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Frailty and potentially inappropriate medications using the 2019 Beers Criteria: findings from the Australian Longitudinal Study on Women’s Health (ALSWH)

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Abstract

Background

Frailty is an essential consideration with potentially inappropriate medications (PIMs), especially among older women.

Aims

This study determined the use of potentially inappropriate medications according to frailty status using the Beers Criteria 2019, identified medications that should be flagged as potentially inappropriate and harmful depending on individual health factors, and determined the association between frailty and PIMs, adjusted for characteristics associated with PIMs.

Methods

This prospective longitudinal study included 9355 participants aged 77–82 years at baseline (2003). Frailty was measured using the FRAIL (fatigue, resistance, ambulation, illness and loss of weight) scale. Generalised estimating equations using log-binomial regressions determined the association between frailty and risk of using PIMs.

Results

Among participants who were frail and non-frail at baseline, the majority used ≥ 3 PIMs (74.2% and 58.5%, respectively). At 2017, the proportion using ≥ 3 PIMs remained constant in the frail group (72.0%) but increased in the non-frail group (66.0%). Commonly prescribed medications that may be potentially inappropriate in both groups included benzodiazepines, proton-pump inhibitors and non-steroidal anti-inflammatory drugs, and risperidone was an additional contributor in the non-frail group. When adjusted for other characteristics, frail women had a 2% higher risk of using PIMs (RR 1.02; 95% CI 1.01, 1.03).

Conclusion

Given that the majority of frail women were using medications that may have been potentially inappropriate, it is important to consider both frailty and PIMs as indicators of health outcomes, and to review the need for PIMs for women aged 77–96 years who are frail.

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References

  1. Stockl KM, Le L, Zhang S et al (2010) Clinical and economic outcomes associated with potentially inappropriate prescribing in the elderly. Am J Manag Care 16:e1–10

    PubMed  Google Scholar 

  2. Perri M, Menon AM, Deshpande AD et al (2005) Adverse outcomes associated with inappropriate drug use in nursing homes. Ann Pharmacother 39:405–411. https://doi.org/10.1345/aph.1E230

    Article  PubMed  Google Scholar 

  3. American Geriatrics Society Beers Criteria® Update Expert Panel (2019) American Geriatrics Society 2019 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. J Am Geriatr Soc 67:674–694. https://doi.org/10.1111/jgs.15767

    Article  Google Scholar 

  4. Fick D (2001) Potentially inappropriate medication use in a Medicare managed care population: Association with higher costs and utilization. J Manag Care Pharm 7:407–413. https://doi.org/10.18553/jmcp.2001.7.5.407

    Article  Google Scholar 

  5. Gregory AT, Armstrong RM, Grassi TD et al (2008) On our selection: Australian longitudinal research studies. Med J Aust 189:650–657. https://doi.org/10.5694/j.1326-5377.2008.tb02230.x

    Article  PubMed  Google Scholar 

  6. Caruana EJ, Roman M, Hernández-Sánchez J et al (2015) Longitudinal studies. J Thorac Dis 7:E537–540. https://doi.org/10.3978/j.issn.2072-1439.2015.10.63

    Article  PubMed  PubMed Central  Google Scholar 

  7. Fried LP, Tangen CM, Walston J et al (2001) Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 56:M146–156. https://doi.org/10.1093/gerona/56.3.m146

    Article  CAS  Google Scholar 

  8. Maclagan LC, Maxwell CJ, Gandhi S et al (2017) Frailty and potentially inappropriate medication use at nursing home transition. J Am Geriatr Soc 65:2205–2212. https://doi.org/10.1111/jgs.15016

    Article  Google Scholar 

  9. Bolina AF, Gomes NC, Marchiori GF et al (2019) Potentially inappropriate medication use and frailty phenotype among community-dwelling older adults: a population-based study. J ClinNurs 28:3914–3922. https://doi.org/10.1111/jocn.14976

