Abstract
Objectives
High-risk prescribing can have deleterious effects on the health of older people.
This study aimed to assess the role of inappropriate prescribing on changes in frailty
status over 3 years of follow-up.
Design, setting
This is a prospective observational study nested in the GAZEL cohort.
Participants
The study sample included 12,405 community-dwelling people aged 58 to 73 in 2012,
and followed for 3 years.
Measurement
Polypharmacy and potentially inappropriate medications (PIMs) were assessed from reimbursement
data by the French National Health Insurance. Frailty was evaluated each year with
the Strawbridge questionnaire. PIMs were defined according to the Laroche list plus
additional criteria dealing with inappropriate prolonged use of medications. The relationship
between PIMs and changes in frailty status (incident frailty and recovery) was analyzed
with Markov multistate modeling.
Results
The prevalence of frailty increased from 14% in 2012 to 17% in 2014, whereas the frequency
of PIMs was 29% in 2012 and 23% in 2014. Polypharmacy (5-9 drugs: aHR 1.31, 95% CI
1.14-1.50; and 10 drugs or more: aHR 1.57, 95% CI 1.28-1.92) and potentially inappropriate
use of nonsteroidal anti-inflammatory drugs (aHR 1.33, 95% CI 1.04-1.71) were significantly
associated with incident frailty, when the presence of at least 1 PIM presented a
small association with the risk of becoming frail (aHR 1.15, 95% CI 1.01-1.32).
Conclusions/Implications
This study brings new elements to our knowledge regarding the association between
inappropriate prescribing and frailty in older adults, which support research development
to alert on inappropriate prescribing and to improve drug prescribing among old people,
especially with polypharmacy.
Keywords
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Article info
Publication history
Published online: August 29, 2018
Footnotes
This study was funded by the Caisse Nationale d'Assurance Maladie des Travailleurs Salariés (CNAMTS).
The authors declare no conflicts of interest.
Identification
Copyright
© 2018 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
