Journal of the American Medical Directors Association
Original StudyAdverse Outcomes in Relation to Polypharmacy in Robust and Frail Older Hospital Patients
Section snippets
Study Sample and Setting
This was a secondary analysis of 3 cohorts of older patients (n = 1418), aged 70 and older, admitted to 11 acute care hospitals in Queensland and Victoria, Australia, between 2005 and 2010, for whom data were collected prospectively. Most (n = 1220) were admitted to general medical units, with 71 in orthopedic wards and 127 in surgical wards. The study sites were diverse, from small secondary care centers with 120 to 160 beds to major tertiary referral centers with more than 650 beds.
Results
Patients’ mean age was 81 (SD 6.8) years, and 55% were women. Before admission, 86% were living independently in the community and 36% were living alone. Sociodemographic and clinical characteristics of the study population by polypharmacy categories are shown in Table 1. Polypharmacy was observed in almost half of the study population (n = 684, 48.2%) and hyper-polypharmacy in 497 (35.0%) patients. Patients with severe cognitive impairment were significantly more likely to be in the
Discussion
In this large and well-characterized cohort of older inpatients, we found no significant association between polypharmacy and a range of clinically relevant adverse outcomes. Within each polypharmacy category, the incidence of adverse outcomes increased with increasing frailty, and the most robust patients taking 10 or more drugs had the lowest incidence compared with other polypharmacy/frailty categories.
Here, the only significant association between polypharmacy and an adverse outcome was an
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The Prevalence of Frailty Among Older Adults Living With Dementia: A Systematic Review
2022, Journal of the American Medical Directors AssociationThe prevalence of frailty and pre-frailty among geriatric hospital inpatients and its association with economic prosperity and healthcare expenditure: A systematic review and meta-analysis of 467,779 geriatric hospital inpatients
2022, Ageing Research ReviewsCitation Excerpt :Differences in the pooled prevalence estimates of frailty were also statistically significant between these alternative age group classifications based on the mean age of study samples (p < 0.001) (Supplementary Figure D). Fifty-three studies were included in pooled analysis of the prevalence of frailty stratified by ward type (Amblàs-Novellas et al., 2018; Andela et al., 2010; Baldwin et al., 2014; Bo et al., 2016; Cheung et al., 2017; Chew et al., 2017; Chia et al., 2016; Chong et al., 2017; Coleman et al., 2012; Dent et al., 2014; Dutzi et al., 2017; Eeles et al., 2012; Guidet et al., 2018; Gullón et al., 2018; Hartley et al., 2017; Heppenstall et al., 2011; Hewitt et al., 2015; Hewitt et al., 2016; Hii et al., 2014; Ibrahim et al., 2019; Induruwa et al., 2017; Jokar et al., 2016; Joosten et al., 2014; Joseph et al., 2014; Joseph et al., 2016; Juma et al., 2016; Karlekar et al., 2017; Khan et al., 2019; Kobe et al., 2016; Koyama et al., 2018; Lee et al., 2018; Le Maguet et al., 2014; Martín et al., 2018; Muessig et al., 2018; Müller et al., 2017; Myint et al., 2018; Nolan, Öztürk et al., 2016, 2017; Papageorgiou et al., 2018; Papakonstantinou et al., 2018; Pasqualetti et al., 2018; Peel et al., 2017; Pollack et al., 2017; Poudel et al., 2016; Purser et al., 2006; Ritt et al., 2015; Rose et al., 2014; Sánchez et al., 2011; Sanchis et al., 2015; Sündermann et al., 2014; Ticinesi et al., 2016; Vidán et al., 2014; Wou et al., 2013). Fifteen of the included studies were specifically conducted on geriatric wards (Amblàs-Novellas et al., 2018; Andela et al., 2010; Bo et al., 2016; Chew et al., 2017; Chong et al., 2017; Dent et al., 2014; Hartley et al., 2017; Joosten et al., 2014; Martín et al., 2018; Müller et al., 2017; Pasqualetti et al., 2018; Peel et al., 2017; Ritt et al., 2015; Ticinesi et al., 2016; Vidán et al., 2014); twelve on general internal medicine wards (Andela et al., 2010; Eeles et al., 2012; Gullón et al., 2018; Heppenstall et al., 2011; Induruwa et al., 2017; Juma et al., 2016; Koyama, Öztürk et al., 2018, 2017; Papakonstantinou et al., 2018; Peel et al., 2017; Rose et al., 2014; Vidán et al., 2014); seven acute wards (Amblàs-Novellas et al., 2018; Bo et al., 2016; Ibrahim et al., 2019; Joosten et al., 2014; Poudel et al., 2016; Ticinesi et al., 2016; Wou et al., 2013), seven cardiology wards (Hii et al., 2014; Kobe et al., 2016; Purser et al., 2006; Sánchez et al., 2011; Sanchis et al., 2015; Sündermann et al., 2014; Vidán et al., 2014); seven surgical wards (Andela et al., 2010; Cheung et al., 2017; Chia et al., 2016; Hewitt et al., 2015; Hewitt et al., 2016; Jokar et al., 2016; Myint et al., 2018); six intensive care wards (Baldwin et al., 2014; Guidet et al., 2018; Le Maguet et al., 2014; Muessig et al., 2018; Papageorgiou et al., 2018; Pollack et al., 2017); six traumatology wards (Andela et al., 2010; Joseph et al., 2014; Joseph et al., 2016; Karlekar et al., 2017; Khan et al., 2019; Lee et al., 2018); and, three on rehabilitation wards (Coleman et al., 2012; Dutzi et al., 2017; Nolan et al., 2016).
The association between polypharmacy, frailty and disability-free survival in community-dwelling healthy older individuals
2022, Archives of Gerontology and GeriatricsA pilot study to identify elderly patients with cognitive impairment for clinical pharmacist polypharmacy review in General Practice
2021, Exploratory Research in Clinical and Social PharmacyCombined Effects of Frailty and Polypharmacy on Health Outcomes in Older Adults: Frailty Outweighs Polypharmacy
2021, Journal of the American Medical Directors Association
The authors declare no conflicts of interest.