    Article  Google Scholar 

  10. Li G, Andrews HF, Chihuri S et al (2019) Prevalence of potentially inappropriate medication use in older drivers. BMC Geriatr 19:260. https://doi.org/10.1186/s12877-019-1287-8

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Alhawassi TM, Alatawi W, Alwhaibi M (2019) Prevalence of potentially inappropriate medications use among older adults and risk factors using the 2015 American Geriatrics Society Beers criteria. BMC Geriatr 19:154. https://doi.org/10.1186/s12877-019-1168-1

    Article  PubMed  PubMed Central  Google Scholar 

  12. Martinot P, Landré B, Zins M et al (2018) Association between potentially inappropriate medications and frailty in the early old age: a longitudinal study in the GAZEL cohort. J Am Med Dir Assoc 19:967–973.e3. https://doi.org/10.1016/j.jamda.2018.07.008

    Article  CAS  Google Scholar 

  13. Muhlack DC, Hoppe LK, Saum K-U et al (2020) Investigation of a possible association of potentially inappropriate medication for older adults and frailty in a prospective cohort study from Germany. Age Ageing 49:20–25. https://doi.org/10.1093/ageing/afz127

    Article  Google Scholar 

  14. Dobson AJ, Hockey R, Brown et al (2015) Cohort profile update: Australian longitudinal study on women’s health. Int J Epidemiol 44:1547a–1547f. https://doi.org/10.1093/ije/dyv110.

    Article  Google Scholar 

  15. Page E, Kemp-Casey A, Korda R, et al (2015) Using Australian Pharmaceutical Benefits Scheme data for pharmacoepidemiological research: challenges and approaches. Public Health Res Pract 25:e2541546. https://doi.org/10.17061/phrp2541546.

    Article  PubMed  Google Scholar 

  16. World Health Organization (2019) Anatomical therapeutic chemical (ATC) classification. http://www.who.int/medicines/regulation/medicines-safety/toolkit_atc/en/. Accessed 8 Sep 2020

  17. Lopez D, Flicker L, Dobson A (2012) Validation of the frail scale in a cohort of older Australian women. J Am GeriatrSoc 60(1):171–173. https://doi.org/10.1111/j.1532-5415.2011.03746.x

    Article  Google Scholar 

  18. Page AT, Falster MO, Litchfield M et al (2019) Polypharmacy among older Australians, 2006–2017: a population-based study. Med J Aust 211:71–75. https://doi.org/10.5694/mja2.50244

    Article  PubMed  Google Scholar 

  19. StataCorp (2019) Stata statistical software: Release 16. College Station: TX: StataCorp LLC

  20. Midi H, Sarkar SK, Rana S (2010) Collinearity diagnostics of binary logistic regression model. J Interdiscip Math 13:253–267. https://doi.org/10.1080/09720502.2010.10700699

    Article  Google Scholar 

  21. Lim LM, McStea M, Chung WW, et al (2017) Prevalence, risk factors and health outcomes associated with polypharmacy among urban community-dwelling older adults in multi-ethnic Malaysia. PloS One 12:e0173466. https://doi.org/10.1371/journal.pone.0173466

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Lau DT, Kasper JD, Potter DEB et al (2005) Hospitalization and death associated with potentially inappropriate medication prescriptions among elderly nursing home residents. Arch Intern Med 165:68–74. https://doi.org/10.1001/archinte.165.1.68

    Article  PubMed  Google Scholar 

  23. Mamun K, Lien CTC, Goh-Tan CYE et al (2004) Polypharmacy and inappropriate medication use in Singapore nursing homes. Ann Acad Med Singapore 33:49–52

    CAS  PubMed  Google Scholar 

  24. Herr M, Robine J-M, Pinot J et al (2015) Polypharmacy and frailty: prevalence, relationship, and impact on mortality in a French sample of 2350 old people. Pharmacoepidemiol Drug Saf 24:637–646. https://doi.org/10.1002/pds.3772

    Article  PubMed  Google Scholar 

  25. Jetha S (2015) Polypharmacy, the elderly, and deprescribing. Consult Pharm 30:527–532. https://doi.org/10.4140/TCP.n.2015.527

    Article  Google Scholar 

  26. Dent E, Lien C, Lim WS et al (2017) The Asia-Pacific clinical practice guidelines for the management of frailty. J Am Med Dir Assoc 18:564–575. https://doi.org/10.1016/j.jamda.2017.04.018.

