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Relationship between frailty and drug use among nursing homes residents: results from the SHELTER study

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Abstract

Background

1.5–8% of older adults live in nursing homes (NHs), presenting a high prevalence of frailty and polypharmacy.

Aims

To investigate the association of frailty with polypharmacy and drug prescription patterns in a sample of European Nursing Home (NH) residents.

Methods

Cross-sectional study based on the data from the Services and Health for Elderly in Long TERm care (SHELTER) study. 4121 NH residents in Europe and Israel. Residents’ clinical, cognitive, social, and physical status were evaluated with the InterRAI LTCF tool, which allows comprehensive, standardized evaluation of persons living in NH. Polypharmacy and hyperpolypharmacy were defined as the concurrent use of ≥ 5 and ≥ 10 medications. Frailty was defined according to the FRAIL-NH scale.

Results

Of 4121 participants, 46.6% were frail (mean age 84.6 ± 9.2 years; 76.4% female). Polypharmacy and hyperpolypharmacy were associated with a lower likelihood of frailty (Odds Ratio = 0.72; 95% CI = 0.59–0.87 and OR = 0.75; 95% CI = 0.60–0.94, respectively). Patterns of drug prescriptions were different between frail and non-frail residents. Symptomatic drugs (laxatives, paracetamol, and opioids) were more frequently prescribed among frail residents, while preventive drugs (bisphosphonates, vitamin D, and acetylsalicylic acid) were more frequently prescribed among non-frail residents.

Conclusions

Frailty is associated with less polypharmacy and with higher prevalence of symptomatic drugs use among NH residents. Further studies are needed to define appropriateness of drug prescription in frail individuals.

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Acknowledgements

The corresponding author affirms that he has listed everyone who contributed significantly to the work.

Funding

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Authors and Affiliations

  1. Department of Geriatrics, Catholic University of the Sacred Heart, Rome, Italy

    Emanuele Rocco Villani, Rosa Liperoti, Katie Palmer & Roberto Bernabei

  2. Karolinska Institutet, Stockholm, Sweden

    Davide Liborio Vetrano

  3. Department of Geriatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

    Rosa Liperoti & Roberto Bernabei

  4. AGAPLESION Bethesda Ulm, Geriatric Research Ulm University and Geriatric Center Ulm/Alb-Donau, Ulm, Germany

    Michael Denkinger

  5. Department on Aging, Netherlands Insititute of Mental Health and Addicition (Trimbos Insititute), Utrecht, The Netherlands

    Henriëtte G. van der Roest

  6. Department of Cardiovascular, Endocrine–Metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy

    Graziano Onder

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  1. Emanuele Rocco Villani
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  4. Katie Palmer
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Contributions

Study concepts: ERV, RB, GO. Study design: GO. Data acquisition: GO, HGR. Quality control of data and algorithms: GO. Data analysis and interpretation: ERV, GO. Statistical analysis: ERV. Manuscript preparation: ERV. Manuscript editing: ERV. Manuscript review: ERV, GO, KP, DLV, RL, HGR, MD.

Corresponding author

Correspondence to Emanuele Rocco Villani.

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No author declares any conflict of interest.

Ethical approval

Ethical approval for the study was obtained in all countries according to the local regulations.

Informed consent

Residents were invited to take part in the study, and were free to decline participation. Consent was obtained with assurance of data confidentiality. Patients who did not give their consent were excluded from the study.

Impact statements

We certify that this work is novel because it describes patterns of drug use among frail and non-frail l Nursing Homes residents.

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Villani, E.R., Vetrano, D.L., Liperoti, R. et al. Relationship between frailty and drug use among nursing homes residents: results from the SHELTER study. Aging Clin Exp Res 33, 2839–2847 (2021). https://doi.org/10.1007/s40520-021-01797-z

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