Characterising polypharmacy in the very old: Findings from the Newcastle 85+ Study.
Aged, 80 and over
Analgesics, Non-Narcotic
/ therapeutic use
Antidepressive Agents
/ therapeutic use
Cardiovascular Diseases
/ prevention & control
Cohort Studies
Demography
Diphosphonates
/ therapeutic use
Drug Prescriptions
/ statistics & numerical data
England
Factor Xa Inhibitors
/ therapeutic use
Female
Humans
Inappropriate Prescribing
/ statistics & numerical data
Male
Multimorbidity
Nitrates
/ therapeutic use
Polypharmacy
Prevalence
Preventive Medicine
/ statistics & numerical data
Prospective Studies
Socioeconomic Factors
Sodium Potassium Chloride Symporter Inhibitors
/ therapeutic use
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2021
2021
Historique:
received:
17
07
2020
accepted:
05
01
2021
entrez:
19
1
2021
pubmed:
20
1
2021
medline:
17
6
2021
Statut:
epublish
Résumé
Polypharmacy is potentially harmful and under-researched amongst the fastest growing subpopulation, the very old (aged ≥85). We aimed to characterise polypharmacy using data from the Newcastle 85+ Study-a prospective cohort of people born in 1921 who turned 85 in 2006 (n = 845). The prevalence of polypharmacy at baseline (mean age 85.5) was examined using cut-points of 0, 1, 2-4, 5-9 and ≥10 medicines-so-called 'no polypharmacy', 'monotherapy', 'minor polypharmacy', 'polypharmacy' and 'hyperpolypharmacy.' Cross-tabulations and upset plots identified the most frequently prescribed medicines and medication combinations within these categories. Mixed-effects models assessed whether gender and socioeconomic position were associated with prescribing changes over time (mean age 85.5-90.5). Participant characteristics were examined through descriptive statistics. Complex multimorbidity (44.4%, 344/775) was widespread but hyperpolypharmacy was not (16.0%, 135/845). The median medication count was six (interquartile range 4-8). Preventative medicines were common to all polypharmacy categories, and prescribing regimens were diverse. Nitrates and oral anticoagulants were more frequently prescribed for men, whereas bisphosphonates, non-opioid analgesics and antidepressants were more common in women. Cardiovascular medicines, including loop diuretics, tended to be more frequently prescribed for socioeconomically disadvantaged people (<25th centile Index of Multiple Deprivation (IMD)), despite no difference in the prevalence of cardiovascular disease (p = 0.56) and diabetes (p = 0.92) by IMD. Considering their complex medical conditions, prescribing is relatively conservative amongst 85-year-olds living in North East England. Prescribing shows significant gender and selected socioeconomic differences. More support for managing preventative medicines, of uncertain benefit, might be helpful in this population.
Sections du résumé
BACKGROUND
Polypharmacy is potentially harmful and under-researched amongst the fastest growing subpopulation, the very old (aged ≥85). We aimed to characterise polypharmacy using data from the Newcastle 85+ Study-a prospective cohort of people born in 1921 who turned 85 in 2006 (n = 845).
METHODS
The prevalence of polypharmacy at baseline (mean age 85.5) was examined using cut-points of 0, 1, 2-4, 5-9 and ≥10 medicines-so-called 'no polypharmacy', 'monotherapy', 'minor polypharmacy', 'polypharmacy' and 'hyperpolypharmacy.' Cross-tabulations and upset plots identified the most frequently prescribed medicines and medication combinations within these categories. Mixed-effects models assessed whether gender and socioeconomic position were associated with prescribing changes over time (mean age 85.5-90.5). Participant characteristics were examined through descriptive statistics.
RESULTS
Complex multimorbidity (44.4%, 344/775) was widespread but hyperpolypharmacy was not (16.0%, 135/845). The median medication count was six (interquartile range 4-8). Preventative medicines were common to all polypharmacy categories, and prescribing regimens were diverse. Nitrates and oral anticoagulants were more frequently prescribed for men, whereas bisphosphonates, non-opioid analgesics and antidepressants were more common in women. Cardiovascular medicines, including loop diuretics, tended to be more frequently prescribed for socioeconomically disadvantaged people (<25th centile Index of Multiple Deprivation (IMD)), despite no difference in the prevalence of cardiovascular disease (p = 0.56) and diabetes (p = 0.92) by IMD.
CONCLUSION
Considering their complex medical conditions, prescribing is relatively conservative amongst 85-year-olds living in North East England. Prescribing shows significant gender and selected socioeconomic differences. More support for managing preventative medicines, of uncertain benefit, might be helpful in this population.
