Polypharmacy, comorbidity and frailty: a complex interplay in older patients at the emergency department
Key summary points Aim To investigate the association of polypharmacy with adverse health outcomes, in relation to comorbidity and frailty. Findings Excessive polypharmacy (≥ 10 medications) is highly prevalent in older adults at the emergency department and associated with falls, mortality and read...
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| Published in: | European geriatric medicine Vol. 13; no. 4; pp. 849 - 857 |
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| Main Authors: | , , , , , , , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
Cham
Springer International Publishing
01-08-2022
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| Subjects: | |
| Online Access: | Get full text |
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| Summary: | Key summary points
Aim
To investigate the association of polypharmacy with adverse health outcomes, in relation to comorbidity and frailty.
Findings
Excessive polypharmacy (≥ 10 medications) is highly prevalent in older adults at the emergency department and associated with falls, mortality and readmission. Frailty and comorbidity partly drive the association of polypharmacy with adverse health outcomes.
Message
Trials that target polypharmacy and inappropriate prescribing are needed to answer the lingering question of causality in the observed polypharmacy–mortality association and to evaluate whether medication review improves health outcomes in older patients at the ED.
Purpose
Older adults at the emergency department (ED) with polypharmacy, comorbidity, and frailty are at risk of adverse health outcomes. We investigated the association of polypharmacy with adverse health outcomes, in relation to comorbidity and frailty.
Methods
This is a prospective cohort study in ED patients ≥ 70 years. Non-polypharmacy was defined as 0–4 medications, polypharmacy 5–9 and excessive polypharmacy ≥ 10. Comorbidity was classified by the Charlson comorbidity index (CCI). Frailty was defined by the Identification of Seniors At Risk—Hospitalized Patients (ISAR-HP) score. The primary outcome was 3-month mortality. Secondary outcomes were readmission to an ED/hospital ward and a self-reported fall < 3 months. The association between polypharmacy, comorbidity and frailty was analyzed by logistic regression.
Results
881 patients were included. 43% had polypharmacy and 18% had excessive polypharmacy. After 3 months, 9% died, 30% were readmitted, and 21% reported a fall. Compared with non-polypharmacy, the odds ratio (OR) for mortality ranged from 2.62 (95% CI 1.39–4.93) in patients with polypharmacy to 3.92 (95% CI 1.95–7.90) in excessive polypharmacy. The OR weakened after adjustment for comorbidity: 1.80 (95% CI 0.92–3.52) and 2.32 (95% CI 1.10–4.90). After adjusting for frailty, the OR weakened to 2.10 (95% CI 1.10–4.00) and OR 2.40 (95% CI 1.15–5.02). No significant association was found for readmission or self-reported fall.
Conclusions
Polypharmacy is common in older patients at the ED. Polypharmacy, and especially excessive polypharmacy, is associated with an increased risk of mortality. The observed association is complex given the confounding effect of comorbidity and frailty. |
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| Bibliography: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
| ISSN: | 1878-7657 1878-7649 1878-7657 |
| DOI: | 10.1007/s41999-022-00664-y |