, the prevalence of polypharmacy should be considered with regard to our definition that encompasses all the medications prescribed over 3-month periods.…”

“…Epidemiological studies have shown that frail people are more likely to receive polypharmacy compared to non-frail individuals [7][8][9][10][11]. Polypharmacy exposes old people to various risks [12], notably adverse drugs events [13], falls [14], increased use of healthcare services, and mortality [15,16].…”

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

“…6–8 Across 1662 men aged who were more than 70 years of age with a follow-up period of 2 years, Gnjidic et al 6 found that the use of more than 5 medications is associated with incident frailty. In a cohort with similar characteristics (n = 1705, follow-up period = 5 years), Jamsen et al 7 found that a higher number of medications was associated with greater risk of mortality in robust community-dwelling older men and with a higher risk of transitioning from the robust state to the prefrail state.…”

“…4,5 Furthermore, several short-term follow-up studies have suggested that polypharmacy is associated with a higher risk for incident frailty. 6–8 However, some limitations are evident with these studies, including the relatively short follow-up period (maximum 5 years) and the small sample sizes. The relationship between polypharmacy and frailty is complex; several studies have suggested polypharmacy is associated with frailty, 6–8 whilst others have suggested that a higher adherence to medications could be associated with lower mortality rate in frail older subjects.…”

“…6–8 However, some limitations are evident with these studies, including the relatively short follow-up period (maximum 5 years) and the small sample sizes. The relationship between polypharmacy and frailty is complex; several studies have suggested polypharmacy is associated with frailty, 6–8 whilst others have suggested that a higher adherence to medications could be associated with lower mortality rate in frail older subjects. 9–11 Given that frailty is a reversible condition if appropriately treated, 12 understanding if polypharmacy is associated with incident frailty could be of public health importance.…”