Evidence of association between the use of drugs and community-dwelling older people frailty

a cross-sectional study

Authors

Keywords:

Polypharmacy, Drug interactions, Potentially inappropriate medication list

Abstract

BACKGROUND: The scientific literature has shown that an association between polypharmacy and frailty exists. However, few studies have also considered drug interactions and the use of potentially inappropriate medications. OBJECTIVE: To evaluate the association between the use of drugs and frailty among community-dwelling older people. DESIGN AND SETTING: Cross-sectional study carried out among 580 older people in Uberaba (MG). METHODS: Data were collected at these older people’s homes using instruments validated in Brazil. Descriptive, bivariate and binary logistic regression analyses were performed (P < 0.05). RESULTS: Most of these individuals were classified as pre-frail (55.7%), while 13.1% were frail. It was found that 31.7% of them presented polypharmacy, 41.7% had drug interactions and 43.8% were using potentially inappropriate medications. In the initial model, polypharmacy (odds ratio, OR = 1.91; confidence interval, CI = 1.27-2.86) and use of potentially inappropriate medications (OR = 2.45; CI = 1.68-3.57) increased the chance that these older people would be pre-frail or frail. In the final adjusted model, use of potentially inappropriate drugs remained associated with the outcome (OR = 2.26; CI = 1.43-3.57). CONCLUSION: Use of potentially inappropriate medications was the independent variable that explained the occurrence of frailty in a representative sample of community-dwelling older adults.

Downloads

Download data is not yet available.

Author Biographies

Marcos Kaic Lopes Alves, Universidade de Brasília – Campus Darcy Ribeiro

BSc. Pharmacist, Universidade de Brasília – Campus Darcy Ribeiro (UnB), Brasília (DF) Brazil

Nayara Gomes Nunes Oliveira, Universidade de Brasília – Campus Darcy Ribeiro

PhD. Nurse, Universidade Federal do Triângulo Mineiro (UFTM), Uberaba (MG), Brazil

Maycon Sousa Pegorari, Universidade de Brasília – Campus Darcy Ribeiro

PhD. Physiotherapist and Adjunct Professor, Physiotherapy Course, Universidade Federal do Amapá (UNIFAP), Macapá (AP), Brazil.

Darlene Mara dos Santos Tavares, Universidade de Brasília – Campus Darcy Ribeiro

PhD. Nurse and Associate Professor, Department of Nursing Education and Community Health Nursing Undergraduate Program, Universidade Federal do Triângulo Mineiro (UFTM), Uberaba (MG), Brazil.

Maria Cristina Soares Rodrigues, Universidade de Brasília – Campus Darcy Ribeiro

PhD. Nurse and Pharmacist, Associate Professor, Universidade de Brasília – Campus Darcy Ribeiro (UnB). Brasília (DF), Brazil.

Alisson Fernandes Bolina, Universidade de Brasília – Campus Darcy Ribeiro

PhD. Nurse and Adjunct Professor, Universidade de Brasília – Campus Darcy Ribeiro (UnB), Brasília (DF), Brazil.

References

Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol. 2001;56(3):M146-56. PMID: 11253156; doi: 10.1093/gerona/56.3.M146.

Fabrício-Wehbe SC, Rodrigues RA, Haas VJ, et al. Association of frailty in hospitalized and institutionalized elderly in the community-dwelling. Rev Bras Enferm. 2016;69(4):691-6. PMID: 27508474; doi: 10.1590/0034-7167.2016690411i.

Rodrigues MCS, Oliveira CD. Drug-drug interactions and adverse drug reactions in polypharmacy among older adults: an integrative review. Rev Lat Am Enfermagem. 2016;24:e2800. PMID: 27598380; doi: 10.1590/1518-8345.1316.2800.

Davies EA, O’Mahony MS. Adverse drug reactions in special populations – the elderly. Br J Clin Pharmacol. 2015;80(4):796-807. PMID: 25619317; doi: 10.1111/bcp.12596.

