Sex-based differences in the association between loneliness and polypharmacy among older adults in Ontario, Canada.
loneliness
national health surveys
older adults
polypharmacy
Journal
Journal of the American Geriatrics Society
ISSN: 1532-5415
Titre abrégé: J Am Geriatr Soc
Pays: United States
ID NLM: 7503062
Informations de publication
Date de publication:
10 2023
10 2023
Historique:
revised:
05
05
2023
received:
15
09
2022
accepted:
20
05
2023
medline:
23
10
2023
pubmed:
20
6
2023
entrez:
20
6
2023
Statut:
ppublish
Résumé
Emerging evidence shows loneliness is associated with polypharmacy and high-risk medications in older adults. Despite notable sex-based differences in the prevalence in each of loneliness and polypharmacy, the role of sex in the relationship between loneliness and polypharmacy is unclear. We explored the relationship between loneliness and polypharmacy in older female and male respondents and described sex-related variations in prescribed medication subclasses. We performed a cross-sectional analysis of representative data from the Canadian Community Health Survey-Healthy Aging cycle (2008/2009) linked to health administrative databases in Ontario respondents aged 66 years and older. Loneliness was measured using the Three-Item Loneliness Scale, with respondents classified as not lonely, moderately lonely, or severely lonely. Polypharmacy was defined as five or more concurrently-prescribed medications. Sex-stratified multivariable logistic regression models with survey weights were used to assess the relationship between loneliness and polypharmacy. Among those with polypharmacy, we examined the distribution of prescribed medication subclasses and potentially inappropriate medications. Of the 2348 individuals included in this study, 54.6% were female respondents. The prevalence of polypharmacy was highest in those with severe loneliness both in female (no loneliness, 32.4%; moderate loneliness, 36.5%; severe loneliness, 44.1%) and male respondents (32.5%, 32.2%, and 42.5%). Severe loneliness was significantly associated with greater adjusted odds of polypharmacy in female respondents (OR = 1.59; 95% CI: 1.01-2.50) but this association was attenuated after adjustment in male respondents (OR = 1.00; 95% CI: 0.56-1.80). Among those with polypharmacy, antidepressants were more commonly prescribed in female respondents with severe loneliness (38.7% [95% CI: 27.3-50.0]) compared to those who were moderately lonely (17.7% [95% CI: 9.3-26.2]). Severe loneliness was independently associated with polypharmacy in older female but not male respondents. Clinicians should consider loneliness as an important risk factor in medication reviews and deprescribing efforts to minimize medication-related harms, particularly in older women.
Sections du résumé
BACKGROUND
Emerging evidence shows loneliness is associated with polypharmacy and high-risk medications in older adults. Despite notable sex-based differences in the prevalence in each of loneliness and polypharmacy, the role of sex in the relationship between loneliness and polypharmacy is unclear. We explored the relationship between loneliness and polypharmacy in older female and male respondents and described sex-related variations in prescribed medication subclasses.
METHODS
We performed a cross-sectional analysis of representative data from the Canadian Community Health Survey-Healthy Aging cycle (2008/2009) linked to health administrative databases in Ontario respondents aged 66 years and older. Loneliness was measured using the Three-Item Loneliness Scale, with respondents classified as not lonely, moderately lonely, or severely lonely. Polypharmacy was defined as five or more concurrently-prescribed medications. Sex-stratified multivariable logistic regression models with survey weights were used to assess the relationship between loneliness and polypharmacy. Among those with polypharmacy, we examined the distribution of prescribed medication subclasses and potentially inappropriate medications.
RESULTS
Of the 2348 individuals included in this study, 54.6% were female respondents. The prevalence of polypharmacy was highest in those with severe loneliness both in female (no loneliness, 32.4%; moderate loneliness, 36.5%; severe loneliness, 44.1%) and male respondents (32.5%, 32.2%, and 42.5%). Severe loneliness was significantly associated with greater adjusted odds of polypharmacy in female respondents (OR = 1.59; 95% CI: 1.01-2.50) but this association was attenuated after adjustment in male respondents (OR = 1.00; 95% CI: 0.56-1.80). Among those with polypharmacy, antidepressants were more commonly prescribed in female respondents with severe loneliness (38.7% [95% CI: 27.3-50.0]) compared to those who were moderately lonely (17.7% [95% CI: 9.3-26.2]).
CONCLUSIONS
Severe loneliness was independently associated with polypharmacy in older female but not male respondents. Clinicians should consider loneliness as an important risk factor in medication reviews and deprescribing efforts to minimize medication-related harms, particularly in older women.
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
3099-3109Subventions
Organisme : CIHR
ID : PJT162221
Pays : Canada
Informations de copyright
© 2023 The American Geriatrics Society.
Références
Blazer D. Social isolation and loneliness in older adults-a mental health/public health challenge. JAMA Psychiat. 2020;77(10):990-991.
Cacioppo JT, Cacioppo S. The growing problem of loneliness. Lancet. 2018;391(10119):426.
