Journal article
Potentially inappropriate medication use is associated with increased risk of incident disability in healthy older adults
Journal of the American Geriatrics Society (JAGS), Vol.71(8), pp.2495-2505
08/2023
DOI: 10.1111/jgs.18353
PMCID: PMC10524300
PMID: 37039393
Abstract
Efforts to minimize medication risks among older adults include avoidance of potentially inappropriate medications (PIMs). However, most PIMs research has focused on older people in aged or inpatient care, creating an evidence gap for community-dwelling older adults. To address this gap, we investigated the impact of PIMs use in the ASPirin in Reducing Events in the Elderly (ASPREE) clinical trial cohort.
Analysis included 19,114 community-dwelling ASPREE participants aged 70+ years (65+ if US minorities) without major cardiovascular disease, cognitive impairment, or significant physical disability. PIMs were defined according to a modified 2019 AGS Beers Criteria. Cox proportional-hazards regression models were used to estimate the association between baseline PIMs exposure and disability-free survival, death, incident dementia, disability, and hospitalization, with adjustment for sex, age, country, years of education, frailty, average gait speed, and comorbidities.
At baseline, 7396 (39% of the total) participants were prescribed at least one PIM. Compared with those unexposed, participants on a PIM at baseline were at an increased risk of persistent physical disability (adjusted hazard ratio [HR] 1.47, 95% confidence interval [CI] 1.21, 1.80) and hospitalization (adjusted HR 1.26, 95% CI 1.20, 1.32), but had similar rates of disability-free survival (adjusted HR 1.02; 95% CI 0.93, 1.13) and death (adjusted HR 0.92, 95% CI 0.81, 1.05). These effects did not vary by polypharmacy status in interaction analyses. PIMs exposure was associated with higher risk of disability followed by hospitalization (adjusted HR 1.92, 95% CI 1.25, 2.96) as well as vice versa (adjusted HR 1.54, 95% CI 1.15, 2.05). PPIs, anti-psychotics and benzodiazepines, were associated with increased risk of disability.
PIMs exposure is associated with subsequent increased risk of both incident disability and hospitalization. Increased risk of disability prior to hospitalization suggests that PIMs use may start the disability cascade in healthy older adults. Our findings emphasize the importance of caution when prescribing PIMs to older adults in otherwise good health.
Details
- Title: Subtitle
- Potentially inappropriate medication use is associated with increased risk of incident disability in healthy older adults
- Creators
- Jessica E Lockery - Monash UniversityTaya A Collyer - Monash UniversityRobyn L Woods - Monash UniversitySuzanne G Orchard - Monash UniversityAnne Murray - University of MinnesotaMark R Nelson - University of TasmaniaNigel P Stocks - The University of AdelaideRory Wolfe - Monash UniversityChris Moran - Monash UniversityMichael E Ernst - University of IowaASPREE Investigator Group
- Resource Type
- Journal article
- Publication Details
- Journal of the American Geriatrics Society (JAGS), Vol.71(8), pp.2495-2505
- DOI
- 10.1111/jgs.18353
- PMID
- 37039393
- PMCID
- PMC10524300
- NLM abbreviation
- J Am Geriatr Soc
- eISSN
- 1532-5415
- Grant note
- Australian-American Fulbright Commission U01AG029824 / NIA NIH HHS Victorian Cancer Agency 334047 / National Health and Medical Research Council Monash University 1127060 / National Health and Medical Research Council
- Language
- English
- Electronic publication date
- 04/11/2023
- Date published
- 08/2023
- Academic Unit
- Family and Community Medicine; Pharmacy Practice and Science
- Record Identifier
- 9984388652502771
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