Medication exposure and frailty in older community-dwelling patients: a cross-sectional study.
Anticholinergic exposure
Drug burden index
Frailty
France
Older patients
Polypharmacy
Sedative exposure
Journal
International journal of clinical pharmacy
ISSN: 2210-7711
Titre abrégé: Int J Clin Pharm
Pays: Netherlands
ID NLM: 101554912
Informations de publication
Date de publication:
Apr 2020
Apr 2020
Historique:
received:
30
08
2019
accepted:
25
02
2020
pubmed:
7
3
2020
medline:
5
3
2021
entrez:
7
3
2020
Statut:
ppublish
Résumé
Objective To investigate the association between the medication exposure, measured by the polypharmacy/excessive polypharmacy and the anticholinergic and/or sedative drug exposure, on frailty status among French older community-dwelling patients. Setting day-care unit in France (Lyon), with retrospective data from July, 2017 to March, 2018. Method This monocentric cross-sectional study included community-dwelling patients aged 65 years and over and admitted at the day-care unit for a geriatric evaluation. Frailty was assessed according to the frailty phenotype, described by Fried et al. Polypharmacy and excessive polypharmacy were defined as the concomitant use of 5-9 and 10 or more drugs, respectively. The cumulative anticholinergic and sedative exposure was measured using the drug burden index (DBI). The DBI score was presented in 4 differentiated scores: a null score (DBI = 0), a combined score (anticholinergic and sedative score), an anticholinergic score, and a sedative score. The association between medication and frailty was assessed by logistic regression models controlled for multiple potential confounders. Main outcome measure Association between medication exposure (polypharmacy, anticholinergic and sedative exposure) and frailty. Results In this study, 403 patients were included: 44.7% were frail and 40.7% were pre-frail. Polypharmacy and excessive polypharmacy affected 44.7% and 17.1% of the population respectively. The mean DBI was 0.33 ± 0.43, with 16.4% of patients with only sedative exposure, 9.7% with only anticholinergic exposure and 33.0% with both exposures. After adjustment, polypharmacy and excessive polypharmacy were associated with frailty with adjusted odds ratios (95% confidence interval) of 2.18 (1.03-4.22) and 2.72 (1.01-7.37) respectively. The cumulative exposure to anticholinergic and sedative drugs (combined score) was significantly associated to an increased risk for frailty with adjusted odds ratios (95% confidence interval) of 3.54 (1.47-8.57). Conclusion The study showed that polypharmacy and cumulative anticholinergic and sedative exposure are associated with frailty. Further research should address the potential benefit of collaborative medication review for preventing medication-associated frailty.
Identifiants
pubmed: 32140916
doi: 10.1007/s11096-020-01007-2
pii: 10.1007/s11096-020-01007-2
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
508-514Références
Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol Ser A Biol Sci Med Sci. 2001;56(3):M146–156.
doi: 10.1093/gerona/56.3.M146
Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet Lond Engl. 2013;381(9868):752–62.
doi: 10.1016/S0140-6736(12)62167-9
Song X, Mitnitski A, Rockwood K. Prevalence and 10-year outcomes of frailty in older adults in relation to deficit accumulation. J Am Geriatr Soc. 2010;58(4):681–7.
pubmed: 20345864
doi: 10.1111/j.1532-5415.2010.02764.x
Eeles EMP, White SV, O’Mahony SM, Bayer AJ, Hubbard RE. The impact of frailty and delirium on mortality in older inpatients. Age Ageing. 2012;41(3):412–6.
pubmed: 22391613
doi: 10.1093/ageing/afs021
Mangerel K, Armand-Branger S, Rhalimi M. Spécificités de la personne âgée et leurs conséquences sur la prise en charge médicamenteuse. 2011;30:167–73.
Field TS, Gurwitz JH, Avorn J, McCormick D, Jain S, Eckler M, et al. Risk factors for adverse drug events among nursing home residents. Arch Intern Med. 2001;161(13):1629–34.
doi: 10.1001/archinte.161.13.1629
Field TS, Gurwitz JH, Harrold LR, Rothschild J, DeBellis KR, Seger AC, et al. Risk factors for adverse drug events among older adults in the ambulatory setting. J Am Geriatr Soc. 2004;52(8):1349–54.
pubmed: 15271125
doi: 10.1111/j.1532-5415.2004.52367.x
Frazier SC. Health outcomes and polypharmacy in elderly individuals: an integrated literature review. J Gerontol Nurs. 2005;31(9):4–11.
pubmed: 16190007
doi: 10.3928/0098-9134-20050901-04
Neutel CI, Perry S, Maxwell C. Medication use and risk of falls. Pharmacoepidemiol Drug Saf. 2002;11(2):97–104.
pubmed: 11998544
doi: 10.1002/pds.686
Cardwell K, Hughes CM, Ryan C. The association between anticholinergic medication burden and health related outcomes in the 'oldest old': a systematic review of the titerature. Drugs Aging. 2015;32(10):835–48.
pubmed: 26442862
doi: 10.1007/s40266-015-0310-9
Jamieson HA, Nishtala PS, Scrase R, Deely JM, Abey-Nesbit R, Hilmer SN, et al. Drug burden index and its association with hip fracture among older adults: a national population-based study. J Gerontol A Biol Sci Med Sci. 2019;74(7):1127–33.
pubmed: 30084928
doi: 10.1093/gerona/gly176
Gnjidic D, Hilmer SN, Blyth FM, Naganathan V, Cumming RG, Handelsman DJ, et al. High-risk prescribing and incidence of frailty among older community-dwelling men. Clin Pharmacol Ther. 2012;91(3):521–8.
pubmed: 22297385
doi: 10.1038/clpt.2011.258
Herr M, Robine J-M, Pinot J, Arvieu J-J, 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.
pubmed: 25858336
doi: 10.1002/pds.3772
Yang F, Chen Q-W. Evaluation of frailty and influencing factors in old people in hospital institution. Med Baltim. 2018;97(3):e9634.
doi: 10.1097/MD.0000000000009634
Herr M, Sirven N, Grondin H, Pichetti S, Sermet C. Frailty, polypharmacy, and potentially inappropriate medications in old people: findings in a representative sample of the French population. Eur J Clin Pharmacol. 2017;73(9):1165–72.
pubmed: 28601963
doi: 10.1007/s00228-017-2276-5
Pegorari MS, Tavares DM dos S. Factors associated with the frailty syndrome in elderly individuals living in the urban area. Rev Lat Am Enfermagem. 2014;22(5):874‑82.