Victor CR, Yang K. The prevalence of loneliness among adults: a case study of the United Kingdom. J Psychol. 2012;146(1-2):85-104.
Bott NT, Sheckter CC, Milstein AS. Dementia care, women's health, and gender equity. JAMA Neurol. 2017;74(7):757-758.
Valtorta NK, Moore DC, Barron L, Stow D, Hanratty B. Older adults' social relationships and health care utilization: a systematic review. Am J Public Health. 2018;108(4):e1-e10.
Hawkley LC, Cacioppo JT. Loneliness and pathways to disease. Brain Behav Immun. 2003;17(1):98-105.
Jaremka LM, Fagundes CP, Glaser R, Bennett JM, Malarkey WB, Kiecolt-Glaser JK. Loneliness predicts pain, depression, and fatigue: understanding the role of immune dysregulation. Psychoneuroendocrinology. 2013;38(8):1310-1317.
Holt-Lunstad J, Smith TB, Baker M, Harris T, Stephenson D. Loneliness and social isolation as risk factors for mortality. Perspect Psychol Sci. 2015;10(2):227-237.
Molloy GJ, Mcgee HM, O'Neill D, Conroy RM. Loneliness and emergency and planned hospitalizations in a community sample of older adults. J Am Geriatr Soc. 2010;58(8):1538-1541.
Blalock SJ, Byrd JE, Hansen RA, et al. Factors associated with potentially inappropriate drug utilization in a sample of rural community-dwelling older adults. Am J Geriatr Pharmacother. 2005;3(3):168-179.
Magro L, Moretti U, Leone R. Epidemiology and characteristics of adverse drug reactions caused by drug-drug interactions. Expert Opin Drug Saf. 2012;11(1):83-94.
Khezrian M, Mcneil CJ, Murray AD, Myint PK. An overview of prevalence, determinants and health outcomes of polypharmacy. Ther Adv Drug Saf. 2020;11:204209862093374.
Drug Use Among Seniors in Canada. Canadian Institute for Health Information (online). 2016. Accessed July 10, 2022. https://www.cihi.ca/en/drug-use-among-seniors-in-canada
Kotwal AA, Steinman MA, Cenzer I, Smith AK. Use of high-risk medications among lonely older adults. JAMA Intern Med. 2021;181(11):1528-1530.
Vyas MV, Watt JA, Yu AYX, Straus SE, Kapral MK. The association between loneliness and medication use in older adults. Age Ageing. 2021;50(2):587-591.
Manteuffel M, Williams S, Chen W, Verbrugge RR, Pittman DG, Steinkellner A. Influence of patient sex and gender on medication use, adherence, and prescribing alignment with guidelines. J Womens Health (Larchmt). 2014;23(2):112-119.
Roe CM, Mcnamara AM, Motheral BR. Gender- and age-related prescription drug use patterns. Ann Pharmacother. 2002;36(1):30-39.
Maxwell CJ, Mondor L, Pefoyo Koné AJ, Hogan DB, Wodchis WP. Sex differences in multimorbidity and polypharmacy trends: a repeated cross-sectional study of older adults in Ontario, Canada. PLoS One. 2021;16(4):e0250567.
Licher S, Kieboom BCT, Visser LE, et al. Epidemiology of polypharmacy in the general population: 27-year prospective cohort study. J Am Med Dir Assoc. 2020;21(8):1177-1179.
Chamberlain SA, Savage R, Bronskill SE, et al. Examining the association between loneliness and emergency department visits using Canadian Longitudinal Study of Aging (CLSA) data: a retrospective cross-sectional study. BMC Geriatr. 2022;22(1):69.
Savage RD, Wu W, Li J, et al. Loneliness among older adults in the community during COVID-19: a cross-sectional survey in Canada. BMJ Open. 2021;11(4):e044517.
Dahlberg L, Andersson L, Mckee KJ, Lennartsson C. Predictors of loneliness among older women and men in Sweden: a national longitudinal study. Aging Ment Health. 2015;19(5):409-417.
Carr D, Bodnar-Deren S. In: Uhlenberg P, ed. International Handbook of Population Aging. Springer; 2009:705-728.
Borys S, Perlman D. Gender differences in loneliness. Pers Soc Psychol Bull. 1985;11(1):63-74.
Altemus M, Sarvaiya N, Neill EC. Sex differences in anxiety and depression clinical perspectives. Front Neuroendocrinol. 2014;35(3):320-330.
Suh S, Cho N, Zhang J. Sex differences in insomnia: from epidemiology and etiology to intervention. Curr Psychiatry Rep. 2018;20(9):69.
Canadian Community Health Survey-Healthy Aging (CCHS). Statistics Canada (online). Accessed July 11, 2022. https://www23.statcan.gc.ca/imdb/p2SV.pl?Function=getSurvey&SDDS=5146
Hughes ME, Waite LJ, Hawkley LC, Cacioppo JT. A short scale for measuring loneliness in large surveys. Res Aging. 2004;26(6):655-672.
