Association of polypharmacy and hyperpolypharmacy with frailty states: a systematic review and meta-analysis

Abstract

Purpose

To investigate: (1) the cross-sectional association between polypharmacy, hyperpolypharmacy and presence of prefrailty or frailty; (2) the risk of incident prefrailty or frailty in persons with polypharmacy, and vice versa.

Methods

A systematic review and meta-analysis was performed according to PRISMA guidelines. We searched PubMed, Web of Science, and Embase from 01/01/1998 to 5/2/2018. Pooled estimates were obtained through random effect models and Mantel–Haenszel weighting. Homogeneity was assessed with the I2 statistic and publication bias with Egger’s and Begg’s tests.

Results

Thirty-seven studies were included. The pooled proportion of polypharmacy in persons with prefrailty and frailty was 47% (95% CI 33–61) and 59% (95% CI 42–76), respectively. Increased odds ratio of polypharmacy were seen for prefrail (pooled OR = 1.52; 95% CI 1.32–1.79) and frail persons (pooled OR = 2.62, 95% CI 1.81–3.79). Hyperpolypharmacy was also increased in prefrail (OR = 1.95; 95% CI 1.41–2.70) and frail (OR = 6.57; 95% CI 9.57–10.48) persons compared to robust persons. Only seven longitudinal studies reported data on the risk of either incident prefrailty or frailty in persons with baseline polypharmacy. A significant higher odds of developing prefrailty was found in robust persons with polypharmacy (pooled OR = 1.30; 95% CI 1.12–1.51). We found no papers investigating polypharmacy incidence in persons with prefrailty/frailty.

Conclusions

Polypharmacy is common in prefrail and frail persons, and these individuals are also more likely to be on extreme drug regimens, i.e. hyperpolypharmacy, than robust older persons. More research is needed to investigate the causal relationship between polypharmacy and frailty syndromes, thereby identifying ways to jointly reduce drug burden and prefrailty/frailty in these individuals.

Prospero registration number

CRD42018104756.

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Acknowledgements

Composition of European Geriatric Medicine Society special interest group on Pharmacology: Marit Bakken, Jean-Pierre Baeyens, Athanase Benetos, Antonio Cherubini, Peter Crome, Alfonso J. Cruz-Jentoft, Michael Denkinger, Tomas Frühwald, Paul Gallagher, Adalsteinn Guðmundsson, Stephen Jackson, Paul Jansen, Wilma Knol, Denis O’Mahony, Graziano Onder, Desmond O’Neill, Mirko Petrovic, Alberto Pilotto, Elina Ronnemaa, Jens-Ulrik Rosholm, José Antonio Serra, George Soulis, Tischa JM van der Cammen, Nathalie van der Velde, Rob van Marum, Martin Wehling, Gijsbertus Ziere.

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Correspondence to Katie Palmer.

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The European Geriatric Medicine Society Pharmacology special interest group members are listed in the Acknowledgement section.

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Palmer, K., Villani, E.R., Vetrano, D.L. et al. Association of polypharmacy and hyperpolypharmacy with frailty states: a systematic review and meta-analysis. Eur Geriatr Med 10, 9–36 (2019). https://doi.org/10.1007/s41999-018-0124-5

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Keywords

  • Frail
  • Prefrail
  • Polypharmacy
  • Drugs
  • Ageing
  • Medications
  • Hyperpolypharmacy