    Article  PubMed  Google Scholar 

  27. Hubbard RE, O’Mahony MS, Woodhouse KW (2013) Medication prescribing in frail older people. Eur J Clin Pharmacol 69:319–326. https://doi.org/10.1007/s00228-012-1387-2

    Article  Google Scholar 

  28. World Health Organization (2020) Falls. https://www.who.int/news-room/fact-sheets/detail/falls. Accessed 18 July 2020.

  29. Miller GE, Sarpong EM, Davidoff AJ et al (2017) Determinants of potentially inappropriate medication use among community-dwelling older adults. Health Serv Res 52:1534–1549. https://doi.org/10.1111/1475-6773.12562

    Article  PubMed  Google Scholar 

  30. Parkes AJ, Coper LC (1997) Inappropriate use of medications in the veteran community: how much do doctors and pharmacists contribute? Aust N Z J Public Health 21:469–476. https://doi.org/10.1111/j.1467-842X.1997.tb01737.x

    Article  CAS  PubMed  Google Scholar 

  31. Weir DL, Lee TC, McDonald EG et al (2020) Both new and chronic potentially inappropriate medications continued at hospital discharge are associated with increased risk of adverse events. J Am Geriatr Soc 68:1184–1192. https://doi.org/10.1111/jgs.16413

    Article  Google Scholar 

  32. Kruse WH (1990) Problems and pitfalls in the use of benzodiazepines in the elderly. Drug Saf 5:328–344

    Article  CAS  Google Scholar 

  33. Zhang X, Zhou S, Pan K et al (2017) Potentially inappropriate medications in hospitalized older patients: a cross-sectional study using the Beers 2015 criteria versus the 2012 criteria. Clin Interv Aging 12:1697–1703. https://doi.org/10.2147/CIA.S146009

    Article  CAS  Google Scholar 

  34. Cvetković Z, Perić A, Dobrić S (2019) Potentially inappropriate prescribing and potential clinically significant drug–drug interactions in older outpatients: Is there any association? Med (Kaunas) 55:332. https://doi.org/10.3390/medicina55070332

    Article  Google Scholar 

  35. Falconer IR, Langley JV, Vacek AT (1983) Effect of prolactin on 86Rb+ uptake, potassium content and [G-3H]ouabain binding of lactating rabbit mammary tissue. J Physiol 334:1–17. https://doi.org/10.1113/jphysiol.1983.sp014476

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Kishimoto T, De Hert M, Carlson HE (2012) Osteoporosis and fracture risk in people with schizophrenia. Curr Opin Psychiatry 25:415–429. https://doi.org/10.1097/YCO.0b013e328355e1ac

    Article  Google Scholar 

  37. Hubbard RE, Maier AB, Hilmer SN et al (2020) Frailty in the face of COVID-19. Age Ageing 49:499–500. https://doi.org/10.1093/ageing/afaa095

    Article  PubMed  Google Scholar 

  38. Thiruchelvam K, Wong PS, Kairuz T et al (2018) Consolidated medication review algorithm to improve medications use in older adults: Components, scoring scheme, and implementation. J Am Med Dir Assoc 19:717–718. https://doi.org/10.1016/j.jamda.2018.03.007

    Article  Google Scholar 

  39. Poudel A, Ballokova A, Hubbard RE et al (2015) Algorithm of medication review in frail older people: focus on minimizing the use of high-risk medications. Geriatr Gerontol Int 16:1002–1013. https://doi.org/10.1111/ggi.12589

