Skip to main content
SpringerLink
Log in

Polypharmacy but not Potential Inappropriate Prescription Was Associated with Frailty in Older Adults from a Middle-Income Country Outpatient Clinic

  • Original Research
  • Clinics and Public Health
  • Published:
The Journal of Frailty & Aging Aims and scope Submit manuscript

Abstract

Objectives

the aims of the present study were: (1) investigate the prevalence and association of polypharmacy and pre-frailty or frailty in a middle-income country sample of older adults; and (2) evaluate the prevalence of potential inappropriate prescription (PIP) and its association with pre-frailty or frailty.

Design

Cross-sectional observational study.

Setting

Outpatient center at a university-based hospital in the state of São Paulo, Brazil.

Participants

629 older adults from both sexes evaluated between June 2014 and July 2016.

Measurements

Frailty was identified through the FRAIL scale. All medications received were analyzed by research staff. Presence of PIP was evaluated according to the 2015 updated Beers list. Binary logistic regression tested the association between 4 definitions of polypharmacy (≥ 3, 4, 5, and 6 drugs), and presence of PIP, and the dependent variable pre-frailty and frailty.

Results

15.7% of participants were frail. Polypharmacy was present in 219 (34.8%), and PIP was observed in 184 (29.3%) older adults. All definitions of polypharmacy were significantly associated with frailty (OR between 2.05 to 2.34, p < 0.001). Polypharmacy with 4 or 5 or more drugs were associated with pre-frailty (OR 1.53 and 1.47, respectively). PIP was not associated with frailty (OR 1.47, p = 0.149).

Conclusions

Several definitions of polypharmacy were associated with frailty, but only two were associated with pre-frailty. The presence of PIP was not associated with pre-frailty or frailty.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Clegg A, Young J, Iliffe S, et al. Frailty in elderly people. Lancet 2013;2:752–762.

    Article  Google Scholar 

  2. Morley JE, Vellas B, van Kan GA, et al. Frailty Consensus: A Call to Action. J Am Med Dir Assoc 2013;14:392–397.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Collard RM, Boter H, Schoevers RA, Oude Voshaar RC. Prevalence of frailty in community-dwelling older persons: a systematic review. J Am Geriatr Soc 2012;60:1487–1492.

    Article  PubMed  Google Scholar 

  4. Da Mata FA, Pereira PP, Andrade KR, Figueiredo AC, Silva MT, Pereira MG. Prevalence of Frailty in Latin America and the Caribbean: A Systematic Review and Meta-Analysis. PLoS One 2016;11(8):e0160019.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  5. Espinoza SE, Hazuda HP. Frailty in older Mexican-American and European American adults: Is there an ethnic disparity? J Am Geriatr Soc 2008;56: 1744–1749.

    Article  PubMed  Google Scholar 

  6. Wise J. Polypharmacy: A necessary evil. BMJ 2013;347:f7033.

    Article  PubMed  Google Scholar 

  7. Saum KU, Schöttker B, Meid ADet al. Is polypharmacy associated with frailty in older people? Results from the ESTHER Cohort Study. J Am Geriatr Soc 2017;65(2):e27–e32.

    Article  PubMed  Google Scholar 

  8. Hartikainen S, Lonnroos E, Louhivuori K. Medication as a risk factor for falls: critical systematic review. J Gerontol A Biol Sci Med Sci 2007;62(10): 1172–1181.

    Article  PubMed  Google Scholar 

  9. Herr M, Robine JM, Pinot J, Arvieu JJ, Ankri J. Polypharmacy and frailty: prevalence, relationship, and impact on mortality in a French sample of 2350 old people. Pharmacoepidemiol Drug Saf 2015;24(6):637–46.

    Article  PubMed  Google Scholar 

  10. Jyrkka 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): 514–522.

    Article  PubMed  Google Scholar 

  11. Rosted E, Schultz M, Sanders S. Frailty and polypharmacy in elderly patients are associated with a high readmission risk. Dan Med J 2016;63(9). pii: A5274.

    PubMed  Google Scholar 

  12. Wallace E, Stuart E, Vaughan N, Bennett K, Fahey T, Smith SM. Risk prediction models to predict emergency hospital admission in community-dwelling adults: a systematic review. Med Care 2014;52(8): 751–765.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Gnjidic D, Hilmer SN, Blyth FM, 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;65:989e995.

