The association between frailty and the risk of medication-related problems among community-dwelling older adults in Europe.

BACKGROUND Studies revealed unidirectional associations between frailty and medication-related problems (MRPs) among older adults. Less is known about the association between frailty and the risk of MRPs. We aimed to assess the bi-directional association between frailty and the risk of MRPs in community-dwelling older adults in five European countries. METHODS Participants were 1785 older adults in the population-based Urban Health Centres Europe project. Repeated assessments were collected at baseline and one-year follow-up, including frailty, the risk of MRPs, and covariates. Linear regression analyses were conducted to examine the unidirectional associations. A cross-lagged panel modeling was used to assess bi-directional associations. RESULTS The unidirectional association between frailty at baseline and the risk of MRPs at follow-up remained statistically significant after adjusting for covariates (β = 0.10, 95%CI:0.08, 0.13). The association between the risk of MRPs at baseline and frailty at follow-up shows similar trends. The bi-directional association was comparable with reported unidirectional associations, with a stronger effect from frailty at baseline to the risk of MRPs at follow-up than reversed path (Wald test for comparing lagged effects: p < 0.05). CONCLUSION This longitudinal study suggests that a cycle may exist where older adults with higher frailty levels are more likely to have a higher risk of MRPs, which in turn contributes to developing a higher level of frailty. Further research is needed to validate our findings and explore underlying pathways.

[1]  P. Gallagher,et al.  Frailty and Potentially Inappropriate Prescribing in Older People with Polypharmacy: A Bi-Directional Relationship? , 2022, Drugs & Aging.

[2]  Laurenz L. Meier,et al.  Effect size guidelines for cross-lagged effects. , 2022, Psychological methods.

[3]  I. Scott,et al.  Scoping Review of Studies Evaluating Frailty and Its Association with Medication Harm , 2022, Drugs & Aging.

[4]  H. Raat,et al.  Factors associated with physical, psychological and social frailty among community-dwelling older persons in Europe: a cross-sectional study of Urban Health Centres Europe (UHCE) , 2021, BMC Geriatrics.

[5]  N. Iihara,et al.  Effect of number of medications and use of potentially inappropriate medications on frailty among early-stage older outpatients , 2021, Journal of Pharmaceutical Health Care and Sciences.

[6]  Md. Asiful Islam,et al.  Prevalence of Drug-Related Problems and Complementary and Alternative Medicine Use in Malaysia: A Systematic Review and Meta-Analysis of 37,249 Older Adults , 2021, Pharmaceuticals.

[7]  M. Cesari.  How polypharmacy affects frailty , 2020, Expert review of clinical pharmacology.

[8]  L. Rodríguez-Mañas,et al.  Physical activity and exercise: Strategies to manage frailty , 2020, Redox biology.

[9]  D. Conen,et al.  Frailty to predict unplanned hospitalization, stroke, bleeding and death in atrial fibrillation. , 2020, European heart journal. Quality of care & clinical outcomes.

[10]  A. Murray,et al.  An overview of prevalence, determinants and health outcomes of polypharmacy , 2020, Therapeutic advances in drug safety.

[11]  P. Cawthon,et al.  Frailty Phenotype and Healthcare Costs and Utilization in Older Men , 2018, Journal of the American Geriatrics Society.

[12]  M. Pegorari,et al.  Potentially inappropriate medication use and frailty phenotype among community- dwelling older adults: a population-based study. , 2019, Journal of clinical nursing.

[13]  L. Fried,et al.  Frailty: implications for clinical practice and public health , 2019, The Lancet.

[14]  J. Woo,et al.  Management of frailty: opportunities, challenges, and future directions , 2019, The Lancet.

[15]  H. Raat,et al.  A coordinated preventive care approach for healthy ageing in five European cities: a mixed-methods study of process evaluation components. , 2019, Journal of advanced nursing.

[16]  Marcus Mund,et al.  Beyond the Cross-Lagged Panel Model: Next-generation statistical tools for analyzing interdependencies across the life course. , 2018, Advances in life course research.

[17]  H. Raat,et al.  The effectiveness of a coordinated preventive care approach for healthy ageing (UHCE) among older persons in five European cities: A pre-post controlled trial. , 2018, International journal of nursing studies.

[18]  M. Inzitari,et al.  The relationship between frailty and polypharmacy in older people: A systematic review , 2018, British journal of clinical pharmacology.

[19]  F. Mair,et al.  Frailty and pre-frailty in middle-aged and older adults and its association with multimorbidity and mortality: a prospective analysis of 493 737 UK Biobank participants , 2018, The Lancet. Public health.

