CHANGE-Rx: frailty, falls, polypharmacy, and inappropriate medication use in a Canadian cohort of people aged 65 years and older with HIV.

Abstract

Objective: To characterize the prevalence of polypharmacy, use of potentially inappropriate medications (PIMs), anticholinergic burden (ACB), and sedative burden and their association with the risk of frailty and falls in a Canadian cohort of older people with HIV.

Design: CHANGE-Rx is a cross-sectional analysis of baseline data from CHANGE-HIV, a prospective Canadian cohort of people with HIV aged 65 years and older.

Methods: Information on prescription, over-the-counter/natural-health product use, comorbidities, HIV-specific factors, frailty, and fall history were assessed at the baseline visit at cohort entry. Proportion of people with polypharmacy (≥5 non-antiretroviral drugs), severe polypharmacy (≥10 non-antiretroviral drugs), PIMs, ACB, and sedative burden were determined. Chi-square tests and multivariate regression analysis were used to assess the association between medication factors and the risk of frailty and falls.

Results: Four hundred forty participants were included: median age 69 years (range: 65-89), 16.4% were classified as frail, 20.7% experienced a fall (last 6 months), 53.8% had polypharmacy, 14.6% had severe polypharmacy, 49.3% had at least one 1 PIM. For prescribed comedications, 16.5 and 55.7% of participants had high ACB and sedative burden, respectively. The odds ratios (ORs) for frailty were 3.3, 2.6, and 2.9 among patients with high ACB, high sedative burden, and severe polypharmacy, respectively. The OR for falls were 1.9 and 1.8 for patients with high sedative burden and at least one PIM, respectively.

Conclusion: Polypharmacy, PIMs, and high ACB and sedative burden are common among older adults with HIV in Canada. It remains to be determined if interventions addressing polypharmacy/PIMs would reduce falls and frailty.