Polypharmacy and Potentially Inappropriate Medications in Adults ≥75 Years of Age by Dementia and Frailty Status: The ARIC Study.

Abstract

Objective: To estimate the prevalence of polypharmacy (concomitant use of ≥5 medications), hyperpolypharmacy (≥10 medications), and potentially inappropriate medication (PIM) use among older adults according to dementia and frailty status.

Patients and methods: Cross-sectional data (2016-2017) from 3912 participants aged 71 to 94 years (mean ± SD, 79.6±4.8 years; 59.2% female; 24.5% Black race) from the community-based Atherosclerosis Risk in Communities (ARIC) study were used. Dementia and mild cognitive impairment status was based on comprehensive neurocognitive assessment, informant interviews, and adjudication by an expert panel. Participants were classified as frail, prefrail, or robust according to the Fried frailty phenotype definition. Medication containers were brought to the clinic. The PIMs were defined using a modified version of the Beers Criteria.

Results: Polypharmacy, hyperpolypharmacy, and PIM use were prevalent in 67.1%, 18.8%, and 23.9% of participants, respectively, and 7.9% were classified as having dementia and 8.0% as frail. The demographic-adjusted relative risk ratio (95% CI) for participants with dementia vs normal cognition was 1.79 (1.27 to 2.51) for hyperpolypharmacy, and the odds ratio (95% CI) for PIM use was 1.58 (1.21 to 2.06). The relative risk ratios (95% CIs) for hyperpolypharmacy were 8.35 (5.57 to 12.54) for frail and 2.70 (2.14 to 3.41) for prefrail compared with robust.

Conclusion: Polypharmacy, hyperpolypharmacy, and PIM use were common in this community-based sample of adults approximately 80 years old. These patterns of use were even more common among participants with dementia and frailty, who are at elevated risk for adverse outcomes.