Polypharmacy in the Elderly: A Marker of Increased Risk of Mortality in a Population-Based Prospective Study (NEDICES)

Abstract

Background: Little information is available on the potential association between polypharmacy and risk of mortality. Objective: To determine in a population-based study whether polypharmacy is associated with increased risk of mortality in elderly persons. Methods: In this population-based, prospective study of 5,052 people aged 65 years and older (Neurological Disorders in Central Spain), current medications were recorded. Cox proportional hazards models, adjusted for sociodemographics and comorbidity factors, were used to assess the risk of death up to 13.3 years later, comparing the polypharmacy group (≥6 drugs) to those who were taking 1-5 drugs and those in a nonmedicated group (0 drugs). Results: Out of 5,052 participants, 2,550 (50.5%) died over a median follow-up of 6.5 years, including 361 (28.8%) deaths among 931 nonmedicated participants, 1,946 (51.4%) deaths among 3,787 participants taking 1-5 drugs daily, and 243 (72.8%) among 334 participants on polypharmacy. In an unadjusted Cox model, risk of mortality was increased in participants on polypharmacy [hazard ratio (HR) = 2.78, 95% confidence interval [CI]: 2.36-3.27, p < 0.001) and in those taking between 1 and 5 drugs (HR = 1.47, 95% CI: 1.31-1.64, p < 0.001) versus those who were nonmedicated (reference group). In a Cox model that adjusted for a variety of demographic factors and comorbidities, HR remained increased in participants on polypharmacy (HR = 1.83, 95% CI: 1.51-2.21, p < 0.001). Conclusion: This study provides evidencethat polypharmacy is associated with increased risk of mortality in elderly people. The extent to which polypharmacy is the proximate cause rather than a marker of this increase risk remains to be determined.

Malnutrition in the elderly residing in long-term care facilities: a cross sectional survey using the Mini Nutritional Assessment (MNA®) screening tool

“…Polypharmacy in the elderly is associated with falls, hip fractures, confusion and preventable hospitalisation. 29 In the facility from the lower socio-economic area, significantly more of the participants had a fluid consumption of less than three glasses per day compared to their counterparts. This may be due to the higher mobility of the participants living in the facility in the higher socio-economic area who are thus able to risk in the elderly, were obtained in a sample of communitydwelling elderly from KwaZulu-Natal, South Africa.…”

Examining factors associated with excess mortality in older people (age ≥ 70 years) with diabetes – a 10‐year cohort study of older people with and without diabetes

“…The mortality risk in those with four or more comorbidities without diabetes, was 27% higher than for the diabetes cohort. Although there have been a number of studies in non‐diabetes populations showing an association between polypharmacy and increased mortality , we are not aware of any previous studies of polypharmacy and mortality in older people with diabetes. Our findings for polypharmacy were similar to those for comorbidity, with higher levels of polypharmacy in the diabetes cohort; but again, the mortality hazard was greater in the reference population.…”

Deprescribing: A narrative review of the evidence and practical recommendations for recognizing opportunities and taking action

“…Additionally, there has been question as to whether the harm caused by inappropriate medications and polypharmacy is reversible. Polypharmacy and potentially inappropriate medications may not be directly responsible for the associated harm, and instead may be a surrogate marker for another variable which is not accounted for in the analysis, for example severity of co-morbidities [6,19]. It could be argued that establishing a solid benefit (e.g.…”