Saum K-U, Schöttker B, Meid AD, Holleczek B, Haefeli WE, Hauer K, et al. Is polypharmacy associated with frailty in older people? results from the ESTHER cohort study. J Am Geriatr Soc. 2017;65(2):e27–32.
pubmed: 28024089
doi: 10.1111/jgs.14718
Jürschik P, Nunin C, Botigué T, Escobar MA, Lavedán A, Viladrosa M. Prevalence of frailty and factors associated with frailty in the elderly population of Lleida, Spain: the FRALLE survey. Arch Gerontol Geriatr. 2012;55(3):625–31.
pubmed: 22857807
doi: 10.1016/j.archger.2012.07.002
Trevisan C, Veronese N, Maggi S, Baggio G, Toffanello ED, Zambon S, et al. Factors influencing transitions between frailty states in elderly adults: the progetto veneto anziani longitudinal study. J Am Geriatr Soc. 2017;65(1):179–84.
pubmed: 27861714
doi: 10.1111/jgs.14515
Jamsen KM, Bell JS, Hilmer SN, Kirkpatrick CMJ, Ilomäki J, Le Couteur D, et al. effects of changes in number of medications and drug burden index exposure on transitions between frailty states and death: the concord health and ageing in men project cohort study. J Am Geriatr Soc. 2016;64(1):89–95.
pubmed: 26782856
doi: 10.1111/jgs.13877
Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. What is polypharmacy? A systematic review of definitions. BMC Geriatr. 2017;17(1):230.
pubmed: 29017448
pmcid: 5635569
doi: 10.1186/s12877-017-0621-2
Hilmer SN, Mager DE, Simonsick EM, Cao Y, Ling SM, Windham BG, et al. A drug burden index to define the functional burden of medications in older people. Arch Intern Med. 2007;167(8):781–7.
doi: 10.1001/archinte.167.8.781
Faure R, Dauphinot V, Krolak-Salmon P, Mouchoux C. A standard international version of the drug burden Index for cross-national comparison of the functional burden of medications in older people. J Am Geriatr Soc. 2013;61(7):1227–8.
pubmed: 23855856
doi: 10.1111/jgs.12343
Durán CE, Azermai M, Vander Stichele RH. Systematic review of anticholinergic risk scales in older adults. Eur J Clin Pharmacol. 2013;69(7):1485–96.
pubmed: 23529548
doi: 10.1007/s00228-013-1499-3
Salahudeen MS, Duffull SB, Nishtala PS. Anticholinergic burden quantified by anticholinergic risk scales and adverse outcomes in older people: a systematic review. BMC Geriatr. 2015;15:31.
pubmed: 25879993
pmcid: 4377853
doi: 10.1186/s12877-015-0029-9
Tune LE. Anticholinergic effects of medication in elderly patients. J Clin Psychiatry. 2001;62(21):11–4.
pubmed: 11584981
Folstein MF, Folstein SE, McHugh PR. « Mini-mental state ». A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189‑98.
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–83.
pubmed: 3558716
pmcid: 3558716
doi: 10.1016/0021-9681(87)90171-8
Gutiérrez-Valencia M, Izquierdo M, Cesari M, Casas-Herrero Á, Inzitari M, Martínez-Velilla N. The relationship between frailty and polypharmacy in older people: a systematic review. Br J Clin Pharmacol. 2018;84(7):1432–44.
pubmed: 29575094
pmcid: 6005607
doi: 10.1111/bcp.13590
Kouladjian L, Gnjidic D, Chen T, Hilmer S, Mangoni A. Drug burden index in older adults: theoretical and practical issues. Clin Interv Aging. 2014;1503.
Santos-Eggimann B, Cuénoud P, Spagnoli J, Junod J. Prevalence of frailty in middle-aged and older community-dwelling Europeans living in 10 countries. J Gerontol A Biol Sci Med Sci. 2009;64(6):675–81.
pubmed: 19276189
doi: 10.1093/gerona/glp012
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(8):1487–92.
pubmed: 22881367
doi: 10.1111/j.1532-5415.2012.04054.x
Szewieczek J, Bieniek J, Wilczyński K. Fried frailty phenotype assessment components as applied to geriatric inpatients. Clin Interv Aging. 2016;453.
Frost R, Belk C, Jovicic A, Ricciardi F, Kharicha K, Gardner B, et al. Health promotion interventions for community-dwelling older people with mild or pre-frailty: a systematic review and meta-analysis. BMC Geriatr. 2017;17(1):157.
pubmed: 28728570
pmcid: 5520298
doi: 10.1186/s12877-017-0547-8
Puts MTE, Toubasi S, Andrew MK, Ashe MC, Ploeg J, Atkinson E, et al. Interventions to prevent or reduce the level of frailty in community-dwelling older adults: a scoping review of the literature and international policies. Age Ageing. 2017;46(3):383–92.
pubmed: 28064173
pmcid: 5405756