    Article  Google Scholar 

  40. Australian Bureau of Statistics (2016) Ageing population. https://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/2071.0~2016~Main%20Features~Ageing%20Population~14. Accessed 16 Nov 2020

  41. Australian Institute of Health and Welfare (2018) Older Australia at a glance, Aged care. https://www.aihw.gov.au/reports/older-people/older-australia-at-a-glance/contents/health-and-aged-care-service-use/aged-care. Accessed 16 Nov 2020

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Acknowledgements

The authors thank Dominic Cavenagh and Peta Forder (Priority Research Centre for Generational Health and Ageing, University of Newcastle), and Natasha Weaver (School of Medicine and Public Health, University of Newcastle) for their statistical input. This research is based on a study conducted as part of the Australian Longitudinal Study on Women’s Health by the University of Queensland and the University of Newcastle. The authors are grateful to the Australian Government Department of Health for funding and to all women who provided the survey data. The authors also acknowledge the Departments of Health and Veterans’ Affairs, and Medicare Australia, for the provision of the PBS data, and the Australian Institute of Health and Welfare (AIHW) as the integrating authority.

Funding

This work was supported by the Australian Government Department of Health.

Author information

Authors and Affiliations

  1. University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia

    Kaeshaelya Thiruchelvam, Julie Byles, Syed Shahzad Hasan, Nicholas Egan & Therese Kairuz

  2. International Medical University, 126 Jalan Jalil Perkasa 19, Bukit Jalil, 57000, Kuala Lumpur, Malaysia

    Kaeshaelya Thiruchelvam & Therese Kairuz

  3. Priority Research Centre for Generational Health and Ageing, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia

    Julie Byles & Nicholas Egan

  4. University of Huddersfield, Queensgate, Huddersfield, HD1 3DH, UK

    Syed Shahzad Hasan

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  1. Kaeshaelya Thiruchelvam
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Contributions

KT contributed to the design and conceptualisation of the study, performed formal analysis, and wrote the first draft and made final corrections. JB contributed to the conceptualisation of the study, reviewed and made final corrections to the manuscript. SSH contributed to the conceptualisation of the study, and reviewed and made final corrections to the manuscript. NE contributed to formal analysis, reviewed and edited the manuscript. TK contributed to the conceptualisation of the study, and reviewed and edited the manuscript. All authors approved the final manuscript.

Corresponding author

Correspondence to Kaeshaelya Thiruchelvam.

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Conflicts of Interest

The authors have no conflicts of interest to declare that are relevant to the content of this article.

Ethics approval

The ALSWH has ongoing ethical approval from the University of Queensland (UQ) (reference 2004000224) and the University of Newcastle (UoN) (reference H-076–0795) Human Research Ethics Committees (HREC), and also for the health record linkage (UQ: reference 2012000132 and UoN: reference H-2011–0371). Our study was approved by the ALSWH Data Access Committee. Access to national data collections was approved by the Australian Institute of Health and Welfare HREC (reference EC2012/1/12).

Human and animal rights

For the linked data (PBS), ALSWH participants who decline health record linkage are excluded from linked data requests. Over 80 percent of all ALSWH participants have explicitly consented to record linkage. Since 2005, the responsible Human Research Ethics Committees have approved opt-out consent; in addition, a waiver applies to unconsented participants who were deceased or lost to follow up before 2005.

Informed consent

For the ALSWH survey data, all participants consented to joining the study and are free to withdraw or suspend their participation at any time with no need to provide a reason.

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Thiruchelvam, K., Byles, J., Hasan, S.S. et al. Frailty and potentially inappropriate medications using the 2019 Beers Criteria: findings from the Australian Longitudinal Study on Women’s Health (ALSWH). Aging Clin Exp Res 33, 2499–2509 (2021). https://doi.org/10.1007/s40520-020-01772-0

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