Abstract
Objectives
To test the association between polypharmacy and 1-year change in physical and cognitive
function among nursing home (NH) residents.
Design
Longitudinal multicenter cohort study based on data from the Services and Health for
Elderly in Long TERm care (SHELTER) study.
Setting
NH in Europe (n = 50) and Israel (n = 7).
Participants
3234 NH older residents.
Measurements
Participants were assessed through the interRAI long-term care facility instrument.
Polypharmacy was defined as the concurrent use of 5 to 9 drugs and excessive polypharmacy
as the use of ≥10 drugs. Cognitive function was assessed through the Cognitive Performance
Scale (CPS). Functional status was evaluated through the Activities of Daily Living
(ADL) Hierarchy scale. The change in CPS and ADL score, based on repeated assessments,
was the outcome, and their association with polypharmacy was modeled via linear mixed
models. The interaction between polypharmacy and time was reported [beta and 95% confidence
intervals (95% CIs)].
Results
A total of 1630 (50%) residents presented with polypharmacy and 781 (24%) excessive
polypharmacy. After adjusting for potential confounders, residents on polypharmacy
(beta 0.10, 95% CI 0.01-0.20) and those on excessive polypharmacy (beta 0.13, 95%
CI 0.01-0.24) had a significantly higher decline in CPS score compared to those using
<5 drugs. No statistically (P > .05) significant change according to polypharmacy status was shown for ADL score.
Conclusions
Polypharmacy is highly prevalent among older NH residents and, over 1 year, it is
associated with worsening cognitive function but not functional decline.
Keywords
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References
- Nursing homes in 10 nations: A comparison between countries and settings.Age Ageing. 1997; 26: 3-12
- Frailty as a predictor of nursing home placement among community-dwelling older adults: A systematic review and meta-analysis.J Geriatr Phys Ther. 2018; 41: 42-48
- Polypharmacy in nursing home residents with severe cognitive impairment: Results from the SHELTER Study.Alzheimers Dement. 2013; 9: 587-593
- Prevalence and factors associated with polypharmacy in long-term care facilities: A systematic review.J Am Med Dir Assoc. 2015; 16: 535.e1-535.e12
- Association of polypharmacy with nutritional status, functional ability and cognitive capacity over a 3-year period in an elderly population.Pharmacoepidemiol Drug Saf. 2011; 20: 514-522
- Frailty, polypharmacy, and potentially inappropriate medications in old people: Findings in a representative sample of the French population.Eur J Clin Pharmacol. 2017; 73: 1165-1172
- Predicting adverse health outcomes in nursing homes: A 9-year longitudinal study and development of the FRAIL-Minimum Data Set (MDS) Quick Screening Tool.J Am Med Dir Assoc. 2015; 16: 1042-1047
- Polypharmacy and medication regimen complexity as risk factors for hospitalization among residents of long-term care facilities: A prospective cohort study.J Am Med Dir Assoc. 2016; 17: 1067.e1-1067.e6
- Clinical consequences of polypharmacy in elderly.Expert Opin Drug Saf. 2014; 13: 57-65
- Polypharmacy and mortality among nursing home residents with advanced cognitive impairment: Results from the SHELTER study.J Am Med Dir Assoc. 2013; 14: 450.e7-450.e12
- Potential workload in applying clinical practice guidelines for patients with chronic conditions and multimorbidity: A systematic analysis.BMJ Open. 2016; 6: e010119
- Associations between polypharmacy and cognitive and physical capability: A British birth cohort study.J Am Geriatr Soc. 2018; (Available at:)
- Assessment of nursing home residents in Europe: The Services and Health for Elderly in Long TERm care (SHELTER) study.BMC Health Serv Res. 2012; 12: 5
- ATC/DDD Index.(Available at:)https://www.whocc.no/atc_ddd_index/Date accessed: March 20, 2018
- MDS Cognitive Performance Scale.J Gerontol. 1994; 49: M174-M182
- Scaling ADLs within the MDS.J Gerontol A Biol Sci Med Sci. 1999; 54: M546-M553
- Association between polypharmacy and cognitive impairment in an elderly Japanese population residing in an urban community.Geriatr Gerontol Int. 2017; 17: 1286-1293
- Polypharmacy in nursing home in Europe: Results from the SHELTER Study.J Gerontol Ser A Biol Sci Med Sci. 2012; 67: 698-704
- Anticholinergic medication burden and 5-year risk of hospitalization and death in nursing home elderly residents with coronary artery disease.J Am Med Dir Assoc. 2016; 17: 1056-1059
- Role of anticholinergic burden in primary care patients with first cognitive complaints.Eur J Neurol. 2017; 24: 950-955
- Association between accelerated multimorbidity and age-related cognitive decline in Older Baltimore Longitudinal Study of Aging Participants without Dementia.J Am Geriatr Soc. 2016; 64: 965-972
- Medication use and functional status decline in older adults: a narrative review.Am J Geriatr Pharmacother. 2011; 9: 378-391
- Associations between Drug Burden Index and physical function in older people in residential aged care facilities.Age Ageing. 2010; 39: 503-507
Article info
Publication history
Published online: May 31, 2018
Footnotes
D.L. Vetrano and E.R. Villani contributed equally to the study.
The authors declare no conflicts of interest.
The SHELTER study was funded by the EU 7th Framework Programme (IGAMH-CRNS-10029-4). All researchers, including the co-authors, were independent from the funder, and the funding body did not play any role in the study design, in the collection, analysis, or interpretation of data, in manuscript preparation, or in the decision to submit the article for publication.
Identification
Copyright
© 2018 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
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- Isn't It Time We Stop Counting the Number of Drugs to Define Polypharmacy in This New Era of Deprescribing and What Related Outcomes Should Be Measured?Journal of the American Medical Directors AssociationVol. 19Issue 8
- PreviewIn this issue appears a paper titled “Association of Polypharmacy With 1-Year Trajectories of Cognitive and Physical Function in Nursing Home Residents: Results From a Multicentre European Study.” The authors defined polypharmacy by medication count as either 5 to 9 drugs or ≥10 drugs, with 0 to 4 drugs as the reference. They found a relationship between polypharmacy and decline in cognitive function as measured by the Cognitive Performance Scale but not with functional status decline as measured by the Activities of Daily Living (ADL) Hierarchy scale.
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