Jennifer G Naples1,2,3, Zachary A Marcum4, Subashan Perera5,6, Anne B Newman5,7, Susan L Greenspan5, Shelly L Gray4, Douglas C Bauer8,9, Eleanor M Simonsick10, Ronald I Shorr11, Joseph T Hanlon5,12,13,7. 1. Division of Geriatrics, Department of Medicine, School of Medicine, University of Pittsburgh, Kaufmann Medical Building, Suite 500, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA. jgn13@pitt.edu. 2. Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, USA. jgn13@pitt.edu. 3. Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA. jgn13@pitt.edu. 4. School of Pharmacy, University of Washington, Seattle, WA, USA. 5. Division of Geriatrics, Department of Medicine, School of Medicine, University of Pittsburgh, Kaufmann Medical Building, Suite 500, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA. 6. Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA. 7. Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA. 8. Department of Medicine, University of California, San Francisco, CA, USA. 9. Department Epidemiology and Biostatistics, University of California, San Francisco, CA, USA. 10. Intramural Research Program, National Institute on Aging, Baltimore, MD, USA. 11. Geriatric Research, Education and Clinical Center, Malcolm Randall Veterans Affairs Medical Center, Gainesville, FL, USA. 12. Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, USA. 13. Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA.
Abstract
BACKGROUND: Gait speed decline, an early marker of functional impairment, is a sensitive predictor of adverse health outcomes in older adults. The effect of potentially inappropriate medications, including drug-disease and drug-drug interactions, on gait speed decline is not well known. OBJECTIVE: The aim of this study was to determine if drug interactions impair functional status as measured by gait speed. METHODS: The sample included 2402 older adults with medication and gait speed data from the Health, Aging and Body Composition study. The independent variable was the frequency of drug-disease and/or drug-drug interactions at baseline and 3 additional years. The main outcome was a clinically meaningful gait speed decline of ≥0.1 m/s the year following drug interaction assessment. Adjusted odds ratios and 95 % confidence intervals (CIs) were calculated using multivariate generalized estimating equations for both the overall sample and a sample stratified by gait speed at time of drug interaction assessment. RESULTS: The prevalence of drug-disease and drug-drug interactions ranged from 7.6 to 9.3 and 10.5 to 12.3 %, respectively, with few participants (3.8-5.7 %) having multiple drug interactions. At least 22 % of participants had a gait speed decline of ≥0.1 m/s annually. Drug interactions were not significantly associated with gait speed decline overall or in the stratified sample of fast walkers. There was some evidence, however, that drug interactions increased the risk of gait speed decline among those participants with slower gait speeds, though p values did not reach statistical significance (adjusted odds ratio 1.22; 95 % CIs 0.96-1.56; p = 0.11). Moreover, a marginally significant dose-response relationship was seen with multiple drug interactions and gait speed decline (adjusted odds ratio 1.40; 95 % CIs 0.95-2.04; p = 0.08). CONCLUSIONS: Drug interactions may increase the likelihood of gait speed decline among older adults with evidence of preexisting debility. Future studies should focus on frail elders with less physiological reserve who may be more susceptible to the harms associated with potentially inappropriate medications.
BACKGROUND: Gait speed decline, an early marker of functional impairment, is a sensitive predictor of adverse health outcomes in older adults. The effect of potentially inappropriate medications, including drug-disease and drug-drug interactions, on gait speed decline is not well known. OBJECTIVE: The aim of this study was to determine if drug interactions impair functional status as measured by gait speed. METHODS: The sample included 2402 older adults with medication and gait speed data from the Health, Aging and Body Composition study. The independent variable was the frequency of drug-disease and/or drug-drug interactions at baseline and 3 additional years. The main outcome was a clinically meaningful gait speed decline of ≥0.1 m/s the year following drug interaction assessment. Adjusted odds ratios and 95 % confidence intervals (CIs) were calculated using multivariate generalized estimating equations for both the overall sample and a sample stratified by gait speed at time of drug interaction assessment. RESULTS: The prevalence of drug-disease and drug-drug interactions ranged from 7.6 to 9.3 and 10.5 to 12.3 %, respectively, with few participants (3.8-5.7 %) having multiple drug interactions. At least 22 % of participants had a gait speed decline of ≥0.1 m/s annually. Drug interactions were not significantly associated with gait speed decline overall or in the stratified sample of fast walkers. There was some evidence, however, that drug interactions increased the risk of gait speed decline among those participants with slower gait speeds, though p values did not reach statistical significance (adjusted odds ratio 1.22; 95 % CIs 0.96-1.56; p = 0.11). Moreover, a marginally significant dose-response relationship was seen with multiple drug interactions and gait speed decline (adjusted odds ratio 1.40; 95 % CIs 0.95-2.04; p = 0.08). CONCLUSIONS: Drug interactions may increase the likelihood of gait speed decline among older adults with evidence of preexisting debility. Future studies should focus on frail elders with less physiological reserve who may be more susceptible to the harms associated with potentially inappropriate medications.
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Authors: Rollin M Wright; Yazan F Roumani; Robert Boudreau; Anne B Newman; Christine M Ruby; Stephanie A Studenski; Ronald I Shorr; Douglas C Bauer; Eleanor M Simonsick; Sarah N Hilmer; Joseph T Hanlon Journal: J Am Geriatr Soc Date: 2009-02 Impact factor: 5.562
Authors: Robert M Boudreau; Joseph T Hanlon; Yazan F Roumani; Stephanie A Studenski; Christine M Ruby; Rollin M Wright; Sarah N Hilmer; Ronald I Shorr; Douglas C Bauer; Eleanor M Simonsick; Anne B Newman Journal: Pharmacoepidemiol Drug Saf Date: 2009-10 Impact factor: 2.890
Authors: Andrew S Levey; Lesley A Stevens; Christopher H Schmid; Yaping Lucy Zhang; Alejandro F Castro; Harold I Feldman; John W Kusek; Paul Eggers; Frederick Van Lente; Tom Greene; Josef Coresh Journal: Ann Intern Med Date: 2009-05-05 Impact factor: 25.391
Authors: Joseph T Hanlon; Robert M Boudreau; Yazan F Roumani; Anne B Newman; Christine M Ruby; Rollin M Wright; Sarah N Hilmer; Ronald I Shorr; Douglas C Bauer; Eleanor M Simonsick; Stephanie A Studenski Journal: J Gerontol A Biol Sci Med Sci Date: 2009-02-04 Impact factor: 6.053