Musich S, Wang SS, Hawkins K, Yeh CS. The impact of loneliness on quality of life and patient satisfaction among older, sicker adults. Gerontol Geriatr Med. 2015;1:2333721415582119.
Perissinotto CM, Stijacic Cenzer I, Covinsky KE. Loneliness in older persons: a predictor of functional decline and death. Arch Intern Med. 2012;172(14):1078-1083.
Holt-Lunstad J, Smith TB, Baker M, Harris T, Stephenson D. Loneliness and social isolation as risk factors for mortality: a meta-analytic review. Perspect Psychol Sci. 2015;10(2):227-237.
Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. What is polypharmacy? A systematic review of definitions. BMC Geriatr. 2017;17(1):230.
Bronskill SE, Gill SS, Paterson JM, Bell CM, Anderson GM, Rochon PA. Exploring variation in rates of polypharmacy across long term care homes. J Am Med Dir Assoc. 2012;13(3):309.e15-309.e21.
Cleveland CB. Classification and coding system of the American Hospital Formulary Service. Am J Health Syst Pharm. 1966;23(2):95-97.
American Geriatrics Society. 2019 Updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. 2019 American Geriatrics Society Beers Criteria® update expert panel. J Am Geriatr Soc. 2019;67(4):674-694.
Koné Pefoyo AJ, Bronskill SE, Gruneir A, et al. The increasing burden and complexity of multimorbidity. BMC Public Health. 2015;15(1):415.
Kone AP, Mondor L, Maxwell C, Kabir US, Rosella LC, Wodchis WP. Rising burden of multimorbidity and related socio-demographic factors: a repeated cross-sectional study of Ontarians. Can J Public Health. 2021;112(4):737-747.
Smith KJ, Victor C. The Association of Loneliness With Health and Social Care Utilization in Older Adults in the general population: a systematic review. Gerontologist. 2021;62:gnab117.
Rochon PA, Petrovic M, Cherubini A, et al. Polypharmacy, inappropriate prescribing, and deprescribing in older people: through a sex and gender lens. Lancet Healthy Longev. 2021;2(5):e290-e300.
Maarsingh OR, Henry Y, Van De Ven PM, Deeg DJ. Continuity of care in primary care and association with survival in older people: a 17-year prospective cohort study. Br J Gen Pract. 2016;66(649):e531-e539.
Tsuji-Hayashi Y, Fukuhara S, Green J, Kurokawa K. Use of prescribed drugs among older people in Japan: association with not having a regular physician. J Am Geriatr Soc. 1999;47(12):1425-1429.
Cheng S-H, Chen C-C. Effects of continuity of care on medication duplication among the elderly. Med Care. 2014;52(2):149-156.
Okamoto K, Tanaka Y. Gender differences in the relationship between social support and subjective health among elderly persons in Japan. Prev Med. 2004;38(3):318-322.
Wang H, Zhao E, Fleming J, et al. Is loneliness associated with increased health and social care utilisation in the oldest old? Findings from a population-based longitudinal study. BMJ Open. 2019;9(5):e024645.
Burns A, Leavey G, Ward M, O'Sullivan R. The impact of loneliness on healthcare use in older people: evidence from a nationally representative cohort. J Public Health. 2022;30:675-684.
Grami N, Tuazon JR, Kalia S, et al. Promoting healthy aging in older women: a call to action. J Am Geriatr Soc. 2022;70(3):928-931.
Canham SL. What's loneliness got to do with it? Older women who use benzodiazepines. Australas J Ageing. 2015;34(1):E7-E12.
Holt-Lunstad J, Perissinotto C. Social isolation and loneliness as medical issues. N Engl J Med. 2023;388(3):193-195.
Liu BC, Chi I. The moderating effect of medication review on polypharmacy and loneliness in older Chinese adults in primary care. J Am Geriatr Soc. 2013;61(2):290-292.
Measuring Loneliness: Guidance for Use of the National Indicators on Surveys. Office for National Statistics (online). Accessed May 1, 2023. https://www.ons.gov.uk/peoplepopulationandcommunity/wellbeing/methodologies/measuringlonelinessguidanceforuseofthenationalindicatorsonsurveys
Lam J, Vuolo M. Longitudinal associations between loneliness and prescription medication use. J Gerontol B Psychol Sci Soc Sci. 2023;78(4):730-735.
Ernst M, Niederer D, Werner AM, et al. Loneliness before and during the COVID-19 pandemic: a systematic review with meta-analysis. Am Psychol. 2022;77(5):660-677.
Raina P, Wolfson C, Griffith L, et al. A longitudinal analysis of the impact of the COVID-19 pandemic on the mental health of middle-aged and older adults from the Canadian Longitudinal Study on Aging. Nat Aging. 2021;1:1137-1147.
Commonwealth Fund Survey. Canadian Institute for Health Information (online). 2021. Accessed January 11, 2023. https://www.cihi.ca/en/commonwealth-fund-survey-2021