Suboptimal Medication Use and Mortality in an Older Adult Community-Based Cohort: Results From the Hispanic EPESE Study

Espino, David V.; Bazaldua, Oralia V.; Palmer, Raymond F.; Mouton, Charles P.; Parchman, Michael L.; Miles, Toni P.; Markides, Kyriakos S.

doi:10.1093/gerona/61.2.170

Cited by 92 publications

(90 citation statements)

References 24 publications

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“…Espino and colleagues reported an increased risk of death associated with polypharmacy (HR 1.27, 95% CI 1.04-1.56) in a cohort study with an 8year followup period. 13 However, Pozzi and colleagues (HR 1.20, 95% CI 0.89-1.60) 15 and Jyrkkä and colleagues (polyphar macy HR 0.77, 95% CI 0.58-1.01; excessive poly pharmacy HR 1.28 95% CI 0.86-1.91) 1 reported no such association. Furthermore, Pozzi and col leagues suggested that potentially inappropriate medications were not associated with an increased risk of death (HR 1.00, 95% CI 0.96-1.06).…”

Section: Discussionmentioning

confidence: 98%

“…[13][14][15] Some studies have shown that polypharmacy or potentially inappropriate medications are positively associated with admis sion to hospital or death, 13 while others have not. 15 Moreover, little is known regarding the ability to predict negative outcomes among poly pharmacy, potentially inappropriate medications or anticholinergic burden, because previous stud ies have focused on single indicators alone.…”

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confidence: 99%

“…15 Moreover, little is known regarding the ability to predict negative outcomes among poly pharmacy, potentially inappropriate medications or anticholinergic burden, because previous stud ies have focused on single indicators alone. [13][14][15] Our aim was to examine changes in polyphar macy, potentially inappropriate medications and anticholinergic burden over time among people aged 65 years and older. In addition, we sought to determine the association between changes in these indicators and clinical outcomes, specifi cally allcause admissions to hospital, fracture specific admissions to hospital and death.…”

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confidence: 99%

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Effect of polypharmacy, potentially inappropriate medications and anticholinergic burden on clinical outcomes: a retrospective cohort study

Wen

Chen

et al. 2015

CMAJ

181

179

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Background: Polypharmacy, potentially inappropriate medications and anticholinergic burden (as assessed by the anticholinergic risk scale) are commonly used as quality indicators of pharmacotherapy in older adults. However, their role in clinical practice is undefined. We sought to investigate longitudinal changes in these indicators and their effects on clinical outcomes. Methods:We used Taiwan's Longitudinal Health Insurance Database to retrieve quarterly information about drug use for people aged 65 years and older over a 10-year period. We analyzed the association between indicators and all-cause admission to hospital, fracture-specific admission to hospital and death using generalized estimating equations. (-0.15 [-0.26 to -0.04]). Polypharmacy, potentially inappropriate medications and anticholinergic risk scale were each associated with an increased risk of admission to hospital, but not with death. In addition, both polypharmacy (5-9 drugs: odds ratio [OR] 1.18, 95% CI 1.12-1.24; ≥ 10 drugs: OR 1.54, 95% CI 1.42-1.66) and anticholinergic burden (score 1-2: 1.39, 95% CI 1.31-1.48; ≥ 3: 1.53, 95% CI 1.41-1.66) showed dose-response relations with fracture-specific admission to hospital. Results Interpretation:The total number of drugs taken (polypharmacy), number of potentially inappropriate medications and anticholinergic risk changed during follow-up and varied across age groups in this cohort of older adult patients. These indicators showed dose-response relations with admission to hospital, but not with death. AbstractSee also review, www.cmaj.ca/lookup

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Section: Discussionmentioning

confidence: 98%

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confidence: 99%

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confidence: 99%

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Effect of polypharmacy, potentially inappropriate medications and anticholinergic burden on clinical outcomes: a retrospective cohort study

Wen

Chen

et al. 2015

CMAJ

181

179

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“…75 Polypharmacy raises the likelihood of adverse drug reactions (ADRs) in older cancer patients, and has been associated with increased mortality. 76,77 Certain drug classes are implicated in a higher frequency of ADRs, including anticoagulants (specifically warfarin) and benzodiazepines. 78 Notably, both medications are frequently used in the treatment of oncology patients (warfarin for cancer-related thrombosis, and benzodiazepines for the management of anxiety or chemotherapyrelated emetogenesis).…”

