Polypharmacy associated with greater risk of mortality and hospitalizations in elderly

1. Polypharmacy was associated with a greater risk of mortality and hospitalizations at one and five years. 

Evidence Rating Level: 2 (Good)

Polypharmacy, commonly defined as the use of five or more medicines, has been associated with a greater risk of adverse drug reactions (ADRs), particularly among the older population. Studies on polypharmacy and its association with sociodemographic and clinical factors have been inconsistent. This retrospective cohort study thus aimed to determine the association of polypharmacy with mortality, hospitalization, ADRs, and falls among community-dwelling adults in the UK at one and five years. This study used a random sample of patients >75 years from the Clinical Practice Research Datalink (CPRD). In total, 977 patients were analyzed (mean [SD] age, 83 [5.5] years; 351 males [36%]) and polypharmacy was present in 457 (47%) patients. At one year and five years, adjusted hazard ratios [95% confidence intervals] indicated polypharmacy was positively associated with mortality (one year: 2.37 [1.40–3.90]; five years: 1.60 [1.30–2.00]) and hospitalization (one year: 2.47 [1.40–4.30]; five years: 1.49 [1.30–1.70]). Polypharmacy was not associated with falls or ADRs, and this was attributed to inadequate recordings of these events in the CPRD database. Adjusted odds ratio (OR) found mortality risk associated with polypharmacy to be higher in women than men (OR 1.89 vs 1.73), in participants aged 75–85 years than 86 years and above (OR 1.77 vs 1.73), in those with ≥ 6 Potentially Inappropriate Medicines (PIMs) than those with less (OR 1.79 vs 1.64), and in those with 3-6 morbidities than 1–2 morbidities (OR 3.55 vs 1.67) (p < 0.05 for all). Hospitalization risk associated with polypharmacy was higher in patients aged 86 years and above than 75–85 years group (OR 3.08 vs 1.69) and in those with ≥ 6 PIMs than in those with less (OR 2.35 vs 2.19) (p < 0.05 for both). Overall, this study found polypharmacy to be a risk factor for mortality and hospitalizations in the short and long term. Future studies are needed to confirm these results. 

Click to read the study in PLOSONE

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