Polypharmacy Status as an Indicator of Mortality in an Elderly Population

Jyrkkä, Johanna; Enlund, Hannes; Korhonen, Maarit Jaana; Sulkava, Raimo; Hartikainen, Sirpa

doi:10.2165/11319530-000000000-00000

Cited by 280 publications

(221 citation statements)

References 36 publications

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“…27 This is perhaps related to the different definitions of polypharmacy used; we chose to analyze it as a continuous variable defined by the total number of drugs taken. Recently, Richardson et al 28 have reported a variation over time in this association; a strong independent association between polypharmacy and mortality can be found in the short term (first 2 years) for both men and women.…”

Section: Discussionmentioning

confidence: 99%

Utility of Geriatric Assessment to Predict Mortality in the Oldest Old: The Octabaix Study 3-Year Follow-Up

Formiga

Ferrer

Chivite

et al. 2013

Rejuvenation Research

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Objective: Few studies have prospectively evaluated the utility of geriatric assessment tools as predictors of mortality in the oldest population. We investigated predictors of death in an oldest-old cohort after 3 years of follow-up. Methods: The Octabaix study is a prospective, community-based study with a follow-up period of 3 years involving 328 subjects aged 85 at baseline. Data were collected on functional and cognitive status, co-morbidity, nutritional and falls risk, quality of life, social risk, and long-term drug prescription. Vital status for the total cohort was evaluated after 3 years of follow-up. Results: Mortality after 3 years was 17.3%. Patients who did not survive had significantly poorer baseline functional status for basic and instrumental activities of daily living (Barthel and Lawton Index), higher comorbidity (Charlson), higher nutritional risk (Mini Nutritional Assessment), higher risk of falls (Tinetti Gait Scale), poor quality of life (visual analog scale of the Quality of Life Test), and higher number of chronic drugs prescribed. Cox regression analysis identified the Lawton Index (hazard ratio [HR] 0.82, 95% confidence interval [CI] 0.73-0.89) and the number of chronic drugs prescribed (HR 1.09, 95% CI 1.01-1.18) as independent predictors of mortality at 3 years. Conclusions: Among the variables studied, the ability to perform instrumental activities of daily living and using few drugs on a chronic basis at baseline are the best predictors of which oldest-old community-dwelling subjects survive after a 3-year follow-up period.

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Section: Discussionmentioning

confidence: 99%

Utility of Geriatric Assessment to Predict Mortality in the Oldest Old: The Octabaix Study 3-Year Follow-Up

Formiga

Ferrer

Chivite

et al. 2013

Rejuvenation Research

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“…It is caused by the addition of new medications by the patient's various medical physicians as an outpatient. As the number of medications increases, so does the risk of having a drugdrug interaction [46]. Often additional medications are prescribed to manage the side effects of the existing medications and the list lengthens.…”

Section: Preoperative Assessment and Preparation For Surgerymentioning

confidence: 99%

Short-term and Long-term Orthopaedic Issues in Patients With Fragility Fractures

Bukata

Kates

O’Keefe

2011

Clinical Orthopaedics &Amp; Related Research

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Background Patients with impaired bone quality who suffer a fragility fracture face substantial challenges in both their short-and long-term care. In addition to poor bone quality, many of these patients have multiple medical comorbidities that alter their surgical risk and affect their ultimate functional recovery. Some medical issues can contribute to the altered bone quality and must be addressed to prevent future fractures. Questions/purposes This review summarizes the modifications in perioperative management and fracture fixation in patients with common fragility fractures who have impaired bone quality. It also summarizes the postoperative diagnosis and treatment of secondary causes of impaired bone quality in these patients. Methods We performed a PubMed search, and literature published after 2000 was prioritized, with the exception of benchmark clinical trial studies published before 2000. Results Patients with altered bone quality require rapid perioperative management of multiple medical comorbidities. Implant selection in patients with poor quality bone should permit early weightbearing, and constructs should maximize surface area contact with the remaining bone. Long-term diagnosis and treatment of other disease states contributing to poor bone quality (vitamin D deficiency/ insufficiency, hypothyroidism, hyperthyroidism, hyperparathyroidism, Cushing's disease, and hypogonadism) must occur to minimize the chances of future fractures. Conclusions Recognition of patients with impaired bone quality and proper treatment of their special needs in both the short and long term are essential for their best opportunity for maximal functional recovery and prevention of future fractures.

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“…Although polypharmacy has no generally accepted definition, most often it is defined by cut-offs, in terms of the number of medications taken, ranging from two to ten (9)(10)(11)(12). However, regardless of the definition, its prevalence has been reported to rise with age, and is associated with an increased risk of inappropriate drug prescription, under-use of effective treatment, medication errors, poor adherence to pharmacological therapies, drug/drug and drug/disease interactions, and adverse effects (3,(13)(14)(15)(16)(17)(18).…”

Section: Introductionmentioning

confidence: 99%

Polypharmacy, length of hospital stay, and in-hospital mortality among elderly patients in internal medicine wards. The REPOSI study

Nobili¹,

Licata²,

Salerno³

et al. 2011

Eur J Clin Pharmacol

279

195

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Purposes: We evaluated the prevalence and factors associated with polypharmacy and investigated the role of polypharmacy as a predictor of length of hospital stay and in-hospital mortality. Methods: Thirty-eight internal medicine wards in Italy participated in the Registro Politerapie SIMI (REPOSI) study during 2008. One thousand three hundred and thirty-two in-patients aged ≥65 years were enrolled. Polypharmacy was defined as the concomitant use of five or more medications. Linear regression analyses were used to evaluate predictors of length of hospital stay and logistic regression models for predictors of in-hospital mortality. Age, sex, Charlson comorbidity index, polypharmacy, and number of in-hospital clinical adverse events (AEs) were used as possible confounders. Results: The prevalence of polypharmacy was 51.9% at hospital admission and 67.0% at discharge. Age, number of drugs at admission, hypertension, ischemic heart disease, heart failure, and chronic obstructive pulmonary disease were independently associated with polypharmacy at discharge. In multivariate analysis, the occurrence of at least one AE while in hospital was the only predictor of prolonged hospitalization (each new AE prolonged hospital stay by 3.57 days, p<0.0001). Age [odds ratio (OR) 1.04; 95% confidence interval (CI) 1.01-1.08; p=0.02), comorbidities (OR 1.18; 95% CI 1.12-1.24; p<0.0001), and AEs (OR 6.80; 95% CI 3.58-12.9; p<0.0001) were significantly associated with in-hospital mortality. Conclusions: Although most elderly in-patients receive polypharmacy, in this study, it was not associated with any hospital outcome. However, AEs were strongly correlated with a longer hospital stay and higher mortality risk. © 2011 Springer-Verlag

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Polypharmacy Status as an Indicator of Mortality in an Elderly Population

Abstract: This study points to the importance of excessive polypharmacy as an indicator for mortality in elderly persons. This association needs to be confirmed following adjustment for co-morbidities.

Cited by 280 publications

References 36 publications

Utility of Geriatric Assessment to Predict Mortality in the Oldest Old: The Octabaix Study 3-Year Follow-Up

Utility of Geriatric Assessment to Predict Mortality in the Oldest Old: The Octabaix Study 3-Year Follow-Up

Short-term and Long-term Orthopaedic Issues in Patients With Fragility Fractures

Polypharmacy, length of hospital stay, and in-hospital mortality among elderly patients in internal medicine wards. The REPOSI study

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