Section: Polypharmacymentioning

confidence: 99%

Evaluating the Older Patient with Cancer: Understanding Frailty and the Geriatric Assessment

Pal¹,

Katheria²,

Hurria³

2010

CA: A Cancer Journal for Clinicians

221

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The majority of cancer incidence and mortality occurs in individuals aged older than 65 years, and the number of older adults with cancer is projected to significantly increase secondary to the aging of the US population. As such, understanding the changes accompanying age in the context of the cancer patient is of critical importance. Agerelated changes can impact tolerance of anticancer therapy and can shift the overall risk-benefit ratio of such treatment. A challenge in implementing evidence-based approaches in older adults is the under-representation of this group in oncology clinical trials. In addition, although older adults are particularly vulnerable to the side effects of cancer therapy, few oncology studies to date have incorporated a measure of health status other than the Eastern Cooperative Oncology Group or Karnofsky performance scales. Novel metrics such as frailty indices or the geriatric assessment recognize heterogeneity among older adults, and may allow for risk-adapted approaches to therapy. It is increasingly recognized that several laboratory markers may predict morbidity and mortality in older adults; these biologic variables may further aid in stratifying this group of patients based on risk. This review describes key studies from the geriatric literature that provide principles for assessing health status in the older patient, and ways that these principles can be applied to oncology care in an older population are proposed. CA Cancer J Clin 2010;60:120-132.

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“…Polypharmacy has important health consequences because adherence becomes more difficult, and the risk for adverse drug reactions, cognitive impairment, falls, and mortality increases with increasing numbers of medications while activities of daily living decline. [4][5][6][7][8][9][10] Previous research indicates that inappropriate medication use occurs in 12% to 40% of seniors living in the community and that inappropriate use increases as the number of medications used increases. 11,12 Additionally, up to 30% of hospital admissions are caused by drug-related problems or side effects of medications.…”

Section: Introductionmentioning

confidence: 99%

Promoting Safe Use of Medications: Providing Medication Education to Seniors Receiving Meals on Wheels

Ward

Cohen²

2015

Consult Pharm

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Study Objectives-To assess whether pharmacist-provided medication education and counseling to Meals on Wheels (MOW) participants decreases medication-related preventable harm and improves adherence. Design-Prospective, quasi-experiment.Setting-Ambulatory congregrate dining centers. PATIENTS: Persons 60 years of age and older participating in MOW receiving prescription, nonprescription, or complementary products were eligible. In total, 42 patients consented. Five patients did not complete the first visit, and 13 patients did not complete the six-month follow-up visit. INTERVENTIONS: Pharmacists provided comprehensive medication education about prescription, nonprescription, and complementary products at baseline. Additional resources to enhance adherence and avoid medication-related preventable harm were provided and discussed.Main Outcome Measures-Medication-related preventable harm and medication adherence were assessed before pharmacist intervention and six months after intervention. Adherence was assessed and compared with baseline using the Morisky scale and pill counts.Results-Women constituted the majority of participants (94.4%) with an average age of 74.5 ± 8.2 years. Mean difference in Morisky score from baseline to six months was 0.28 (-0.11 to 0.56). After adjustment for age and living situation, the change in Morisky score was associated with a 14% improvement in adherence. Mean differences in drug-drug and drug-supplement interactions, and medication-related harm were not significantly reduced from baseline to study end.Conclusion-Pharmacist intervention with MOW participants appeared to improve medication adherence rates but had limited effect on medication-related preventable harm. No findings reached statistical significance as the sample size was inadequate. Larger studies are needed to confirm these findings.

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Suboptimal Medication Use and Mortality in an Older Adult Community-Based Cohort: Results From the Hispanic EPESE Study

Abstract: Polypharmacy (>4 medications) is significantly associated with mortality in Mexican American older adults. This community-based study is the first to demonstrate a direct association between polypharmacy and mortality in this population.

Cited by 92 publications

References 24 publications

Effect of polypharmacy, potentially inappropriate medications and anticholinergic burden on clinical outcomes: a retrospective cohort study

Effect of polypharmacy, potentially inappropriate medications and anticholinergic burden on clinical outcomes: a retrospective cohort study

Evaluating the Older Patient with Cancer: Understanding Frailty and the Geriatric Assessment

Promoting Safe Use of Medications: Providing Medication Education to Seniors Receiving Meals on Wheels

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