Frailty, polypharmacy, and potentially inappropriate medications in old people: findings in a representative sample of the French population



This study analyses the relationship between medication use and frailty by considering the quantity of medications prescribed (polypharmacy) and the quality of medication prescribing (according to French criteria for Potentially Inappropriate Medications—PIMs) in people aged 65 and over.


This is a cross-sectional study based on the data from a nationally representative study about health and use of healthcare resources in France (ESPS 2012). The number of frailty criteria was assessed among exhaustion, unintentional weight loss, muscle weakness, impaired mobility, and low level of physical activity. Polypharmacy and PIMs were assessed from the data of reimbursement by the National Health Insurance over the whole year 2012. PIMs were defined according to the Laroche list plus additional criteria dealing with inappropriate prolonged use of medications. The analyses used Poisson regression models, with the number of frailty criteria as dependent variable.


The study population was composed of 1003 women and 887 men, of mean age 74.7 +/− 7.4 years. Polypharmacy (5 to 9 drugs) and excessive polypharmacy (≥10 drugs) were reported in 42.9 and 27.4% of the study population, respectively, while 46.7% of the study population received at least one PIM during the year 2012. Polypharmacy and PIMs were both associated with the number of frailty criteria in models adjusted for socio-demographic and health characteristics of the participants. The prescription of anticholinergic medications was the only PIM that remained significantly associated with the number of frailty criteria after adjustment for polypharmacy.


Polypharmacy and use of anticholinergic medications are independently associated with frailty in old people.

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  1. 1.

    Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, McBurnie MA (2001) Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 56(3):M146–M156

    CAS  Article  PubMed  Google Scholar 

  2. 2.

    Sirven N, Rapp T (2016) The cost of frailty in France. The European journal of health economics : HEPAC : health economics in prevention and care. doi:10.1007/s10198-016-0772-7

  3. 3.

    Sirven N, Rapp T (2016) The dynamics of hospital use among older people evidence for Europe using SHARE data. Health Serv Res. doi:10.1111/1475-6773.12518

  4. 4.

    Bergman H, Ferrucci L, Guralnik J, Hogan DB, Hummel S, Karunananthan S, Wolfson C (2007) Frailty: an emerging research and clinical paradigm--issues and controversies. J Gerontol A Biol Sci Med Sci 62(7):731–737

    Article  PubMed  PubMed Central  Google Scholar 

  5. 5.

    Shamliyan T, Talley KM, Ramakrishnan R, Kane RL (2013) Association of frailty with survival: a systematic literature review. Ageing Res Rev 12(2):719–736. doi:10.1016/j.arr.2012.03.001

    Article  PubMed  Google Scholar 

  6. 6.

    Morley JE, Vellas B, van Kan GA, Anker SD, Bauer JM, Bernabei R, Cesari M, Chumlea WC, Doehner W, Evans J, Fried LP, Guralnik JM, Katz PR, Malmstrom TK, McCarter RJ, Gutierrez Robledo LM, Rockwood K, von Haehling S, Vandewoude MF, Walston J (2013) Frailty consensus: a call to action. J Am Med Dir Assoc 14(6):392–397. doi:10.1016/j.jamda.2013.03.022

    Article  PubMed  PubMed Central  Google Scholar 

  7. 7.

    Herr M, Robine JM, Pinot J, Arvieu JJ, Ankri J (2015) Polypharmacy and frailty: prevalence, relationship, and impact on mortality in a French sample of 2350 old people. Pharmacoepidemiol Drug Saf 24(6):637–646. doi:10.1002/pds.3772

    Article  PubMed  Google Scholar 

  8. 8.

    Chang CI, Chan DC, Kuo KN, Hsiung CA, Chen CY (2011) Prevalence and correlates of geriatric frailty in a northern Taiwan community. J Formos Med Assoc 110(4):247–257. doi:10.1016/S0929-6646(11)60037-5

    Article  PubMed  Google Scholar 

  9. 9.

    Gnjidic D, Hilmer SN, Blyth FM, Naganathan V, Cumming RG, Handelsman DJ, McLachlan AJ, Abernethy DR, Banks E, Le Couteur DG (2012) High-risk prescribing and incidence of frailty among older community-dwelling men. Clin Pharmacol Ther 91(3):521–528. doi:10.1038/clpt.2011.258

    CAS  Article  PubMed  Google Scholar 

  10. 10.

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

  11. 11.

    Saum KU, Schottker B, Meid AD, Holleczek B, Haefeli WE, Hauer K, Brenner H (2017) Is polypharmacy associated with frailty in older people? Results from the ESTHER cohort study. J Am Geriatr Soc 65(2):e27–e32. doi:10.1111/jgs.14718

    Article  PubMed  Google Scholar 

  12. 12.

    Fried TR, O'Leary J, Towle V, Goldstein MK, Trentalange M, Martin DK (2014) Health outcomes associated with polypharmacy in community-dwelling older adults: a systematic review. J Am Geriatr Soc 62(12):2261–2272. doi:10.1111/jgs.13153

    Article  PubMed  PubMed Central  Google Scholar 

  13. 13.

    Frazier SC (2005) Health outcomes and polypharmacy in elderly individuals: an integrated literature review. J Gerontol Nurs 31(9):4–11

    Article  PubMed  Google Scholar 

  14. 14.