Lana LD, Schneider RH. The frailty syndrome in elderly: a narrative review. Rev Bras Geriatr Gerontol. 2014;17(3):673-80. doi: 10.1590/1809-9823.2014.12162.

Pegorari MS, Tavares DMS. Fatores associados à síndrome de fragilidade em idosos residentes em área urbana. Rev Latino-Am Enfermagem. 2014;22(5):874-82. doi: 10.1590/0104-1169.0213.2493.

Morley JE, Vellas B, Van Kan GA, et al. Frailty consensus: a call to action. J Am Med Dir Assoc. 2013;14(6):392-7. PMID: 23764209; doi: 10.1016/j.jamda.2013.03.022.

Hovstadius B, Petersson G. Factors leading to excessive polypharmacy. Clin Geriatr Med. 2012;28(2):159-72. PMID: 22500536; doi: 10.1016/j.cger.2012.01.001.

Poudel A, Peel NM, Nissen LM, et al. Adverse Outcomes in Relation to Polypharmacy in Robust and Frail Older Hospital Patients. J Am Med Dir Assoc. 2016;17(8):767.e9-767.e13. PMID: 27373672; doi: 10.1016/j.jamda.2016.05.017.

Gnjidic D, Hilmer SN. Use of potentially inappropriate medications in the care of frail older people. Aging Health. 2010;6(6):705-16. doi: 10.2217/ahe.10.78.

Oates JA. The science of drug therapy. In: Brunton LL. Goodman & Gilman's The pharmacological basis of therapeutics. 11th ed. New York: McGraw-Hill; 2006. p. 77.

Oliveira MG, Amorim WW, Oliveira CRB, et al. Consenso brasileiro de medicamentos potencialmente inapropriados para idosos [Brazilian consensus of potentially inappropriate medication for elderly people]. Geriatr Gerontol Aging. 2016; 10(4): 168-181; doi: 10.5327/z2447-211520161600054.

Lavan AH, O’Mahony D, Gallagher P. STOPPFrail (Screening Tool of Older Persons’ Prescriptions in Frail adults with a limited life expectancy) criteria: application to a representative population awaiting long-term nursing care. Eur J Clin Pharmacol. 2019;75(5):723-31. PMID: 30685856; doi: 10.1007/s00228-019-02630-3.

Granas AG, Stendal Bakken M, Ruths S, Taxis K. Deprescribing for frail older people - Learning from the case of Mrs. Hansen. Res Social Adm Pharm. 2018;14(6):612-6. PMID: 28733142; doi: 10.1016/j.sapharm.2017.07.003.

Saum KU, Schöttker B, Meid AD, et al. Is Polypharmacy Associated with Frailty in Older People? Results from the ESTHER Cohort Study. J Am Geriatr Soc. 2016;65(2):e27-e32. PMID: 28024089; doi: 10.1111/jgs.14718.

Veronese N, Stubbs B, Noale M, et al. Polypharmacy is associated with higher frailty risk in older people: an 8-year longitudinal cohort study. J Am Med Dir Assoc. 2017;18(7):624-8. PMID: 28396180; doi: 10.1016/j.jamda.2017.02.009.

Woodford HJ, Fisher J. New horizons in deprescribing for older people. Age Ageing. 2019;48(6):768-75. PMID: 31595290; doi: 10.1093/ageing/afz109.

Brasil. Lei nº 10.741 de 01 de outubro de 2003. Dispõe sobre o Estatuto do Idoso e dá outras providências. Diário Oficial da União, Brasília. Available from: http://www.planalto.gov.br/ccivil_03/leis/2003/l10.741.htm Accessed in 2020 (Jul 2).

Bertolucci PHF, Brucki SMD, Campacci SR, et al. O Mini-Exame do Estado Mental em uma população geral: impacto da escolaridade [The Mini-Mental State Examination in an outpatient population: influence of literacy]. Arq Neuro-Psiquiatr. 1994;52(1):01-07. doi: 10.1590/S0004-282X1994000100001.

