Abstract
OBJECTIVES: Polypharmacy may affect frailty, a common and costly condition among older adults. Frailty prevalence is elevated among racial/ethnic minorities and persons living in the US South, and research is needed to inform future pharmacologic interventions in these populations. Our aim was to quantify the prevalence of frailty and polypharmacy, and to estimate the association between polypharmacy and incident frailty. DESIGN: Prospective cohort study. SETTING: A community-based cohort study of adults residing in Johnston County, North Carolina. PARTICIPANTS: White and African American adults aged 50 to 95 years (n=1697). MEASUREMENTS: At each study visit, all prescription and over-the-counter medications were recorded. We calculated annual polypharmacy (5-9 medications) and excessive polypharmacy (≥10 medications) prevalence at the 2006-2010 visit (n = 1697) and operationalized the Fried frailty phenotype to describe prevalent and incident frailty at two consecutive visits (2006-2010 and 2013-2015). We estimated risk ratios (RRs) and 95% confidence intervals (CIs) for the association between polypharmacy and incident frailty using weighted log-binomial regression to account for measured confounding and attrition using inverse probability of treatment and attrition weights, respectively. RESULTS: At the 2006-2010 visit, 678 (41%) and 260 (16%) participants were exposed to polypharmacy and excessive polypharmacy, respectively. Overall, 353 (21%) participants and 180 (21%) participants were frail at the 2006-2010 and 2013-2015 visits, respectively. Frailty was more common among participants identifying as white, women, and having less educational attainment relative to those without these characteristics. Incident frailty at the 2013-2015 visit was 15% (mean follow-up = 5.5 years). Our results suggest that polypharmacy is positively associated with incident frailty (weighted RR = 1.4; 95% CI =.9-2.0), yet estimates are imprecise and should be interpreted with caution. CONCLUSION: Consistent with the current weight of evidence, our results suggest an association between polypharmacy and incident frailty. Prospective studies evaluating deprescribing interventions are needed to clarify whether reducing polypharmacy decreases frailty incidence. J Am Geriatr Soc 67:2482–2489, 2019.
| Original language | English |
|---|---|
| Pages (from-to) | 2482-2489 |
| Number of pages | 8 |
| Journal | Journal of the American Geriatrics Society |
| Volume | 67 |
| Issue number | 12 |
| DOIs | |
| State | Published - Dec 1 2019 |
Bibliographical note
Funding Information:This work was funded in part by the Centers for Disease Control and Prevention (CDC)/Association of Schools of Public Health cooperative agreements S043, S1734, and S3486, CDC U01DP003206, CDC U01DP006266, National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) Multipurpose Arthritis and Musculoskeletal Disease Center grant 5‐P60‐AR3070, and NIAMS Multidisciplinary Clinical Research Center grant 5‐P60‐AR49465‐03. Jennifer L. Lund receives salary support from R01 AG056479 from the National Institute on Aging (NIA). Priya Palta received salary support from K99 AG052830 from the NIA.
Funding Information:
We are very thankful to the participants and staff in the Johnston County Osteoarthritis Project for their efforts and dedication to the study. This work was funded in part by the Centers for Disease Control and Prevention (CDC)/Association of Schools of Public Health cooperative agreements S043, S1734, and S3486, CDC U01DP003206, CDC U01DP006266, National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) Multipurpose Arthritis and Musculoskeletal Disease Center grant 5-P60-AR3070, and NIAMS Multidisciplinary Clinical Research Center grant 5-P60-AR49465-03. Jennifer L. Lund receives salary support from R01 AG056479 from the National Institute on Aging (NIA). Priya Palta received salary support from K99 AG052830 from the NIA. Jennifer L. Lund's spouse is a full-time paid employee of GlaxoSmithKline. The authors have declared no conflicts of interest for this article. Conception and design: Shmuel, Lund, and Golightly. Development of methodology: Shmuel, Lund, Golightly, Palta, and Kucharska-Newton. Acquisition of subjects and/or data; Shmuel, Alvarez, Jordan, Nelson, and Golightly. Analysis and interpretation of data: All authors. Writing, review, and/or revision of manuscript: All authors. Administrative, technical, or material support (eg, constructing data sets, data cleaning): Shmuel, Alvarez, and Hsu. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
Publisher Copyright:
© 2019 The American Geriatrics Society
Keywords
- aging health
- cohort study
- epidemiology
- frailty
- polypharmacy
ASJC Scopus subject areas
- Geriatrics and Gerontology