    Lai SW, Liao KF, Liao CC, Muo CH, Liu CS, Sung FC (2010) Polypharmacy correlates with increased risk for hip fracture in the elderly: a population-based study. Medicine 89(5):295–299. doi:10.1097/MD.0b013e3181f15efc

    Article  PubMed  Google Scholar 

  15. 15.

    Gnjidic D, Hilmer SN, Blyth FM, Naganathan V, Waite L, Seibel MJ, McLachlan AJ, Cumming RG, Handelsman DJ, Le Couteur DG (2012) 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 65(9):989–995. doi:10.1016/j.jclinepi.2012.02.018

    Article  PubMed  Google Scholar 

  16. 16.

    Beer C, Hyde Z, Almeida OP, Norman P, Hankey GJ, Yeap BB, Flicker L (2011) Quality use of medicines and health outcomes among a cohort of community dwelling older men: an observational study. Br J Clin Pharmacol 71(4):592–599. doi:10.1111/j.1365-2125.2010.03875.x

    Article  PubMed  PubMed Central  Google Scholar 

  17. 17.

    Beers MH, Ouslander JG, Fingold SF, Morgenstern H, Reuben DB, Rogers W, Zeffren MJ, Beck JC (1992) Inappropriate medication prescribing in skilled-nursing facilities. Ann Intern Med 117(8):684–689

    CAS  Article  PubMed  Google Scholar 

  18. 18.

    Célant N, Guillaume S, Rochereau T (2014) Enquête sur la santé et la protection sociale 2012. Les rapports de l'IRDES n° 556. In: ed

  19. 19.

    Laroche ML, Charmes JP, Merle L (2007) Potentially inappropriate medications in the elderly: a French consensus panel list. Eur J Clin Pharmacol 63(8):725–731. doi:10.1007/s00228-007-0324-2

    Article  PubMed  Google Scholar 

  20. 20.

    Jardin M, Bocquier A, Cortaredona S, Nauleau S, Millon C, Savard-Chambard S, Allaria-Lapierre V, Sciortino V, Bouvenot G, Verger P (2012) Potentially inappropriate prescriptions for the elderly: a study of health insurance reimbursements in southeastern France. Revue d'epidemiologie et de sante publique 60(2):121–130. doi:10.1016/j.respe.2011.10.004

    CAS  Article  PubMed  Google Scholar 

  21. 21.

    Rémunération sur objectif de santé publique (ROSP) concernant les Benzodiazépines. L'Assurance Maladie. In: ed

  22. 22.

    (2012) The American geriatrics society 2012 beers criteria update expert panel. American geriatrics society updated beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc 60: 616–631

  23. 23.

    Tommelein E, Mehuys E, Petrovic M, Somers A, Colin P, Boussery K (2015) Potentially inappropriate prescribing in community-dwelling older people across Europe: a systematic literature review. Eur J Clin Pharmacol 71(12):1415–1427. doi:10.1007/s00228-015-1954-4

    Article  PubMed  Google Scholar 

  24. 24.

    Dormann CF, Elith J, Bacher S, Buchmann C, Carl G, Carre G, Marquez JRG, Gruber B, Lafourcade B, Leitao PJ, Munkemuller T, McClean C, Osborne PE, Reineking B, Schroder B, Skidmore AK, Zurell D, Lautenbach S (2013) Collinearity: a review of methods to deal with it and a simulation study evaluating their performance. Ecography 36(1):27–46. doi:10.1111/j.1600-0587.2012.07348.x

    Article  Google Scholar 

  25. 25.

    Moulis F, Moulis G, Balardy L, Gerard S, Montastruc F, Sourdet S, Rouge-Bugat ME, Lapeyre-Mestre M, Montastruc JL, Rolland Y, Vellas B (2015) Exposure to atropinic drugs and frailty status. J Am Med Dir Assoc 16(3):253–257. doi:10.1016/j.jamda.2014.11.017

    Article  PubMed  Google Scholar 

  26. 26.

    Gerretsen P, Pollock BG (2011) Drugs with anticholinergic properties: a current perspective on use and safety. Expert Opin Drug Saf 10(5):751–765. doi:10.1517/14740338.2011.579899

    Article  PubMed  Google Scholar 

  27. 27.

    Gnjidic D, Hilmer SN (2012) Potential contribution of medications to frailty. J Am Geriatr Soc 60(2):401. doi:10.1111/j.1532-5415.2011.03810.x

    Article  PubMed  Google Scholar 

  28. 28.

    Wang R, Chen L, Fan L, Gao D, Liang Z, He J, Gong W, Gao L (2015) Incidence and effects of polypharmacy on clinical outcome among patients aged 80+: a five-year follow-up study. PLoS One 10(11):e0142123. doi:10.1371/journal.pone.0142123

    Article  PubMed  PubMed Central  Google Scholar 

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Correspondence to Marie Herr.

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Herr, M., Sirven, N., Grondin, H. et al. Frailty, polypharmacy, and potentially inappropriate medications in old people: findings in a representative sample of the French population. Eur J Clin Pharmacol 73, 1165–1172 (2017).

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  • Aged
  • Anticholinergic medications
  • Frailty
  • Inappropriate prescribing
  • Polypharmacy