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. 2022 Aug;13(4):849-857.
doi: 10.1007/s41999-022-00664-y. Epub 2022 Jun 20.

Polypharmacy, comorbidity and frailty: a complex interplay in older patients at the emergency department

Carmen S van Dam #  1 , Helena A Labuschagne #  2 , Kris van Keulen  3 , Cornelis Kramers  4 , Emma E Kleipool  2 , Emiel O Hoogendijk  5 , Wilma Knol  6 , Prabath W B Nanayakkara  7 , Majon Muller  2 , Marijke C Trappenburg  2   3 , Mike J L Peters  2   6
Affiliations

Polypharmacy, comorbidity and frailty: a complex interplay in older patients at the emergency department

Carmen S van Dam et al. Eur Geriatr Med. 2022 Aug.

Abstract

Purpose: Older adults at the emergency department (ED) with polypharmacy, comorbidity, and frailty are at risk of adverse health outcomes. We investigated the association of polypharmacy with adverse health outcomes, in relation to comorbidity and frailty.

Methods: This is a prospective cohort study in ED patients ≥ 70 years. Non-polypharmacy was defined as 0-4 medications, polypharmacy 5-9 and excessive polypharmacy ≥ 10. Comorbidity was classified by the Charlson comorbidity index (CCI). Frailty was defined by the Identification of Seniors At Risk-Hospitalized Patients (ISAR-HP) score. The primary outcome was 3-month mortality. Secondary outcomes were readmission to an ED/hospital ward and a self-reported fall < 3 months. The association between polypharmacy, comorbidity and frailty was analyzed by logistic regression.

Results: 881 patients were included. 43% had polypharmacy and 18% had excessive polypharmacy. After 3 months, 9% died, 30% were readmitted, and 21% reported a fall. Compared with non-polypharmacy, the odds ratio (OR) for mortality ranged from 2.62 (95% CI 1.39-4.93) in patients with polypharmacy to 3.92 (95% CI 1.95-7.90) in excessive polypharmacy. The OR weakened after adjustment for comorbidity: 1.80 (95% CI 0.92-3.52) and 2.32 (95% CI 1.10-4.90). After adjusting for frailty, the OR weakened to 2.10 (95% CI 1.10-4.00) and OR 2.40 (95% CI 1.15-5.02). No significant association was found for readmission or self-reported fall.

Conclusions: Polypharmacy is common in older patients at the ED. Polypharmacy, and especially excessive polypharmacy, is associated with an increased risk of mortality. The observed association is complex given the confounding effect of comorbidity and frailty.

Keywords: Comorbidity; Emergency department; Frailty; Older adults; Polypharmacy.

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Conflict of interest statement

The authors have no relevant financial or non-financial interests to disclose.

Figures

Fig. 1
Fig. 1
Flowchart study population. Numbers displayed as n (%)
Fig. 2
Fig. 2
Associations between polypharmacy and adverse outcomes at 3 months for mortality (panel A), readmission (panel B), fall (panel C) and additional odds per 1 medication (panel D). ISAR-HP identification of seniors at risk—hospitalized patients; CCI Charlson comorbidity index score
See this image and copyright information in PMC

References

    1. Woitok BK, Ravioli S, Funk GC, et al. Characteristics of very elderly patients in the emergency department—a retrospective analysis. Am J Emerg Med. 2020;46:200–203. doi: 10.1016/j.ajem.2020.07.012. - DOI - PubMed
    1. Masnoon N, Shakib S, Kalisch-Ellett L, et al. What is polypharmacy? A systematic review of definitions. BMC Geriatr. 2017;17(1):1–10. doi: 10.1186/s12877-017-0621-2. - DOI - PMC - PubMed
    1. Lemmens LC, Weda M (2013) Improving medication safety for the elderly; some bottlenecks (no. 0880027001/2013). RIVM brief rapport. https://www.rivm.nl/bibliotheek/rapporten/080027001.pdf. Accessed April 1, 2022
    1. 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. 2017;65(2):e27–32. doi: 10.1111/jgs.14718. - DOI - PubMed
    1. Wimmer BC, Cross AJ, Jokanovic N, et al. Clinical outcomes associated with medication regimen complexity in older people: a systematic review. J Am Geriatr Soc. 2017;65(4):747–753. doi: 10.1111/jgs.14682. - DOI - PubMed