Association of polypharmacy and hyperpolypharmacy with frailty states: a systematic review and meta-analysis

On behalf of the European Geriatric Medicine Society Pharmacology special interest group

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Purpose: To investigate: (1) the cross-sectional association between polypharmacy, hyperpolypharmacy and presence of prefrailty or frailty; (2) the risk of incident prefrailty or frailty in persons with polypharmacy, and vice versa. Methods: A systematic review and meta-analysis was performed according to PRISMA guidelines. We searched PubMed, Web of Science, and Embase from 01/01/1998 to 5/2/2018. Pooled estimates were obtained through random effect models and Mantel–Haenszel weighting. Homogeneity was assessed with the I 2 statistic and publication bias with Egger’s and Begg’s tests. Results: Thirty-seven studies were included. The pooled proportion of polypharmacy in persons with prefrailty and frailty was 47% (95% CI 33–61) and 59% (95% CI 42–76), respectively. Increased odds ratio of polypharmacy were seen for prefrail (pooled OR = 1.52; 95% CI 1.32–1.79) and frail persons (pooled OR = 2.62, 95% CI 1.81–3.79). Hyperpolypharmacy was also increased in prefrail (OR = 1.95; 95% CI 1.41–2.70) and frail (OR = 6.57; 95% CI 9.57–10.48) persons compared to robust persons. Only seven longitudinal studies reported data on the risk of either incident prefrailty or frailty in persons with baseline polypharmacy. A significant higher odds of developing prefrailty was found in robust persons with polypharmacy (pooled OR = 1.30; 95% CI 1.12–1.51). We found no papers investigating polypharmacy incidence in persons with prefrailty/frailty. Conclusions: Polypharmacy is common in prefrail and frail persons, and these individuals are also more likely to be on extreme drug regimens, i.e. hyperpolypharmacy, than robust older persons. More research is needed to investigate the causal relationship between polypharmacy and frailty syndromes, thereby identifying ways to jointly reduce drug burden and prefrailty/frailty in these individuals. Prospero registration number: CRD42018104756.

Original languageEnglish
Pages (from-to)9-36
Number of pages28
JournalEuropean Geriatric Medicine
Volume10
Issue number1
DOIs
Publication statusPublished - Feb 15 2019

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Polypharmacy
Meta-Analysis
Publication Bias
PubMed
Pharmaceutical Preparations
Longitudinal Studies
Odds Ratio
Guidelines

Keywords

  • Ageing
  • Drugs
  • Frail
  • Hyperpolypharmacy
  • Medications
  • Polypharmacy
  • Prefrail

ASJC Scopus subject areas

  • Gerontology
  • Geriatrics and Gerontology

Cite this

Association of polypharmacy and hyperpolypharmacy with frailty states : a systematic review and meta-analysis. / On behalf of the European Geriatric Medicine Society Pharmacology special interest group.

In: European Geriatric Medicine, Vol. 10, No. 1, 15.02.2019, p. 9-36.

Research output: Contribution to journalArticle

On behalf of the European Geriatric Medicine Society Pharmacology special interest group 2019, 'Association of polypharmacy and hyperpolypharmacy with frailty states: a systematic review and meta-analysis', European Geriatric Medicine, vol. 10, no. 1, pp. 9-36. https://doi.org/10.1007/s41999-018-0124-5
On behalf of the European Geriatric Medicine Society Pharmacology special interest group. Association of polypharmacy and hyperpolypharmacy with frailty states: a systematic review and meta-analysis. European Geriatric Medicine. 2019 Feb 15;10(1):9-36. https://doi.org/10.1007/s41999-018-0124-5
On behalf of the European Geriatric Medicine Society Pharmacology special interest group. / Association of polypharmacy and hyperpolypharmacy with frailty states : a systematic review and meta-analysis. In: European Geriatric Medicine. 2019 ; Vol. 10, No. 1. pp. 9-36.
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AU - On behalf of the European Geriatric Medicine Society Pharmacology special interest group

AU - Palmer, Katie

AU - Villani, Emanuele R.

AU - Vetrano, Davide L.

AU - Cherubini, Antonio

AU - Cruz-Jentoft, Alfonso J.

AU - Curtin, Denis

AU - Denkinger, Michael

AU - Gutiérrez-Valencia, Marta

AU - Guðmundsson, Adalsteinn

AU - Knol, Wilma

AU - Mak, Diane V.