Tavares DMDS, Pelizaro PB, Pegorari MS, Paiva MM, Marchiori GF. Prevalência de morbidades autorreferidas e fatores associados entre idosos comunitários de Uberaba, Minas Gerais, Brasil [Prevalence of self-reported morbidities and associated factors among community-dwelling elderly in Uberaba, Minas Gerais, Brazil]. Cien Saude Colet. 2019;24(9):3305-3313. doi: 10.1590/1413-81232018249.31912017.

Batistoni SST, Neri AL, Cupertino APFB. Validade da escala de depressão do Center for Epidemiological Studies entre idosos brasileiros [Validity of the Center for Epidemiological Studies Depression Scale Among Brazilian Elderly]. Rev Saude Publica. 2007;41(4):598-605. PMID: 17589758; doi: 10.1590/S0034-89102007000400014.

Mazo GZ, Benedetti TRB. Adaptação do questionário internacional de atividade física para idosos [Adaptation of the international physical activity questionnaire for the elderly]. Rev Bras Cineantropom Desempenho Hum. 2010;12(6):480-4. doi: 10.1590/S1980-00372010000600013.

Pate RR, Pratt M, Blair SN, et al. Physical activity and public health. A recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA. 1995;273(5):402-7. PMID: 7823386; doi: 10.1001/jama.1995.03520290054029.

Micromedex Health care Series [Internet]. Greenwood Village: Thomson Reuters (Healthcare); 2011. Available from: https://www.micromedexsolutions.com/home/dispatch Accessed in 2020 (Jul 27).

Herr M, Sirven N, Grondin H, Pichetti S, Sermet C. Frailty, polypharmacy, and potentially inappropriate medications in old people: findings in a representative sample of the French population. Eur J Clin Pharmacol. 2017;73(9):1165-72. PMID: 28601963; doi: 10.1007/s00228-017-2276-5.

Yamada Y, Nanri H, Watanabe Y, et al. Prevalence of Frailty Assessed by Fried and Kihon Checklist Indexes in a Prospective Cohort Study: Design and Demographics of the Kyoto-Kameoka Longitudinal Study. J Am Med Dir Assoc. 2017;18(8):733.e7-733.e15. PMID: 28501417; doi: 10.1016/j.jamda.2017.02.022.

Gale CR, Cooper C, Sayer AA. Prevalence of frailty and disability: findings from the English Longitudinal Study of Ageing. Age Ageing. 2015;44(1):162-5. PMID: 25313241; doi: 10.1093/ageing/afu148.

Gobbens RJ, Van Assen MA, Luijkx KG, Wijnen-Sponselee MT, Schols JM. Determinants of Frailty. J Am Med Dir Assoc. 2010;11(5):356-64. PMID: 20511103; doi: 10.1016/j.jamda.2009.11.008.

Neves AQ, Silva AMC, Cabral JF, et al. Prevalence of and factors associated with frailty in elderly users of the Family Health Strategy. Rev Bras Geriatr Gerontol. 2018;21(6):680-90. doi: 10.1590/1981-22562018021.180043.

Carneiro JA, Ramos GC, Barbosa AT, et al. Prevalência e fatores associados à fragilidade em idosos não institucionalizados [Prevalence and factors associated with frailty in non-institutionalized older adults]. Rev. Bras. Enferm. 2016;69(3):435-42. PMID: 27355291; doi: https://doi.org/10.1590/0034-7167.2016690304i

Collard RM, Boter H, Schoevers RA, Oude Voshaar RC. Prevalence of frailty in community-dwelling older persons: a systematic review. J Am Geriatr Soc. 2012; 60(8):1487-92. PMID: 22881367; doi: 10.1111/j.1532-5415.2012.04054.x.

Hubbard RE, O’Mahony MS, Woodhouse KW. Medication prescribing in frail older people. Eur J Clin Pharmacol, 2013;69(3):319-26. PMID: 22965651; doi: 10.1007/s00228-012-1387-2.

