A R M Saifuddin Ekram1, Robyn L Woods2, Joanne Ryan2, Sara E Espinoza3, Julia F M Gilmartin-Thomas4, Raj C Shah5, Raaj Mehta6, Bharati Kochar6, Judy A Lowthian7, Jessica Lockery2, Suzanne Orchard2, Mark Nelson8, Michelle A Fravel9, Danny Liew2, Michael E Ernst10. 1. School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, St Kilda, Victoria 3004, Australia. Electronic address: saifuddin.ekram@monash.edu. 2. School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, St Kilda, Victoria 3004, Australia. 3. Sam and Ann Barshop Institute, UT Health San Antonio Texas Research Park Campus, San Antonio, TX, USA; Geriatrics Research, South Texas Veterans Health Care System, San Antonio, Texas, USA. 4. School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, St Kilda, Victoria 3004, Australia; College of Health and Biomedicine, and Institute for Health & Sport, Victoria University, Victoria, Australia; Australian Institute for Musculoskeletal Science, Victoria, Australia. 5. Rush Alzheimer's Disease Center, Rush University, Chicago, IL, USA. 6. Clinical & Translational Epidemiology Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. 7. School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, St Kilda, Victoria 3004, Australia; Bolton Clarke Research Institute, Bolton Clarke, Burwood Highway, Forest Hill, Victoria, Australia. 8. Menzies Research Institute, University of Tasmania, Churchill Ave, Hobart, Tasmania, Australia. 9. Department of Pharmacy Practice and Science, College of Pharmacy, The University of Iowa, Iowa City, IA, USA. 10. Department of Pharmacy Practice and Science, College of Pharmacy, The University of Iowa, Iowa City, IA, USA; Department of Family Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA.
Abstract
OBJECTIVES: Polypharmacy and frailty are two common geriatric conditions. In community-dwelling healthy older adults, we examined whether polypharmacy is associated with frailty and affects disability-free survival (DFS), assessed as a composite of death, dementia, or persistent physical disability. METHODS: We included 19,114 participants (median age 74.0 years, IQR: 6.1 years) from ASPirin in Reducing Events in the Elderly (ASPREE) clinical trial. Frailty was assessed by a modified Fried phenotype and a deficit accumulation Frailty Index (FI). Polypharmacy was defined as concomitant use of five or more prescription medications. Multinomial logistic regression was used to examine the cross-sectional association between polypharmacy and frailty at base line, and Cox regression to determine the effect of polypharmacy and frailty on DFS over five years. RESULTS: Individuals with polypharmacy (vs. <5 medications) were 55% more likely to be pre-frail (Relative Risk Ratio or RRR: 1.55; 95%Confidence Interval or CI:1.44, 1.68) and three times more likely to be frail (RRR: 3.34; 95%CI:2.64, 4.22) according to Fried phenotype. Frailty alone was associated with double risk of the composite outcome (Hazard ratio or HR: 2.16; 95%CI: 1.56, 2.99), but frail individuals using polypharmacy had a four-fold risk (HR: 4.24; 95%CI: 3.28, 5.47). Effect sizes were larger when frailty was assessed using the FI. CONCLUSION: Polypharmacy was significantly associated with pre-frailty and frailty at baseline. Polypharmacy-exposed frailty increased the risk of reducing disability-free survival among older adults. Addressing polypharmacy in older people could ameliorate the impact of frailty on individuals' functional status, cognition and survival.
OBJECTIVES: Polypharmacy and frailty are two common geriatric conditions. In community-dwelling healthy older adults, we examined whether polypharmacy is associated with frailty and affects disability-free survival (DFS), assessed as a composite of death, dementia, or persistent physical disability. METHODS: We included 19,114 participants (median age 74.0 years, IQR: 6.1 years) from ASPirin in Reducing Events in the Elderly (ASPREE) clinical trial. Frailty was assessed by a modified Fried phenotype and a deficit accumulation Frailty Index (FI). Polypharmacy was defined as concomitant use of five or more prescription medications. Multinomial logistic regression was used to examine the cross-sectional association between polypharmacy and frailty at base line, and Cox regression to determine the effect of polypharmacy and frailty on DFS over five years. RESULTS: Individuals with polypharmacy (vs. <5 medications) were 55% more likely to be pre-frail (Relative Risk Ratio or RRR: 1.55; 95%Confidence Interval or CI:1.44, 1.68) and three times more likely to be frail (RRR: 3.34; 95%CI:2.64, 4.22) according to Fried phenotype. Frailty alone was associated with double risk of the composite outcome (Hazard ratio or HR: 2.16; 95%CI: 1.56, 2.99), but frail individuals using polypharmacy had a four-fold risk (HR: 4.24; 95%CI: 3.28, 5.47). Effect sizes were larger when frailty was assessed using the FI. CONCLUSION: Polypharmacy was significantly associated with pre-frailty and frailty at baseline. Polypharmacy-exposed frailty increased the risk of reducing disability-free survival among older adults. Addressing polypharmacy in older people could ameliorate the impact of frailty on individuals' functional status, cognition and survival.
Authors: Kenneth Rockwood; Xiaowei Song; Chris MacKnight; Howard Bergman; David B Hogan; Ian McDowell; Arnold Mitnitski Journal: CMAJ Date: 2005-08-30 Impact factor: 8.262
Authors: Joanne Ryan; Sara Espinoza; Michael E Ernst; A R M Saifuddin Ekram; Rory Wolfe; Anne M Murray; Raj C Shah; Suzanne G Orchard; Sharyn Fitzgerald; Lawrence J Beilin; Stephanie A Ward; Jeff D Williamson; Anne B Newman; John J McNeil; Robyn L Woods Journal: J Gerontol A Biol Sci Med Sci Date: 2022-01-07 Impact factor: 6.591
Authors: Joanne Ryan; Elsdon Storey; Anne M Murray; Robyn L Woods; Rory Wolfe; Christopher M Reid; Mark R Nelson; Trevor T J Chong; Jeff D Williamson; Stephanie A Ward; Jessica E Lockery; Suzanne G Orchard; Ruth Trevaks; Brenda Kirpach; Anne B Newman; Michael E Ernst; John J McNeil; Raj C Shah Journal: Neurology Date: 2020-03-25 Impact factor: 11.800