The association between polypharmacy, frailty and disability-free survival in community-dwelling healthy older individuals

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dc.contributor.authorEkram, A.R.M.S.
dc.contributor.authorWoods, R.L.
dc.contributor.authorRyan, J.
dc.contributor.authorEspinoza, S.E.
dc.contributor.authorGilmartin-Thomas, J.F.M.
dc.contributor.authorShah, R.C.
dc.contributor.authorMehta, R.
dc.contributor.authorKochar, B.
dc.contributor.authorLowthian, J.A.
dc.contributor.authorLockery, J.
dc.contributor.authorOrchard, S.
dc.contributor.authorNelson, M.
dc.contributor.authorFravel, M.A.
dc.contributor.authorLiew, D.
dc.contributor.authorErnst, M.E.
dc.date.issued2022
dc.description.abstractObjectives: Polypharmacy and frailty are two common geriatric conditions. In community-dwelling healthy older adults, we examined whether polypharmacy is associated with frailty and affects disability-free survival (DFS), assessed as a composite of death, dementia, or persistent physical disability. Methods: We included 19,114 participants (median age 74.0 years, IQR: 6.1 years) from ASPirin in Reducing Events in the Elderly (ASPREE) clinical trial. Frailty was assessed by a modified Fried phenotype and a deficit accumulation Frailty Index (FI). Polypharmacy was defined as concomitant use of five or more prescription medications. Multinomial logistic regression was used to examine the cross-sectional association between polypharmacy and frailty at base line, and Cox regression to determine the effect of polypharmacy and frailty on DFS over five years. Results: Individuals with polypharmacy (vs. <5 medications) were 55% more likely to be pre-frail (Relative Risk Ratio or RRR: 1.55; 95%Confidence Interval or CI:1.44, 1.68) and three times more likely to be frail (RRR: 3.34; 95%CI:2.64, 4.22) according to Fried phenotype. Frailty alone was associated with double risk of the composite outcome (Hazard ratio or HR: 2.16; 95%CI: 1.56, 2.99), but frail individuals using polypharmacy had a four-fold risk (HR: 4.24; 95%CI: 3.28, 5.47). Effect sizes were larger when frailty was assessed using the FI. Conclusion: Polypharmacy was significantly associated with pre-frailty and frailty at baseline. Polypharmacy- exposed frailty increased the risk of reducing disability-free survival among older adults. Addressing polypharmacy in older people could ameliorate the impact of frailty on individuals’ functional status, cognition and survival.
dc.description.statementofresponsibilityA R M Saifuddin Ekram, Robyn L. Woods, Joanne Ryan, Sara E. Espinoza, Julia F.M. Gilmartin-Thomas, Raj C. Shah, Raaj Mehta, Bharati Kochar, Judy A. Lowthian, Jessica Lockery, Suzanne Orchard, Mark Nelson, Michelle A. Fravel, Danny Liew, Michael E. Ernst
dc.identifier.citationArchives of Gerontology and Geriatrics, 2022; 101:104694-1-104694-9
dc.identifier.doi10.1016/j.archger.2022.104694
dc.identifier.issn0167-4943
dc.identifier.issn1872-6976
dc.identifier.orcidLiew, D. [0000-0002-0131-623X] [0000-0003-2064-181X]
dc.identifier.urihttps://hdl.handle.net/2440/135812
dc.language.isoen
dc.publisherElsevier BV
dc.relation.granthttp://purl.org/au-research/grants/nhmrc/334047
dc.relation.granthttp://purl.org/au-research/grants/nhmrc/1127060
dc.relation.granthttp://purl.org/au-research/grants/nhmrc/1135727
dc.relation.granthttp://purl.org/au-research/grants/nhmrc/1107476
dc.rights© 2022 Elsevier B.V. All rights reserved.
dc.source.urihttps://doi.org/10.1016/j.archger.2022.104694
dc.subjectASPREE
dc.subjectDisability-free survival
dc.subjectFrailty index
dc.subjectFried phenotype
dc.subjectPolypharmacy
dc.subject.meshHumans
dc.subject.meshPolypharmacy
dc.subject.meshGeriatric Assessment
dc.subject.meshCross-Sectional Studies
dc.subject.meshAged
dc.subject.meshFrail Elderly
dc.subject.meshIndependent Living
dc.subject.meshFrailty
dc.titleThe association between polypharmacy, frailty and disability-free survival in community-dwelling healthy older individuals
dc.typeJournal article
pubs.publication-statusPublished

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