Frailty, Polypharmacy, and Health Outcomes in Older Adults: The Frailty and Dependence in Albacete Study

Abstract

Background/objectives: To investigate if polypharmacy modifies the association between frailty and health outcomes in older adults.

Design: Ongoing cohort study.

Setting: Albacete City, Spain.

Participants: A total for 773 participants, 457 women (59.1%), over age 70 years from the FRADEA Study.

Measurements: Frailty phenotype, polypharmacy considered as the chronic use of 5 or more drugs, and comorbidity were collected at the baseline visit. Participants were categorized in 6 groups according to frailty and polypharmacy, and were followed up for 5.5 years (mean 1057 days, range 1-2007). Mortality or incident disability in basic activities of daily living was considered the main outcome variable. Hospitalization and visits to the emergency department were also recorded. The adjusted association between combined frailty status and polypharmacy with outcome variables was analyzed.

Results: The mean age of study population was 78.5 years. In this population, we identified a 15.3% (n = 118) of frail with polypharmacy, 3.4% (n = 26) of frail without polypharmacy, 35.3% (n = 273) of prefrail with polypharmacy, 20.3% (n = 157) of prefrail without polypharmacy, 10.3% (n = 80) of nonfrail with polypharmacy, and 15.4% (n = 119) of nonfrail participants without polypharmacy. Participants with frailty and polypharmacy had a higher adjusted risk of mortality or incident disability [odds ratio (OR) 5.3; 95% confidence interval (CI) 2.3-12.5] and hospitalization (OR 2.3; 95% CI 1.2-4.4), compared with those without frailty and polypharmacy. Frail and prefrail participants with polypharmacy had a higher adjusted mortality risk compared with the nonfrail without polypharmacy, hazard ratio 5.8 (95% CI 1.9-17.5) and hazard ratio 3.1 (95% CI 1.1-9.1), respectively.

Conclusions: Polypharmacy is associated with mortality, incident disability, hospitalization, and emergency department visits in frail and prefrail older adults, but not in nonfrail adults. Polypharmacy should be monitored in these patient subgroups to optimize health outcomes.

Keywords: Frailty; disability; mortality; older adults; polypharmacy.