Identifiants
pubmed: 33465141
doi: 10.1371/journal.pone.0245648
pii: PONE-D-20-22139
pmc: PMC7815158
doi:
Substances chimiques
Analgesics, Non-Narcotic
0
Antidepressive Agents
0
Diphosphonates
0
Factor Xa Inhibitors
0
Nitrates
0
Sodium Potassium Chloride Symporter Inhibitors
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0245648Subventions
Organisme : Medical Research Council
ID : G0500997
Pays : United Kingdom
Organisme : Medical Research Council
ID : MR/J50001X/1
Pays : United Kingdom
Organisme : Department of Health
ID : SPCR-2014-10043
Pays : United Kingdom
Organisme : Biotechnology and Biological Sciences Research Council
Pays : United Kingdom
Organisme : British Heart Foundation
Pays : United Kingdom
Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
Mech Ageing Dev. 2011 Oct;132(10):496-502
pubmed: 21864562
Lancet. 1971 Feb 27;1(7696):405-12
pubmed: 4100731
Aging Clin Exp Res. 2006 Apr;18(2):116-26
pubmed: 16702780
BMC Med. 2015 Apr 07;13:74
pubmed: 25889849
BMC Geriatr. 2007 Jun 26;7:14
pubmed: 17594470
Scand J Public Health. 2020 May;48(3):308-315
pubmed: 29199915
J Am Med Dir Assoc. 2016 Feb;17(2):168-72
pubmed: 26441359
Pharm World Sci. 2002 Apr;24(2):46-54
pubmed: 12061133
BMC Res Notes. 2014 Jun 05;7:340
pubmed: 24897943
PLoS One. 2014 Feb 07;9(2):e88016
pubmed: 24516578
BMJ. 2009 Dec 22;339:b4904
pubmed: 20028777
BMC Geriatr. 2018 May 16;18(1):118
pubmed: 29769020
Arch Gen Psychiatry. 2006 Jan;63(1):50-6
pubmed: 16389196
Am J Epidemiol. 2003 Jan 15;157(2):98-112
pubmed: 12522017
Biomed Res Int. 2016;2016:8745670
pubmed: 26885519
Br J Clin Pharmacol. 1998 Oct;46(4):403-7
pubmed: 9803990
Age Ageing. 2013 Jan;42(1):62-9
pubmed: 22910303
Intern Med J. 2017 Sep;47(9):1019-1025
pubmed: 28632340
Ann Pharmacother. 2001 Sep;35(9):1004-9
pubmed: 11573845
BMC Clin Pharmacol. 2010 Dec 02;10:16
pubmed: 21122160
Drugs Aging. 2009;26(6):493-503
pubmed: 19591524
PLoS One. 2014 Oct 10;9(10):e108370
pubmed: 25302500
BMC Geriatr. 2010 Sep 17;10:64
pubmed: 20849598
Pharmacol Rev. 2004 Jun;56(2):163-84
pubmed: 15169926
Pharmacoepidemiol Drug Saf. 2017 Feb;26(2):152-161
pubmed: 27790805
Arch Intern Med. 2006 Mar 27;166(6):605-9
pubmed: 16567597
Age Ageing. 2011 Nov;40(6):752-5
pubmed: 21937515
Drugs Aging. 2013 Sep;30(9):655-66
pubmed: 23749475
BMJ. 1995 Apr 8;310(6984):923-5
pubmed: 7719188
BMJ. 2007 Aug 11;335(7614):285-7
pubmed: 17690369
Clin Pharmacol Ther. 2012 Mar;91(3):521-8
pubmed: 22297385
Pharmacoepidemiol Drug Saf. 2011 May;20(5):488-96
pubmed: 21264988
J R Coll Physicians Lond. 1993 Apr;27(2):121-6
pubmed: 8501666
Aging Clin Exp Res. 2008 Apr;20(2):91-102
pubmed: 18431075
Clin Pharmacokinet. 2009;48(3):143-57
pubmed: 19385708
PLoS One. 2012;7(2):e31665
pubmed: 22355385
Age Ageing. 2012 Mar;41(2):218-24
pubmed: 22130561
BMJ Open. 2018 Jan 24;8(1):e019218
pubmed: 29371280
Age Ageing. 2018 Mar 01;47(2):261-268
pubmed: 29281041
Annu Rev Public Health. 1984;5:433-58
pubmed: 6372818
Am J Med. 2017 Aug;130(8):927-936.e9
pubmed: 28454668
Int J Epidemiol. 2015 Dec;44(6):1823-32
pubmed: 26082404
BMJ. 2004 Jul 3;329(7456):15-9
pubmed: 15231615
Lancet. 1991 Jun 8;337(8754):1387-93
pubmed: 1674771
J Health Soc Behav. 1985 Sep;26(3):156-82
pubmed: 3905939
Eur J Clin Pharmacol. 1997;53(1):7-11
pubmed: 9349923
N Z Med J. 2014 Jul 04;127(1397):13-29
pubmed: 24997698
N Engl J Med. 2011 Nov 24;365(21):2002-12
pubmed: 22111719
Arch Gerontol Geriatr. 2015 May-Jun;60(3):405-11
pubmed: 25747850
Bioinformatics. 2017 Sep 15;33(18):2938-2940
pubmed: 28645171
Drugs Aging. 2011 Dec 1;28(12):993-1005
pubmed: 22117097
J Am Med Dir Assoc. 2020 Feb;21(2):181-187
pubmed: 31926797
Expert Rev Clin Pharmacol. 2018 Sep;11(9):825-827
pubmed: 30092160
Handb Exp Pharmacol. 2012;(214):169-82
pubmed: 23027451
BMJ. 2005 Apr 30;330(7498):1007-11
pubmed: 15860828
J Clin Epidemiol. 2002 Aug;55(8):809-17
pubmed: 12384196
J Epidemiol Community Health. 1999 Oct;53(10):603-11
pubmed: 10616672