AU - O’Mahony, Denis

AU - Pazan, Farhad

AU - Petrovic, Mirko

AU - Rajkumar, Chakravarthi

AU - Topinkova, Eva

AU - Trevisan, Catarina

AU - van der Cammen, Tischa J.M.

AU - van Marum, Rob J.

AU - Wehling, Martin

AU - Ziere, Gijsbertus

AU - Bernabei, Roberto

AU - Onder, Graziano

PY - 2019/2/15

Y1 - 2019/2/15

N2 - Purpose: To investigate: (1) the cross-sectional association between polypharmacy, hyperpolypharmacy and presence of prefrailty or frailty; (2) the risk of incident prefrailty or frailty in persons with polypharmacy, and vice versa. Methods: A systematic review and meta-analysis was performed according to PRISMA guidelines. We searched PubMed, Web of Science, and Embase from 01/01/1998 to 5/2/2018. Pooled estimates were obtained through random effect models and Mantel–Haenszel weighting. Homogeneity was assessed with the I 2 statistic and publication bias with Egger’s and Begg’s tests. Results: Thirty-seven studies were included. The pooled proportion of polypharmacy in persons with prefrailty and frailty was 47% (95% CI 33–61) and 59% (95% CI 42–76), respectively. Increased odds ratio of polypharmacy were seen for prefrail (pooled OR = 1.52; 95% CI 1.32–1.79) and frail persons (pooled OR = 2.62, 95% CI 1.81–3.79). Hyperpolypharmacy was also increased in prefrail (OR = 1.95; 95% CI 1.41–2.70) and frail (OR = 6.57; 95% CI 9.57–10.48) persons compared to robust persons. Only seven longitudinal studies reported data on the risk of either incident prefrailty or frailty in persons with baseline polypharmacy. A significant higher odds of developing prefrailty was found in robust persons with polypharmacy (pooled OR = 1.30; 95% CI 1.12–1.51). We found no papers investigating polypharmacy incidence in persons with prefrailty/frailty. Conclusions: Polypharmacy is common in prefrail and frail persons, and these individuals are also more likely to be on extreme drug regimens, i.e. hyperpolypharmacy, than robust older persons. More research is needed to investigate the causal relationship between polypharmacy and frailty syndromes, thereby identifying ways to jointly reduce drug burden and prefrailty/frailty in these individuals. Prospero registration number: CRD42018104756.

AB - Purpose: To investigate: (1) the cross-sectional association between polypharmacy, hyperpolypharmacy and presence of prefrailty or frailty; (2) the risk of incident prefrailty or frailty in persons with polypharmacy, and vice versa. Methods: A systematic review and meta-analysis was performed according to PRISMA guidelines. We searched PubMed, Web of Science, and Embase from 01/01/1998 to 5/2/2018. Pooled estimates were obtained through random effect models and Mantel–Haenszel weighting. Homogeneity was assessed with the I 2 statistic and publication bias with Egger’s and Begg’s tests. Results: Thirty-seven studies were included. The pooled proportion of polypharmacy in persons with prefrailty and frailty was 47% (95% CI 33–61) and 59% (95% CI 42–76), respectively. Increased odds ratio of polypharmacy were seen for prefrail (pooled OR = 1.52; 95% CI 1.32–1.79) and frail persons (pooled OR = 2.62, 95% CI 1.81–3.79). Hyperpolypharmacy was also increased in prefrail (OR = 1.95; 95% CI 1.41–2.70) and frail (OR = 6.57; 95% CI 9.57–10.48) persons compared to robust persons. Only seven longitudinal studies reported data on the risk of either incident prefrailty or frailty in persons with baseline polypharmacy. A significant higher odds of developing prefrailty was found in robust persons with polypharmacy (pooled OR = 1.30; 95% CI 1.12–1.51). We found no papers investigating polypharmacy incidence in persons with prefrailty/frailty. Conclusions: Polypharmacy is common in prefrail and frail persons, and these individuals are also more likely to be on extreme drug regimens, i.e. hyperpolypharmacy, than robust older persons. More research is needed to investigate the causal relationship between polypharmacy and frailty syndromes, thereby identifying ways to jointly reduce drug burden and prefrailty/frailty in these individuals. Prospero registration number: CRD42018104756.

KW - Ageing

KW - Drugs

KW - Frail

KW - Hyperpolypharmacy

KW - Medications

KW - Polypharmacy

KW - Prefrail

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