Pagno AR, Gross CB, Gewehr DM, et al. A terapêutica medicamentosa, interações potenciais e iatrogenia como fatores relacionados à fragilidade em idosos [Drug therapy, potential interactions and iatrogenesis as factors related to frailty in the elderly]. Rev Bras Geriatr Gerontol. 2018;21(5):588-96. doi: 10.1590/1981-22562018021.180085.

Yuki A, Otsuka R, Tange C, et al. Polypharmacy is associated with frailty in Japanese community-dwelling older adults. Geriatr Gerontol Int. 2018;18(10):1497-500. PMID: 30168240; doi: 10.1111/ggi.13507.

Santiago LM, Mattos IE. Prevalência e fatores associados à fragilidade em idosos institucionalizados das regiões Sudeste e Centro-Oeste do Brasil [Prevalence and factors associated to frailty in institutionalized elderly of Southeastern and Middle-Western Brazil]. Rev Bras Geriatr Gerontol. 2014;17(2):327-37. doi: 10.1590/S1809-98232014000200010.

Muhlack DC, Hoppe LK, Stock C, et al. The associations of geriatric syndromes and other patient characteristics with the current and future use of potentially inappropriate medications in a large cohort study. Eur J Clin Pharmacol. 2018;74(12):1633-44. PMID: 30159676; doi: 10.1007/s00228-018-2534-1.

Cullinan S, O’Mahony D, O’Sullivan D, Byrne S. Use of a frailty index to identify potentially inappropriate prescribing and adverse drug reaction risks in older patients. Age Ageing. 2016;45(1):115-20. PMID: 26683048; doi: 10.1093/ageing/afv166.

Cassoni TC, Corona LP, Romano-Lieber NS, et al. Uso de medicamentos potencialmente inapropriados por idosos do Município de São Paulo, Brasil: Estudo SABE [Use of potentially inappropriate medication by the elderly in São Paulo, Brazil: SABE Study]. Cad. Saude Publica. 2014;30(8):1708-20. PMID: 25210910; doi: 10.1590/0102-311x00055613.

Bolina AF, Gomes NC, Marchiori GF, Pegorari MS, Tavares DMDS. Potentially inappropriate medication use and frailty phenotype among community-dwelling older adults: A population based study. J Clin Nurs. 2019;28(21-22):3914-22. PMID: 31240751; doi: 10.1111/jocn.14976.

Dent E, Lien C, Lim WS, et al. The Asia-Pacific clinical practice guidelines for the management of frailty [published correction appears in J Am Med Dir Assoc. 2018 Jan;19(1):94]. J Am Med Dir Assoc. 2018;18(7):564-75. PMID: 28648901; doi: 10.1016/j.jamda.2017.04.018.

Curtin D, Dukelow T, James K, et al. Deprescribing in multi-morbid older people with polypharmacy: agreement between STOPPFrail explicit criteria and gold standard deprescribing using 100 standardized clinical cases. Eur J Clin Pharmacol. 2019;75(1):427-32. PMID: 30421220; doi: 10.1007/s00228-018-2598-y

Lavan AH, Gallagher P, Parsons C, O’Mahony D. STOPPFrail (Screening Tool of Older Persons Prescriptions in Frail adults with limited life expectancy): consensus validation. Age Ageing. 2017;46(4):600-7. PMID: 28119312; doi: 10.1093/ageing/afx005.

Secoli SR. Polifarmácia: interações e reações adversas no uso de medicamentos por idosos [Polypharmacy: interaction and adverse reactions in the use of drugs by elderly people]. Rev Bras Enferm. 2010;63(1):136-40. PMID: 20339769; doi: 10.1590/S0034-71672010000100023.

Vieira RA, Guerra RO, Giacomin KC, et al. Prevalência de fragilidade e fatores associados em idosos comunitários de Belo Horizonte, Minas Gerais, Brasil: dados do estudo FIBRA. [Prevalence of frailty and associated factors in community-dwelling elderly in Belo Horizonte, Minas Gerais State, Brazil: data from the FIBRA study] [published correction appears in Cad Saude Publica. 2013 Nov;29(11):2357]. Cad Saude Publica. 2013;29(8):1631-43. PMID: 24005928; doi: 10.1590/0102-311X00126312.

