Katie Palmer1, Emanuele R Villani2, Davide L Vetrano2,3, Antonio Cherubini4, Alfonso J Cruz-Jentoft5, Denis Curtin6, Michael Denkinger7, Marta Gutiérrez-Valencia8, Adalsteinn Guðmundsson9,10, Wilma Knol11, Diane V Mak11, Denis O'Mahony6, Farhad Pazan12, Mirko Petrovic13, Chakravarthi Rajkumar14, Eva Topinkova15, Catarina Trevisan16, Tischa J M van der Cammen17,18,19, Rob J van Marum20,21, Martin Wehling22, Gijsbertus Ziere18, Roberto Bernabei2, Graziano Onder2. 1. Fondazione Ospedale San Camillo IRCCS, Via Alberoni 70, 30126, Venezia, Italia. katie.palmer@ospedalesancamillo.net. 2. Department of Geriatrics, Centro Medicina dell'Invecchiamento, Università Cattolica del Sacro Cuore, Rome, Italy. 3. Aging Research Center, NVS, Karolinska Institutet, Stockholm, Sweden. 4. Geriatria, Accettazione geriatrica e Centro di ricerca per l'invecchiamento, IRCCS INRCA, Ancona, Italy. 5. Servicio de Geriatría, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain. 6. Department of Medicine, Department of Geriatric Medicine, University College Cork, Cork University Hospital, Cork, Ireland. 7. Agaplesion Bethesda Clinic Ulm, Geriatric Center Ulm/Alb-Donau and Geriatric Research Unit, Ulm University, Ulm, Germany. 8. Department of Pharmacy, Navarrabiomed, Universidad Pública de Navarra (UPNA), Complejo Hospitalario de Navarra (CHN), IdiSNA, Pamplona, Navarra, Spain. 9. Faculty of Medicine, University of Iceland, Reykjavík, Iceland. 10. Department of Geriatrics, Landspitali University Hospital, Reykjavík, Iceland. 11. Department of Geriatric Medicine, Expertise Centre Pharmacotherapy in Old Persons, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands. 12. Institute for Clinical Pharmacology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany. 13. Department of Internal Medicine, Section of Geriatrics, Ghent University, Ghent, Belgium. 14. Department of Medicine, Brighton and Sussex Medical School, University of Sussex, Brighton, UK. 15. Department of Geriatrics, First Faculty of Medicine, Charles University, General Faculty Hospital, Prague, Czech Republic. 16. Department of Medicine, Geriatrics Division, University of Padova, Padua, Italy. 17. Faculty of Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands. 18. Department of Internal Medicine, Division of Geriatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands. 19. Academic Department of Geriatrics, Brighton and Sussex Medical School, Brighton, East Sussex, UK. 20. Department of General Practice and Old Age Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands. 21. Department of Geriatrics, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands. 22. Medical Faculty Mannheim, Clinical Pharmacology, University of Heidelberg, Heidelberg, Germany.
Abstract
PURPOSE: To investigate: (1) the cross-sectional association between polypharmacy, hyperpolypharmacy and presence of prefrailty or frailty; (2) the risk of incident prefrailty or frailty in persons with polypharmacy, and vice versa. METHODS: A systematic review and meta-analysis was performed according to PRISMA guidelines. We searched PubMed, Web of Science, and Embase from 01/01/1998 to 5/2/2018. Pooled estimates were obtained through random effect models and Mantel-Haenszel weighting. Homogeneity was assessed with the I2 statistic and publication bias with Egger's and Begg's tests. RESULTS: Thirty-seven studies were included. The pooled proportion of polypharmacy in persons with prefrailty and frailty was 47% (95% CI 33-61) and 59% (95% CI 42-76), respectively. Increased odds ratio of polypharmacy were seen for prefrail (pooled OR = 1.52; 95% CI 1.32-1.79) and frail persons (pooled OR = 2.62, 95% CI 1.81-3.79). Hyperpolypharmacy was also increased in prefrail (OR = 1.95; 95% CI 1.41-2.70) and frail (OR = 6.57; 95% CI 9.57-10.48) persons compared to robust persons. Only seven longitudinal studies reported data on the risk of either incident prefrailty or frailty in persons with baseline polypharmacy. A significant higher odds of developing prefrailty was found in robust persons with polypharmacy (pooled OR = 1.30; 95% CI 1.12-1.51). We found no papers investigating polypharmacy incidence in persons with prefrailty/frailty. CONCLUSIONS: Polypharmacy is common in prefrail and frail persons, and these individuals are also more likely to be on extreme drug regimens, i.e. hyperpolypharmacy, than robust older persons. More research is needed to investigate the causal relationship between polypharmacy and frailty syndromes, thereby identifying ways to jointly reduce drug burden and prefrailty/frailty in these individuals. PROSPERO REGISTRATION NUMBER: CRD42018104756.
