The association between polypharmacy and late life deficits in cognitive, physical and emotional capability: a cohort study

Abstract

Background Polypharmacy is a growing health concern for older adults and is associated with poorer clinical outcome. Objective This study aim is to investigate the association between polypharmacy and impairment in cognitive, physical and emotional capability controlling for the confounding effect of co-morbidities. Setting The Aberdeen 1936 Birth Cohort from 1999 to 2004. Method Recruited were 498 dementia free participants around 64 years old and recruited into wave one. Linear regression and structural equation models were used. Models were adjusted for the effect of age, gender, childhood IQ, education and Body Mass Index. A triad of impairment was defined as a composite measure of impairment in cognitive, physical and emotional function. Main outcome measure The relationships between polypharmacy, co-morbidity and triad of impairment. Results The prevalence of polypharmacy was 12.3% in this relatively healthy sample. Polypharmacy was significantly associated with increased impairment in cognitive, physical and emotional ability (β = 3.6, p = 0.003) after controlling for the effect of comorbidities and other confounding variables. As expected, higher childhood IQ and educational achievement had protective effects against impairment while higher comorbidity score and Body Mass Index were associated with increased impairment in this population. Conclusions The independent association of polypharmacy and reduced cognitive, physical and emotional capability makes this a promising target for predicting and potentially reducing the risk of impairment and associated healthcare costs in older adults. Longitudinal studies are required to investigate the underlying mechanisms for the observed relationships further. Electronic supplementary material The online version of this article (10.1007/s11096-018-0761-2) contains supplementary material, which is available to authorized users.

Polypharmacy Is Associated with Lower Memory Function in African American Older Adults

“…In a study of 498 dementia-free participants around 64 years old, polypharmacy was significantly more common in individuals with cognitive impairment. This association was independent of confounders such as comorbidities [15]. In the SHELTER study, which stands for "Services and Health for Elderly in Long TERm care", conducted in Europe and Israel, polypharmacy was predictive of worsened cognitive function but not functional decline [51].…”

“…Polypharmacy is associated with reduced medication adherence [6][7][8][9] and an increase in potentially inappropriate medication (PIM) use [10]. Polypharmacy is also associated with undesirable clinical and health outcomes such as falls [11], hospitalization [12], emergency department visits [12,13], cognitive decline [14][15][16], and premature mortality [17][18][19]. Given the negative health consequences of inappropriate polypharmacy, researchers have shown interest in understanding factors that are associated with polypharmacy.…”

“…Although polypharmacy is associated with cognitive decline and memory loss [14,15,25,26], minimal information exists on how polypharmacy contributes to memory loss in AA older adults. While some cross-sectional and longitudinal studies have suggested that polypharmacy may be a risk factor for cognitive changes in the general population [14,15,25,26], we still need to explore the same association in economically challenged AA older adults. If polypharmacy is also responsible for some of the cognitive decline of AA older adults with multimorbidity, then prevention of inappropriate polypharmacy becomes a core strategy to prevent the cognitive/memory decline of this population.…”

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

“…Polypharmacy has been linked to numerous negative clinical outcomes such as frailty, hospitalization and even mortality [ 62 , 63 ]. Here, we report the results from previous reviews and recent studies on the association between polypharmacy and major clinical outcomes in older adults.…”

Relationships between cognitive leisure activities and cognitive function in older adults with depressive symptoms: a cross-sectional study

“…Fifth, we did not investigate whether participants were taking antidepressants. We only investigated the number of medications taken based on the previous finding that polypharmacy increased cognitive impairment even after controlling for the effects of comorbidities and other confounding variables 31. Finally, we did not examine cognitive functions other than memory, attention, executive function and processing speed.…”