[20]  M. Izquierdo,et al.  Relationship between frailty, polypharmacy, and underprescription in older adults living in nursing homes , 2018, European Journal of Clinical Pharmacology.

[21]  G. Kojima.  Frailty as a Predictor of Nursing Home Placement Among Community-Dwelling Older Adults: A Systematic Review and Meta-analysis , 2018, Journal of geriatric physical therapy.

[22]  R. Gobbens,et al.  Exploring the efficiency of the Tilburg Frailty Indicator: a review , 2017, Clinical interventions in aging.

[23]  C. Bell,et al.  Frailty and Potentially Inappropriate Medication Use at Nursing Home Transition , 2017, Journal of the American Geriatrics Society.

[24]  H. Raat,et al.  Evaluation design of Urban Health Centres Europe (UHCE): preventive integrated health and social care for community-dwelling older persons in five European cities , 2017, BMC Geriatrics.

[25]  A. Pilotto,et al.  Polypharmacy Is Associated With Higher Frailty Risk in Older People: An 8-Year Longitudinal Cohort Study. , 2017, Journal of the American Medical Directors Association.

[26]  A. Steffen,et al.  Validating the Medication Risk Questionnaire with Family Caregivers of Older Adults. , 2016, The Consultant pharmacist : the journal of the American Society of Consultant Pharmacists.

[27]  R. Yu,et al.  Frailty Screening in the Community Using the FRAIL Scale. , 2015, Journal of the American Medical Directors Association.

[28]  B. Guthrie,et al.  Drug-disease and drug-drug interactions: systematic examination of recommendations in 12 UK national clinical guidelines , 2015, BMJ : British Medical Journal.

[29]  Ellen L Hamaker,et al.  A critique of the cross-lagged panel model. , 2015, Psychological methods.

[30]  Joseph Hanlon,et al.  Clinical consequences of polypharmacy in elderly , 2014, Expert opinion on drug safety.

[31]  M. Castell,et al.  Frailty prevalence and slow walking speed in persons age 65 and older: implications for primary care , 2013, BMC Family Practice.

[32]  S. Iliffe,et al.  Frailty in elderly people , 2013, The Lancet.

[33]  A. Calderón-Larrañaga,et al.  Multimorbidity, polypharmacy, referrals, and adverse drug events: are we doing things well? , 2012, The British journal of general practice : the journal of the Royal College of General Practitioners.

[34]  Luigi Ferrucci,et al.  Development and validation of criteria for determining undernutrition in community-dwelling older men and women: The Short Nutritional Assessment Questionnaire 65+. , 2012, Clinical nutrition.

[35]  P. Myint,et al.  Healthier ageing , 2012, BMJ : British Medical Journal.

[36]  S. Hilmer,et al.  Potential Contribution of Medications to Frailty , 2012, Journal of the American Geriatrics Society.

[37]  L. Fratiglioni,et al.  Aging with multimorbidity: A systematic review of the literature , 2011, Ageing Research Reviews.

[38]  R. Sulkava,et al.  Association of polypharmacy with nutritional status, functional ability and cognitive capacity over a three‐year period in an elderly population , 2011, Pharmacoepidemiology and drug safety.

[39]  Rose Anne Kenny,et al.  A Frailty Instrument for primary care: findings from the Survey of Health, Ageing and Retirement in Europe (SHARE) , 2010, BMC geriatrics.

[40]  Katrien G Luijkx,et al.  The Tilburg Frailty Indicator: psychometric properties. , 2010, Journal of the American Medical Directors Association.

[41]  J. Spagnoli,et al.  Prevalence of frailty in middle-aged and older community-dwelling Europeans living in 10 countries. , 2009, The journals of gerontology. Series A, Biological sciences and medical sciences.

[42]  M. Tinetti,et al.  The Relationship Between Number of Medications and Weight Loss or Impaired Balance in Older Adults , 2004, Journal of the American Geriatrics Society.

[43]  Hedva Barenholtz Levy.  Self-administered medication-risk questionnaire in an elderly population. , 2003, The Annals of pharmacotherapy.

[44]  M. Afilalo,et al.  Polypharmacy, adverse drug-related events, and potential adverse drug interactions in elderly patients presenting to an emergency department. , 2001, Annals of emergency medicine.

[45]  K. Kaback,et al.  Medication-Related Visits to the Emergency Department: A Prospective Study , 1999, The Annals of pharmacotherapy.

[46]  D. Kivlahan,et al.  The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol Use Disorders Identification Test. , 1998, Archives of internal medicine.

[47]  G P Samsa,et al.  Adverse Drug Events In High Risk Older Outpatients , 1997, Journal of the American Geriatrics Society.