medigraphic.com
Instituto Nacional de Salud Pública

2020, Number 3

<< Back Next >>

salud publica mex 2020; 62 (3)

Polypharmacy is associated with multiple health-related outcomes in Mexican community-dwelling older adults

Salinas-Rodríguez A, Manrique-Espinoza B, Rivera-Almaraz A, Ávila-Funes JA

Language: English
References: 36
Page: 246-254
PDF size: 253.56 Kb.


ABSTRACT

Objective. To determine the association between polypharmacy and multiple health-related outcomes in older adults. Materials and methods. We carried out a cross-sectional analysis with 274 community-dwelling older adults aged ≥60 years in Mexico City. We used the following health-related outcomes: frailty, dementia, functional capacity, falls, disability, and quality of life. The main exposure was polypharmacy (chronic use of six or more drugs). Ordinal logistic regression, binary logistic regression, Poisson regression, and linear regression models were used to estimate the association between polypharmacy and the outcomes analyzed. Results. Polypharmacy was present in 45% of the sample. Polypharmacy was significantly associated with frailty status, and marginally, with dementia. We also observed significant associations for instrumental activities of daily living, falls, disability, and quality of life. Conclusions. Given that polypharmacy has reached levels of a global epidemic, it is necessary to take radical actions to reduce the concomitant problems of the use of multiple drugs.


REFERENCES

  1. Maher RL, Hanlon J, Hajjar ER. Clinical consequences of polypharmacy in elderly. Expert Opin Drug Saf. 2014;13(1):57-65. https://doi.org/10.1517 /14740338.2013.827660

  2. Gnjidic D, Hilmer SN, Blyth FM, Naganathan V, Waite L, Seibel MJ, et al. Polypharmacy cutoff and outcomes: five or more medicines were used to identify community-dwelling older men at risk of different adverse outcomes. J Clin Epidemiol. 2012;65(9):989-95. https://doi.org/10.1016/j. jclinepi.2012.02.018

  3. Jyrkkä J, Enlund H, Lavikainen P, Sulkava R, Hartikainen S. Association of polypharmacy with nutritional status, functional ability and cognitive capacity over a three-year period in an elderly population. Pharmacoepidemiol Drug Saf. 2011;20(5):514-22. https://doi.org/10.1002/pds.2116

  4. Gutiérrez-Valencia M, Izquierdo M, Cesari M, Casas-Herrero Á, Inzitari M, Martínez-Velilla N. The relationship between frailty and polypharmacy in older people: A systematic review. Br J Clin Pharmacol. 2018;84(7):1432-44. https://doi.org/10.1111/bcp.13590

  5. Rosso AL, Eaton CB, Wallace R, Gold R, Stefanick ML, Ockene JK, et al. Geriatric syndromes and incident disability in older women: results from the women’s health initiative observational study. J Am Geriatr Soc. 2013;61(3):371-9. https://doi.org/10.1111/jgs.12147

  6. Meraya AM, Dwibedi N, Sambamoorthi U. Polypharmacy and healthrelated quality of life among us adults with arthritis, medical expenditure panel survey, 2010-2012. Prev Chronic Dis. 2016;13(E132):1-10. https:// doi.org/10.5888/pcd13.160092

  7. Beer C, Hyde Z, Almeida OP, Norman P, Hankey GJ, Yeap BB, et al. Quality use of medicines and health outcomes among a cohort of community dwelling older men: an observational study. Br J Clin Pharmacol. 2011;71(4):592-9. https://doi.org/10.1111/j.1365-2125.2010.03875.x

  8. Richardson K, Ananou A, Lafortune L, Brayne C, Matthews FE. Variation over time in the association between polypharmacy and mortality in the older population. Drugs Aging. 2011;28(7):547-60. https://doi. org/10.2165/11592000-000000000-00000

  9. Mangin D, Bahat G, Golomb BA, Mallery LH, Moorhouse P, Onder G, et al. International group for reducing inappropriate medication use & polypharmacy (IGRIMUP): Position statement and 10 recommendations for action. Drugs Aging. 2018;35(7):575-87. https://doi.org/10.1007/ s40266-018-0554-2

  10. Elmståhl S, Linder H. Polypharmacy and inappropriate drug use among older people -A systematic review. Healthy Aging Clin Care Elder. 2013;5:1-8. https://doi.org/10.4137/HACCE.S11173

  11. Jokanovic N, Tan EC, Dooley MJ, Kirkpatrick CM, Bell JS. Prevalence and factors associated with polypharmacy in long-term care facilities: a systematic review. J Am Med Dir Assoc. 2015;16(6):535.e1-535.e12. https://doi.org/10.1016/j.jamda.2015.03.003

  12. Alvarado-Orozco M, Mendoza-Núñez VM. Prevalencia y factores de riesgo para polifarmacia en adultos mayores del Valle del Mezquital, Hidalgo. Revista Mexicana de Ciencias Farmacéuticas. 2006;37(4):12-20.

  13. Martínez-Arroyo JL, Gómez-García A, Sauceda-Martínez D. Prevalencia de la polifarmacia y la prescripción de medicamentos inapropiados en el adulto mayor hospitalizado por enfermedades cardiovasculares. Gac Med Mex. 2014;150(Suppl 1):29-38.