PURPOSE: To investigate: (1) the cross-sectional association between polypharmacy, hyperpolypharmacy and presence of prefrailty or frailty; (2) the risk of incident prefrailty or frailty in persons with polypharmacy, and vice versa. METHODS: A systematic review and meta-analysis was performed according to PRISMA guidelines. We searched PubMed, Web of Science, and Embase from 01/01/1998 to 5/2/2018. Pooled estimates were obtained through random effect models and Mantel-Haenszel weighting. Homogeneity was assessed with the I2 statistic and publication bias with Egger's and Begg's tests. RESULTS: Thirty-seven studies were included. The pooled proportion of polypharmacy in persons with prefrailty and frailty was 47% (95% CI 33-61) and 59% (95% CI 42-76), respectively. Increased odds ratio of polypharmacy were seen for prefrail (pooled OR = 1.52; 95% CI 1.32-1.79) and frail persons (pooled OR = 2.62, 95% CI 1.81-3.79). Hyperpolypharmacy was also increased in prefrail (OR = 1.95; 95% CI 1.41-2.70) and frail (OR = 6.57; 95% CI 9.57-10.48) persons compared to robust persons. Only seven longitudinal studies reported data on the risk of either incident prefrailty or frailty in persons with baseline polypharmacy. A significant higher odds of developing prefrailty was found in robust persons with polypharmacy (pooled OR = 1.30; 95% CI 1.12-1.51). We found no papers investigating polypharmacy incidence in persons with prefrailty/frailty. CONCLUSIONS: Polypharmacy is common in prefrail and frail persons, and these individuals are also more likely to be on extreme drug regimens, i.e. hyperpolypharmacy, than robust older persons. More research is needed to investigate the causal relationship between polypharmacy and frailty syndromes, thereby identifying ways to jointly reduce drug burden and prefrailty/frailty in these individuals. PROSPERO REGISTRATION NUMBER: CRD42018104756.
Authors: F Lombardi; L Paoletti; B Carrieri; G Dell'Aquila; M Fedecostante; M Di Muzio; A Corsonello; F Lattanzio; A Cherubini Journal: Eur Geriatr Med Date: 2021-03-11 Impact factor: 1.710
Authors: Shelley A Sternberg; Mirko Petrovic; Graziano Onder; Antonio Cherubini; Denis O'Mahony; Jerry H Gurwitz; Francesco Pegreffi; Robin Mason; Jennifer Akerman; Lisa McCarthy; Andrea Lawson; Joyce Li; Wei Wu; Paula A Rochon Journal: Eur Geriatr Med Date: 2021-04-09 Impact factor: 1.710
Authors: Emanuele Rocco Villani; Davide Liborio Vetrano; Rosa Liperoti; Katie Palmer; Michael Denkinger; Henriëtte G van der Roest; Roberto Bernabei; Graziano Onder Journal: Aging Clin Exp Res Date: 2021-02-15 Impact factor: 3.636
Authors: Farhad Pazan; Mirko Petrovic; Antonio Cherubini; Graziano Onder; Alfonso J Cruz-Jentoft; Michael Denkinger; Tischa J M van der Cammen; Jennifer M Stevenson; Kinda Ibrahim; Chakravarthi Rajkumar; Marit Stordal Bakken; Jean-Pierre Baeyens; Peter Crome; Thomas Frühwald; Paul Gallaghar; Adalsteinn Guðmundsson; Wilma Knol; Denis O'Mahony; Alberto Pilotto; Elina Rönnemaa; José Antonio Serra-Rexach; George Soulis; Rob J van Marum; Gijsbertus Ziere; Alpana Mair; Heinrich Burkhardt; Agnieszka Neumann-Podczaska; Katarzyna Wieczorowska-Tobis; Marilia Andreia Fernandes; Heidi Gruner; Dhayana Dallmeier; Jean-Baptiste Beuscart; Nathalie van der Velde; Martin Wehling Journal: Eur J Clin Pharmacol Date: 2020-08-07 Impact factor: 2.953