Abstract
Objectives
Existing studies cannot evaluate the time-varying properties of frailty and polypharmacy
despite raising concerns about their combined effects in older individuals.
This study investigated the longitudinal association between different combined statuses
of frailty and polypharmacy on risks of adverse outcomes.
Design
Retrospective cohort study.
Setting and Participants
Subjects aged between 65 and 100 years (n = 100,000) were identified from Taiwan's
National Health Insurance Research Database.
Measures
Frailty was categorized into fit, mild, moderate, and severe frailty based on the
multimorbidity frailty index. Concomitant use of 5 to 9 and ≥10 chronic medications
was considered polypharmacy and excessive polypharmacy. We used generalized estimating
equation models to examine the association among 12 groups of combined effects of
frailty and polypharmacy and risks of all-cause mortality, all-cause hospitalization,
and unplanned hospitalization. Age-stratified analyses were conducted for those aged
65 to 74, 75 to 84, and 85+ years.
Results
Compared with fit without polypharmacy, severe frailty with excess polypharmacy was
associated with increased risks of adverse outcomes, particularly unplanned hospitalization
(adjusted relative risk (aRR): 20.01 [95% confidence interval (CI)] 19.30–20.75).
However, the combined effects varied in distinct groups. Within each polypharmacy
category, there were dose-response associations between frailty category and adverse
outcomes. For instance, within the polypharmacy group, the aRRs of mortality were
1.58 (1.52–1.64), 2.70 (2.60–2.80), 4.62 (4.44–4.82), and 6.81 (6.50–7.13) for the
fit and mild, moderate, and severe frailty groups, respectively. By contrast, within
each frailty category, the dose-response association between polypharmacy and adverse
outcomes was limited to fit and mildly frail people. Age-stratified analyses yielded
similar results.
Conclusions and Relevance
Both frailty and polypharmacy modified the risks of mortality and hospital admissions
in older people, but the combined effects varied in distinct groups. This study thus
highlights the potential to optimize care of older people by capturing the dynamic
and combined changes related to frailty and polypharmacy.
Keywords
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Article info
Publication history
Published online: August 29, 2020
Footnotes
The authors declare no conflicts of interest.
F.Y. Hsiao, L.K. Chen, Y.Z. Chen, and S.T. Huang received research assistantships from a research project (MOST 107–2634-F-010–001, MOST 108–2634-F-010–001 and MOST 109–2634-F-010–001) sponsored by the Ministry of Science and Technology, Taiwan.
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© 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