  14. Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. What is polypharmacy? A systematic review of definitions. BMC Geriatr. 2017;17(1):230. https://doi.org/10.1186/s12877-017-0621-2

  15. Veehof LJG, Meyboom-De Jong B, Haaijer-Ruskamp FM. Polypharmacy in the elderly - a literature review. Eur J Gen Pract. 2000;6(3):98-106. https://doi.org/10.3109/13814780009069956

  16. Kim HA, Shin JY, Kim MH, Park BJ. Prevalence and predictors of polypharmacy among Korean elderly. PLoS One. 2014;9(6):1-7. https://doi. org/10.1371/journal.pone.0098043

  17. Fried TR, O’Leary J, Towle V, Goldstein MK, Trentalange M, Martin DK. Health outcomes associated with polypharmacy in community-dwelling older adults: A systematic review. J Am Geriatr Soc. 2014;62(12):2261-72. https://doi.org/10.1111/jgs.13153

  18. Salinas-Rodríguez A, Manrique-Espinoza B, Heredia-Pi I, Rivera-Almaraz A, Ávila-Funes JA. Healthcare Costs of Frailty: Implications for Longterm Care. J Am Med Dir Assoc. 2019;20(1):102.e2-103.e2. https://doi. org/10.1016/j.jamda.2018.09.019

  19. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146-56. https://doi.org/10.1093/gerona/56.3.m146

  20. Siordia C. Alternative Scoring for Physical Activity Scale for the Elderly (PASE). Maturitas. 2012;72(4):379-82. https://doi.org/10.1016/j.maturitas. 2012.05.009

  21. Katz S, Branch LG, Branson MH, Papsidero JA, Beck JC, Greer DS. Active life expectancy. N Engl J Med. 1983;309(20):1218-24. https://doi. org/10.1056/NEJM198311173092005

  22. Lawton MP, Brody EM. Assessment of older people: Self maintaining and instrumental activities of daily living. Gerontologist. 1969;9(3):179-86. https://doi.org/10.1093/geront/9.3_Part_1.179

  23. Üstün TB, Chatterji S, Kostanjsek N, Rehm J, Kennedy C, Epping-Jordan J, et al. Developing the world health organization disability assessment schedule 2.0. Bull WHO. 2010;88(11):815-23. https://doi.org/10.2471/ BLT.09.067231

  24. Ware JE Jr, Sherbourne C. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992; 30(6): 473-83. https://doi.org/10.1097/00005650-199206000-00002

  25. Rolland Y, Morley JE. Frailty and polypharmacy. J Nutr Health Aging. 2016;20(6):645-6. https://doi.org/10.1007/s12603-015-0510-3

  26. Golchin N, Frank S, Isham L, Vince A, Meropol SB. Polypharmacy in the elderly. Pharmacoepidemiol Drug Saf. 2011;20(S1):S296-7. https://doi. org/10.1002/pds.2206

  27. Manrique-Espinoza B, Salinas-Rodríguez A, Moreno-Tamayo KM, Acosta-Castillo I, Sosa-Ortiz AL, Gutiérrez-Robledo LM, et al. Health conditions and functional status of older adults in Mexico. Salud Publica Mex. 2013;55(suppl 2):S323-31. https://doi.org/10.21149/spm.v55s2.5131

  28. Lai SW, Lin CH, Liao KF, Su LT, Sung FC, Lin CC. Association between polypharmacy and dementia in older people: a population-based casecontrol study in Taiwan. Geriatr Gerontol Int. 2012;12(3):491-8. https:// doi.org/10.1111/j.1447-0594.2011.00800.x

  29. Meraya AM, Dwibedi N, Sambamoorthi U. Polypharmacy and Health- Related Quality of Life Among US Adults With Arthritis, Medical Expenditure Panel Survey, 2010-2012. Prev Chronic Dis. 2016;13(E132):1-10. https://doi.org/10.5888/pcd13.160092

  30. Lee EA, Brettler JW, Kanter MH, Steinberg SG, Khang P, Distasio CC, et al. Refining the definition of polypharmacy and its link to disability in older adults: conceptualizing necessary polypharmacy, unnecessary polypharmacy, and polypharmacy of unclear benefit. Perm J. 2020;24:18(212):1-6. https://doi.org/10.7812/TPP/18.212

  31. Wastesson JW, Morin L, Tan ECK, Johnell K. An update on the clinical consequences of polypharmacy in older adults: a narrative review. Expert Opin Drug Saf. 2018;17(12):1185-96. https://doi.org/10.1080/14740338.2 018.1546841

  32. Kojima T, Akishita M, Nakamura T, Nomura K, Ogawa S, Iijima K, et al. Polypharmacy as a risk for fall occurrence in geriatric outpatients. Geriatr Gerontol Int. 2012;12(3):425-30. https://doi.org/10.1111/j.1447- 0594.2011.00783.x

  33. Crentsil V, Ricks MO, Xue QL, Fried LP. A pharmacoepidemiologic study of community-dwelling, disabled older women: Factors associated with medication use. Am J Geriatr Pharmacother. 2010;8(3):215-24. https://doi.org/10.1016/j.amjopharm.2010.06.003

  34. Corsonello A, Pedone C, Incalzi RA. Age-related pharmacokinetic and pharmacodynamic changes and related risk of adverse drug reactions. Curr Med Chem. 2010;17(6):571-84. https://doi. org/10.2174/092986710790416326

  35. Hill-Taylor B, Walsh KA, Stewart S, Hayden J, Byrne S, Sketris IS. Effectiveness of the STOPP/START (Screening Tool of Older Persons’ potentially inappropriate Prescriptions/Screening Tool to Alert doctors to the Right Treatment) criteria: Systematic review and meta-analysis of randomized controlled studies. J Clin Pharm Ther. 2016;41(2):158-69. https:// doi.org/10.1111/jcpt.12372

  36. Haque R. ARMOR: A tool to evaluate polypharmacy in elderly persons. Ann of Longterm Care. 2009;17(6):26-30.




2020     |     www.medigraphic.com