Doctor of Philosophy
Background: Polypharmacy has no consensus definition in the literature. Previously used definitions include those based on the number of medications and those based on unnecessary or inappropriate medication use. Polypharmacy has been associated with increased risk of disability and functional limitations that impair a person's ability to live independently. Older adults are a population of interest as they are at increased risk for both polypharmacy and functional impairments. Understanding the relationship between polypharmacy and functional impairment in older adults could help health care providers and policy makers to target an at-risk population for interventions.
To assess the relationship between the number of medications taken and functional status in community-dwelling older adults using a nationally representative dataset.
To assess the change in the relationship between the number of medications taken and functional status over time (2 years and 4 years).
To study confounders of the relationship between polypharmacy and functional status.
Methods: Data came from the Health and Retirement Study (HRS), collected in the following years: 2004, 2006 and 2008. The primary outcome was functional limitation as measured using the following validated tools: activities of daily living and instrumental activities of daily living (ADL and IADL). The exposure under study was polypharmacy status (no polypharmacy: <5 prescribed medications, and polypharmacy: ≥5 prescribed medications). Both cross-sectional and longitudinal models were used to examine different aspects of the relationship between polypharmacy and functional status.
Results: A total sample size of 1,545 was included in our study. The prevalence of polypharmacy was 35.9% at the beginning of the study. Polypharmacy status was significantly associated with functional decline in both the cross-sectional and longitudinal analyses after controlling for confounders. Self-reported health (SRH) and light exercise were associated with functional decline in all cross-sectional analyses. Age, arthritis, and SRH were also associated with functional decline in all longitudinal analyses. Other confounders were also associated with functional decline.
Conclusion: Polypharmacy, defined as the use of more than five prescribed medications is a significant risk factor for functional decline in community-dwelling older adults.
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Available for download on Wednesday, May 08, 2019