Baldoni Ade O, Ayres LR, Martinez EZ, et al. Factors associated with potentially inappropriate medications use by the elderly according to Beers criteria 2003 and 2012. Int J Clin Pharm. 2014; 36(2):316-24. PMID: 24271923; doi: 10.1007/s11096-013-9880-y.

Buck MD, Atreja A, Brunker CP, et al. Potentially inappropriate medication prescribing in outpatient practices: prevalence and patient characteristics based on electronic health records. Am J Geriatr Pharmacother. 2009;7(2):84-92. PMID: 19447361; doi: 10.1016/j.amjopharm.2009.03.001.

Gallagher PF, Barry PJ, Ryan C, Hartigan I, O’Mahony D. Inappropriate prescribing in an acutely ill population of elderly patients as determined by Beers’ Criteria. Age Ageing, 2008;37(1):96-101. PMID: 17933759; doi: 10.1093/ageing/afm116.

Gallagher P, Lang PO, Cherubini A, et al. Prevalence of potentially inappropriate prescribing in an acutely ill population of older patients admitted to six European hospitals. Eur J Clin Pharmacol. 2011;67(11):1175-88. PMID: 21584788; doi: 10.1007/s00228-011-1061-0.

Gavilán ME, Morales Suárez-Varela MT, Hoyos Esteban JA, Pérez Suanes AM. Polimedicación y prescripción de fármacos inadecuados en pacientes ancianos inmovilizados que viven en la comunidad [Inappropriate multiple medication and prescribing of drugs in immobile elderly patients living in the community]. Aten Primaria. 2006;38(9):476-82. PMID: 17194349; doi: 10.1157/13095047.

Holguín-Hernández E, Orozco-Díaz JG. Medicación potencialmente inapropiada en ancianos en un hospital de primer nivel, Bogotá 2007 [Potentially inappropriate medication in elderly in a first level hospital, Bogota 2007]. Rev Salud Publica (Bogota). 2010;12(2):287-99. PMID: 21031239; doi: 10.1590/s0124-00642010000200012.

Oliveira MG, Amorim WW, de Jesus SR, Rodrigues VA, Passos LC. Factors associated with potentially inappropriate medication use by the elderly in the Brazilian primary care setting. Int J Clin Pharm. 2012;34(4):626-32. PMID: 22692715; doi: 10.1007/s11096-012-9656-9.

Blalock SJ, Byrd JE, Hansen RA, et al. Factors associated with potentially inappropriate drug utilization in a sample of rural community-dwelling older adults. Am J Geriatr Pharmacother. 2005;3(3):168-79. PMID: 16257819; doi: 10.1016/S1543-5946(05)80023-6

Rozenfeld S, Fonseca MJ, Acurcio FA. Drug utilization and polypharmacy among the elderly: a survey in Rio de Janeiro City, Brazil. Rev Panam Salud Publica, 2018;23(1):34-43. PMID: 18291071; doi: 10.1590/s1020-49892008000100005.

Lorenzo-López L, López-López R, Maseda A, et al. Changes in frailty status in a community-dwelling cohort of older adults: The VERISAÚDE study. Maturitas, 2019;119:54-60. PMID: 30502751; doi: 10.1016/j.maturitas.2018.11.006.

Downloads

Published

2020-12-03

How to Cite

1.
Alves MKL, Oliveira NGN, Pegorari MS, Tavares DM dos S, Rodrigues MCS, Bolina AF. Evidence of association between the use of drugs and community-dwelling older people frailty: a cross-sectional study. Sao Paulo Med J [Internet]. 2020 Dec. 3 [cited 2025 Oct. 16];138(6):465-74. Available from: https://periodicosapm.emnuvens.com.br/spmj/article/view/563

Issue

Section

Original Article