Potentially inappropriate medication use is associated with increased risk of incident disability in healthy older adults

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dc.contributor.authorLockery, J.E.
dc.contributor.authorCollyer, T.A.
dc.contributor.authorWoods, R.L.
dc.contributor.authorOrchard, S.G.
dc.contributor.authorMurray, A.
dc.contributor.authorNelson, M.R.
dc.contributor.authorStocks, N.P.
dc.contributor.authorWolfe, R.
dc.contributor.authorMoran, C.
dc.contributor.authorErnst, M.E.
dc.contributor.authorASPREE Investigator Group,
dc.date.issued2023
dc.descriptionPublished August 2023
dc.description.abstractBACKGROUND: Efforts to minimize medication risks among older adults include avoidance of potentially inappropriate medications (PIMs). However, most PIMs research has focused on older people in aged or inpatient care, creating an evidence gap for community-dwelling older adults. To address this gap, we investigated the impact of PIMs use in the ASPirin in Reducing Events in the Elderly (ASPREE) clinical trial cohort. METHODS: Analysis included 19,114 community-dwelling ASPREE participants aged 70+ years (65+ if US minorities) without major cardiovascular disease, cognitive impairment, or significant physical disability. PIMs were defined according to a modified 2019 AGS Beers Criteria. Cox proportional-hazards regression models were used to estimate the association between baseline PIMs exposure and disability-free survival, death, incident dementia, disability, and hospitalization, with adjustment for sex, age, country, years of education, frailty, average gait speed, and comorbidities. RESULTS: At baseline, 7396 (39% of the total) participants were prescribed at least one PIM. Compared with those unexposed, participants on a PIM at baseline were at an increased risk of persistent physical disability (adjusted hazard ratio [HR] 1.47, 95% confidence interval [CI] 1.21, 1.80) and hospitalization (adjusted HR 1.26, 95% CI 1.20, 1.32), but had similar rates of disability-free survival (adjusted HR 1.02; 95% CI 0.93, 1.13) and death (adjusted HR 0.92, 95% CI 0.81, 1.05). These effects did not vary by polypharmacy status in interaction analyses. PIMs exposure was associated with higher risk of disability followed by hospitalization (adjusted HR 1.92, 95% CI 1.25, 2.96) as well as vice versa (adjusted HR 1.54, 95% CI 1.15, 2.05). PPIs, anti-psychotics and benzodiazepines, were associated with increased risk of disability. CONCLUSIONS: PIMs exposure is associated with subsequent increased risk of both incident disability and hospitalization. Increased risk of disability prior to hospitalization suggests that PIMs use may start the disability cascade in healthy older adults. Our findings emphasize the importance of caution when prescribing PIMs to older adults in otherwise good health.
dc.description.statementofresponsibilityJessica E. Lockery, Taya A. Collyer, Robyn L. Woods, Suzanne G. Orchard, Anne Murray, Mark R. Nelson, Nigel P. Stocks, Rory Wolfe, Chris Moran, Michael E. Ernst, on behalf of the ASPREE Investigator Group
dc.identifier.citationJournal of The American Geriatrics Society, 2023; 71(8):2495-2505
dc.identifier.doi10.1111/jgs.18353
dc.identifier.issn0002-8614
dc.identifier.issn1532-5415
dc.identifier.orcidStocks, N.P. [0000-0002-9018-0361]
dc.identifier.urihttps://hdl.handle.net/2440/138114
dc.language.isoen
dc.publisherWiley
dc.relation.granthttp://purl.org/au-research/grants/nhmrc/1127060
dc.relation.granthttp://purl.org/au-research/grants/nhmrc/334047
dc.rights© 2023 The Authors. Journal of the American Geriatrics Society published by Wiley Periodicals LLC on behalf of The American Geriatrics Society. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
dc.source.urihttps://doi.org/10.1111/jgs.18353
dc.subject2019 AGS Beers Criteria
dc.subjectdisablement process
dc.subjectdrug related
dc.subjecthospital related
dc.titlePotentially inappropriate medication use is associated with increased risk of incident disability in healthy older adults
dc.typeJournal article
pubs.publication-statusPublished

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