The Association Between Polypharmacy and Physical Function in Older Adults: a Systematic Review

Abstract

BACKGROUND: Reduced physical function and polypharmacy (PPha) are two highly prevalent negative effects of aging, which are expected to increase more, since demographic aging is expected to grow rapidly within the next decades. Previous research suggests that polypharmacy (PPha) is a predictor of poor physical function and vice versa in older adults and therefore we conducted a systematic review of the literature to summarize and critically analyze the relationship between physical function and PPha and vice versa in older adults, in order to provide recent scientific evidence. METHODS: We searched MEDLINE and Embase from their inception to 19th October 2018 for Englishlanguage observational studies or trials assessing the effect of PPha on physical function and vice versa in older adults. Two investigators independently extracted study data and assessed the quality of the studies, after having screened the available studies from the literature search. Any disagreement was resolved by consensus. RESULTS: Eighteen observational studies met the inclusion criteria. Eight studies assessed the impact of physical function on PPha and ten studies assessed the impact of PPha on physical function. Regarding the studies with PPha measurements as the outcome, all of them, except for one, found that better physical function is associated with lower risk of PPha. Likewise, all the studies with physical function measurements as the outcome, except for one, suggested that PPha is associated with lower physical function. DISCUSSION: Evidence examining the effect of PPha on physical function and vice versa in older adults suggests a strong bidirectional association between these two factors and clinicians should be aware of this strong relationship. The limitations of our study include the high variability in PPha definitions and physical function measures, and the treatment of PPha and physical function as constant instead of time-varying variables in the studies' analyses.

Inappropriate medications and physical function: a systematic review

“… 14 , 23 , 32 , 51 , 52 , 61 , 65 Aside from the use of PIMs, the combination of different medications can lead to drug interactions that could have exacerbated the adverse effects experienced by older adults, thereby leading to higher propensity for impaired physical function. 10 Furthermore, adverse drug reactions can occur independently of PIMs, which can contribute to accentuating the impact on physical function. 67 Anticholinergic cognitive burden is also associated with increased susceptibility of delirium, longer hospital stays and increased prescription of more medications.…”

“… 6 Inappropriate prescriptions have been shown to be associated with a significant decline in physical performance, 7 ADL during hospitalisation, 8 as well as falls and injuries in frail older adults. 9 Previous reviews have examined associations between polypharmacy and physical function in older adults, 10 and between inappropriate medication use and functional decline. 11 …”

Polypharmacy in older adults: a narrative review of definitions, epidemiology and consequences

“…Polypharmacy has been shown to be associated with a physical impairment in older adults [ 36 , 85 , 86 ]. A systematic review on the association between polypharmacy and physical function in older adults concluded that there is a strong bidirectional relationship between polypharmacy and physical function [ 87 ]. However, a causal relationship based on the 18 observational studies included in that review could not be proven [ 87 ].…”

“…A systematic review on the association between polypharmacy and physical function in older adults concluded that there is a strong bidirectional relationship between polypharmacy and physical function [ 87 ]. However, a causal relationship based on the 18 observational studies included in that review could not be proven [ 87 ]. The authors concluded that objective measures of physical function and polypharmacy are necessary to prove this causal relationship in future studies [ 87 ].…”

“…However, a causal relationship based on the 18 observational studies included in that review could not be proven [ 87 ]. The authors concluded that objective measures of physical function and polypharmacy are necessary to prove this causal relationship in future studies [ 87 ]. Interestingly, in a multicenter study of European nursing homes polypharmacy was not associated with a faster decline in functional status [ 83 ].…”