Barbara C Wimmer1, J Simon Bell2, Johan Fastbom3, Michael D Wiese4, Kristina Johnell3. 1. Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia barbara.wimmer@monash.edu. 2. Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia. 3. Aging Research Center, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden. 4. Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia.
Abstract
OBJECTIVES: To investigate whether medication regimen complexity and/or polypharmacy are associated with all-cause mortality in older people. METHODS: This was a population-based cohort study among community-dwelling and institutionalized people ≥60 years old (n = 3348). Medication regimen complexity was assessed using the 65-item Medication Regimen Complexity Index (MRCI) in 10-unit steps. Polypharmacy was assessed as a continuous variable (number of medications). Mortality data were obtained from the Swedish National Cause of Death Register. Cox proportional hazard models were used to compute unadjusted and adjusted hazard ratios (HRs) and 95% CIs for the association between regimen complexity and polypharmacy with all-cause mortality over a 3-year period. Subanalyses were performed stratifying by age (≤80 and>80 years), sex, and cognition (Mini-Mental State Examination [MMSE] <26 and ≥26). RESULTS: During follow-up, 14% of the participants (n = 470) died. After adjusting for age, sex, comorbidity, educational level, activities of daily living, MMSE, and residential setting, a higher MRCI was associated with mortality (adjusted HR = 1.12; 95% CI = 1.01-1.25). Polypharmacy was not associated with mortality (adjusted HR = 1.03; 95% CI = 0.99-1.06). When stratifying by sex, both MRCI and polypharmacy were associated with mortality in men but not in women. MRCI was associated with mortality in participants ≤80 years old and in participants with MMSE ≥26 but not in participants >80 years old or with MMSE <26. CONCLUSION: Regimen complexity was a better overall predictor of mortality than polypharmacy. However, regimen complexity was not predictive of mortality in women, in participants >80 years old, or in those with MMSE<26. These different associations with mortality deserve further investigation.
OBJECTIVES: To investigate whether medication regimen complexity and/or polypharmacy are associated with all-cause mortality in older people. METHODS: This was a population-based cohort study among community-dwelling and institutionalized people ≥60 years old (n = 3348). Medication regimen complexity was assessed using the 65-item Medication Regimen Complexity Index (MRCI) in 10-unit steps. Polypharmacy was assessed as a continuous variable (number of medications). Mortality data were obtained from the Swedish National Cause of Death Register. Cox proportional hazard models were used to compute unadjusted and adjusted hazard ratios (HRs) and 95% CIs for the association between regimen complexity and polypharmacy with all-cause mortality over a 3-year period. Subanalyses were performed stratifying by age (≤80 and>80 years), sex, and cognition (Mini-Mental State Examination [MMSE] <26 and ≥26). RESULTS: During follow-up, 14% of the participants (n = 470) died. After adjusting for age, sex, comorbidity, educational level, activities of daily living, MMSE, and residential setting, a higher MRCI was associated with mortality (adjusted HR = 1.12; 95% CI = 1.01-1.25). Polypharmacy was not associated with mortality (adjusted HR = 1.03; 95% CI = 0.99-1.06). When stratifying by sex, both MRCI and polypharmacy were associated with mortality in men but not in women. MRCI was associated with mortality in participants ≤80 years old and in participants with MMSE ≥26 but not in participants >80 years old or with MMSE <26. CONCLUSION: Regimen complexity was a better overall predictor of mortality than polypharmacy. However, regimen complexity was not predictive of mortality in women, in participants >80 years old, or in those with MMSE<26. These different associations with mortality deserve further investigation.
Authors: Scot H Simpson; Dean T Eurich; Sumit R Majumdar; Rajdeep S Padwal; Ross T Tsuyuki; Janice Varney; Jeffrey A Johnson Journal: BMJ Date: 2006-06-21
Authors: Barbara Caecilia Wimmer; Kristina Johnell; Johan Fastbom; Michael David Wiese; J Simon Bell Journal: Eur J Clin Pharmacol Date: 2015-06-14 Impact factor: 2.953
Authors: Terri R Fried; John O'Leary; Virginia Towle; Mary K Goldstein; Mark Trentalange; Deanna K Martin Journal: J Am Geriatr Soc Date: 2014-12 Impact factor: 5.562
Authors: Tischa J M van der Cammen; Chakravarthi Rajkumar; Graziano Onder; Carolyn S Sterke; Mirko Petrovic Journal: Age Ageing Date: 2013-11-12 Impact factor: 10.668
Authors: James A Feinstein; Hannah Friedman; Lucas E Orth; Chris Feudtner; Allison Kempe; Sadaf Samay; Allison B Blackmer Journal: JAMA Netw Open Date: 2021-08-02