    Article  Google Scholar 

  14. Bradley MC, Motterlini N, Padmanabhan S, et al. Potentially inappropriate prescribing among older people in the United Kingdom. BMC Geriatr 2014;14:72.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Spinewine A, Schmader KE, Barber N, et al. Appropriate prescribing in elderly people: how well can it be measured and optimised? Lancet 2007;370(9582):173–84.

    Article  PubMed  Google Scholar 

  16. American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatrics Soc 2015;63(11):2227–46.

    Google Scholar 

  17. Gnjidic D, Hilmer SN. Potential contribution of medications to frailty. J Am Geriatr Soc 2012;60(2): 401.

    Article  PubMed  Google Scholar 

  18. Gnjidic D, Hilmer SN, Blyth FM, et al. High-risk prescribing and incidence of frailty among older community-dwelling men. Clin Pharmacol Ther 2012;91:521e528.

    Article  Google Scholar 

  19. Bennett A, Gnjidic D, Gillett M, et al. Prevalence and impact of fall-risk-increasing drugs, polypharmacy, and drug-drug interactions in robust versus frail hospitalised falls patients: A prospective cohort study. Drugs Aging 2014;31:225e232.

    Article  Google Scholar 

  20. Turner JP, Shakib S, Singhal N, et al. Prevalence and factors associated with polypharmacy in older people with cancer. Support Care Cancer 2014;22:1727e1734.

    Google Scholar 

  21. Woo J, Leung J Multi-morbidity, dependency, and frailty singly or in combination have different impact on health outcomes. Age (Dordr) 2014;36:923e931.

    Google Scholar 

  22. Moulis F, Moulis G, Balardy L, et al. Searching for a polypharmacy threshold associated with frailty. J Am Med Dir Assoc 2015;16(3):259–61.

    Article  PubMed  Google Scholar 

  23. Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001;56:M146–M156.

    Article  PubMed  CAS  Google Scholar 

  24. Nasreddine ZS, Phillips NA, Bédirian V, et al. The Montreal Cognitive Assessment: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc 2005;53:695–699.

    Article  PubMed  Google Scholar 

  25. Pfeffer RI, Kurosaki TT, Harrah CH Jr., Chance JM, Filos S. Measurement of functional activities in older adults in the community. J Gerontol 1982;37:323–329.

    Article  PubMed  CAS  Google Scholar 

  26. Morley JE, Malmstrom TK, Miller DK. A simple frailty questionnaire (FRAIL) predicts outcomes in middle aged African Americans. J Nutr Health Aging 2012;16:601–608.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  27. Aprahamian I, Lin SM, Suemoto CK, et al. Feasibility and Factor Structure of the FRAIL Scale in Older Adults. J Am Med Dir Assoc 2017;18:367.e11–367.e18.

    Article  Google Scholar 

  28. Wang R, Chen L, Fan L, et al. Incidence and effects of polypharmacy on clinical outcome among patients aged 80+: A five-year follow-up study. PLoS ONE 2015;10:e0142123.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Investigation on Multimorbidity and Mental Health in Aging (IMMA) Lab, Department of Internal Medicine, Faculty of Medicine of Jundiaí, Rua Francisco Telles, 250, ZIP code: 13202-550. Vila Arens, Jundiaí, State of São Paulo, Brazil

    Ivan Aprahamian, G. Vano Aricó De Almeida, F. Pegoraro, A. V. Alves Pedrini, B. Cestari, L. H. Bignotto, B. Alvarez Ribeiro De Melo & J. E. Martinelli

  2. Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, University of São Paulo, São Paulo, Brazil

    Ivan Aprahamian & M. M. Biella

Authors
  1. Ivan Aprahamian
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. M. Biella
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. G. Vano Aricó De Almeida
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. F. Pegoraro
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A. V. Alves Pedrini
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. B. Cestari
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. L. H. Bignotto
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. B. Alvarez Ribeiro De Melo
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. J. E. Martinelli
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ivan Aprahamian.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Aprahamian, I., Biella, M.M., Vano Aricó De Almeida, G. et al. Polypharmacy but not Potential Inappropriate Prescription Was Associated with Frailty in Older Adults from a Middle-Income Country Outpatient Clinic. J Frailty Aging 7, 108–112 (2018). https://doi.org/10.14283/jfa.2018.5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.14283/jfa.2018.5

Key words

Search

Navigation