Polypharmacy Observed to Cause Frailty in Older Adults

Older adults taking 5 or more medications may be at an increased risk of become frail.

As individuals age, they typically develop chronic diseases that must be managed with prescription and over-the-counter drugs. However, a new study found that polypharmacy—taking 5 or more medications— can lead to frailty in older adults.

While medication use is meant to help a patient improve their health, polypharmacy can cause numerous adverse events that may lead to hospitalization in some cases. The investigators believe that polypharmacy-induced frailty results from drugs altering body functions, according to the study, which was published by the Journal of the American Geriatrics Society.

Frailty is a concern in the elderly population because it can cause an individual to become weak, have less endurance, and decrease function. Frailty is also linked to falls, disability, and even death in some cases.

Included in the study were 2000 participants involved with the ESTHER study, which examined how polypharmacy can affect frailty. The study began in 2000, and follow-ups were conducted after 2, 5, 8, and 11 years. All participants were aged 50 to 75 at baseline.

At the 8-year follow up, the investigators visited the participants’ homes to assess how many different kinds of medications they were taking. Patients were asked to disclose prescription and over-the-counter drugs they were being treated with.

Participants who were taking 0 to 4 medications were categorized as non-polypharmacy; those taking 5 to 9 were categorized as polypharmacy; and those taking 10 or more were categorized as hyper-polypharmacy.

Pharmacists then reviewed the medications, and excluded any treatments not known to elicit adverse events, according to the study.

Once patient characteristics were accounted for, the investigators found that individuals who were at risk of frailty or who were frail were more likely to be in the polypharmacy or hyper-polypharmacy group, compared with those who were not frail.

Participants taking between 5 and 9 medications were 1.5 times more likely to become frail within 3 years, compared with those who were categorized as non-polypharmacy, according to the study. Patients taking more than 10 medications were twice as likely to become frail during this time compared with non-polypharmacy patients.

The researchers said that reducing the volume of medications is a promising way to lessen the risk of frailty in elderly adults, but cutting back should only be done when clinically appropriate.

It is important that elderly adults and their caregivers understand how medications can interact with one another and cause harm, such as falls, delirium, or frailty.

Although primary care physicians are typically aware of the negative adverse events experienced, they cannot manage the patient properly if they do not know all of the prescription and over-the-counter drugs they take, according to the study.

It is increasingly important that physicians and pharmacists evaluate whether certain drugs should be changed or discontinued to prevent adverse events.

“In a perfect world, your physician would talk about your medications with a pharmacist and a geriatrician,” concluded study co-author Kai-Uwe Saum, PhD, MPH. “This might help to reduce avoidable multiple drug prescriptions and possibly also lessen medication-induced risks for frailty and other negative effects of unnecessary, avoidable polypharmacy.”