Frailty, Polypharmacy, and Health Outcomes in Older Adults: The Frailty and Dependence in Albacete Study

Autor: Leocadio Rodríguez-Mañas, Danijela Gnjidic, Marta Martínez-Reig, Tránsito Salvador, Pedro Manuel Sánchez-Jurado, Pedro Abizanda, Gabriel Ariza, Beatriz Bonaga
Rok vydání: 2018
Předmět:
Male
Gerontology
medicine.medical_specialty
Population
Kaplan-Meier Estimate
Risk Assessment
Severity of Illness Index
Cohort Studies
Disability Evaluation
03 medical and health sciences
0302 clinical medicine
030502 gerontology
Activities of Daily Living
Outcome Assessment
Health Care
Risk of mortality
Humans
Medicine
Disabled Persons
030212 general & internal medicine
education
Geriatric Assessment
General Nursing
Aged
Proportional Hazards Models
Aged
80 and over
Polypharmacy
education.field_of_study
Frailty
business.industry
Health Policy
Hazard ratio
General Medicine
Odds ratio
medicine.disease
Survival Analysis
Comorbidity
Confidence interval
Hospitalization
Logistic Models
Spain
Quality of Life
Physical therapy
Female
Geriatrics and Gerontology
Emergency Service
Hospital
0305 other medical science
business
Cohort study
Zdroj: Journal of the American Medical Directors Association. 19:46-52
ISSN: 1525-8610
DOI: 10.1016/j.jamda.2017.07.008
Popis: Background/Objectives To investigate if polypharmacy modifies the association between frailty and health outcomes in older adults. Design Ongoing cohort study. Setting Albacete City, Spain. Participants A total for 773 participants, 457 women (59.1%), over age 70 years from the FRADEA Study. Measurements Frailty phenotype, polypharmacy considered as the chronic use of 5 or more drugs, and comorbidity were collected at the baseline visit. Participants were categorized in 6 groups according to frailty and polypharmacy, and were followed up for 5.5 years (mean 1057 days, range 1-2007). Mortality or incident disability in basic activities of daily living was considered the main outcome variable. Hospitalization and visits to the emergency department were also recorded. The adjusted association between combined frailty status and polypharmacy with outcome variables was analyzed. Results The mean age of study population was 78.5 years. In this population, we identified a 15.3% (n = 118) of frail with polypharmacy, 3.4% (n = 26) of frail without polypharmacy, 35.3% (n = 273) of prefrail with polypharmacy, 20.3% (n = 157) of prefrail without polypharmacy, 10.3% (n = 80) of nonfrail with polypharmacy, and 15.4% (n = 119) of nonfrail participants without polypharmacy. Participants with frailty and polypharmacy had a higher adjusted risk of mortality or incident disability [odds ratio (OR) 5.3; 95% confidence interval (CI) 2.3–12.5] and hospitalization (OR 2.3; 95% CI 1.2–4.4), compared with those without frailty and polypharmacy. Frail and prefrail participants with polypharmacy had a higher adjusted mortality risk compared with the nonfrail without polypharmacy, hazard ratio 5.8 (95% CI 1.9–17.5) and hazard ratio 3.1 (95% CI 1.1–9.1), respectively. Conclusions Polypharmacy is associated with mortality, incident disability, hospitalization, and emergency department visits in frail and prefrail older adults, but not in nonfrail adults. Polypharmacy should be monitored in these patient subgroups to optimize health outcomes.
Databáze: OpenAIRE
Externí odkaz: