Impacts on practice
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Considering number of medications could improve our understanding of functional health status in older adults.
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Interventions to reduce inappropriate polypharmacy might improve cognitive, physical and emotional capability and outcomes in the elderly.
Introduction
Aim of the study
Ethics approval
Methods
Population
Participants’ health details
Education achievement
Neuropsychological and cognitive tests
Physical and mental health examination
Triad of impairment
Statistical analysis
Results
Gender differences
Characteristics | All N = 341 | Female N = 171 | Male N = 170 |
---|---|---|---|
Age mean (SD) | 64.8 (0.8) | 64.9 (0.8) | 64.7 (0.8) |
Number of medications n (%)
| |||
0 | 104 (30.5) | 49 (28.6) | 55 (32.3) |
1–4 | 195 (57.2) | 97 (56.7) | 98 (57.6) |
≥ 5 (polypharmacy) | 42 (12.3) | 25 (14.6) | 17 (10.0) |
Charlson’s co-morbidity index median (range) | 1 (0–8) | 1 (0–8) | 1 (0–4) |
Charlson’s co-morbidity index n (%)
| |||
0 (not ill) | 147 (43.1) | 68 (39.8) | 79 (46.5) |
1–2 (mildly to moderately ill) | 166 (48.7) | 84 (49.1) | 82 (48.2) |
≥ 3 (severely ill) | 28 (8.2) | 19 (11.1) | 9 (5.3) |
Childhood IQ mean (SD) | 44.2 (12.3) | 45.2 (12.0) | 43.2 (12.5) |
Education mean (SD) | 3.3 (2.3) | 3.4 (2.3) | 3.2 (2.3) |
BMI mean (SD) | 27.0 (4.2) | 27.1 (4.8) | 26.9 (3.5) |
Cognitive mean (SD)
| |||
Ravens progressive matrices (RPM) | 36.8 (8) | 36.6 (8.1) | 36.9 (7.8) |
Auditory verbal learning test (AVLT) | 59.6 (12.8) | 64.4 (11.6)** | 54.8 (12.1)** |
Digit symbol (DS) | 44.9 (11.3) | 47.1 (11.5)** | 42.7 (10.6)** |
Block design test (BLK) | 25.2 (8.4) | 23.4 (8.3)** | 27.0 (8.2)** |
Physical mean (SD)
| |||
SF36 mean of physical health | 75.1 (21.4) | 75.9 (20.0) | 74.4 (22.8) |
6 m walk time test (s) (WTM) | 3.0 (0.7) | 3.3 (0.7)** | 2.9 (0.6)** |
Emotional mean (SD)
| |||
SF36 mean of mental health | 81.9 (17.1) | 81.7 (16.8) | 82.0 (17.5) |
HADS anxiety | 5.8 (3.1) | 6.4 (3.2)** | 5.2 (2.8)** |
HADS depression | 2.9 (2.3) | 3.0 (2.4) | 2.8 (2.2) |
Triad of impairment mean (SD) | 69.1 (8.3) | 69.8 (8.4) | 68.4 (8.1) |
Extraction of derived physical, emotional and cognitive factors and TOI
Association between polypharmacy and TOI
Characteristics | Unadjusted model | Adjusted modela | Adjusted modelb | |||
---|---|---|---|---|---|---|
β (95% CI) | p value | β (95% CI) | p value | β (95% CI) | p value | |
Intercept | 68.3 | < 0.001 | 66.3 | < 0.001 | 87.3 | 0.003 |
0–4 medicines | 0 | 0 | 0 | |||
≥ 5 medicines (polypharmacy) | 5.9 (3.3, 8.6) | < 0.001 | 4.3 (1.5, 7.0) | 0.002 | 3.6 (1.2, 6.0) | 0.003 |
Co-morbidity score
| ||||||
0 | – | 0 | 0 | |||
1–2 (mildly to moderately ill) | – | 3.7 (1.9, 5.4) | < 0.001 | 2.5 (0.9, 4.1) | 0.002 | |
≥ 3 (severely ill) | – | 5.7 (2.3, 9.1) | 0.001 | 5.3 (2.3, 8.3) | 0.001 | |
Age | – | – | − 0.2 (− 1.1, 0.6) | 0.565 | ||
Gender
| ||||||
Male | – | – | 0 | |||
Female | – | – | 1.5 (− 0.1, 2.9) | 0.046 | ||
Childhood IQ | – | – | − 0.2 (− 0.3, − 0.1) | < 0.001 | ||
Education | – | – | − 0.8 (− 1.2, − 0.4) | < 0.001 | ||
BMI | – | – | 0.2 (0.1, 0.4) | 0.007 | ||
R2 | 0.056 | 0.113 | 0.353 | |||
Adjusted R2 | 0.053 | 0.105 | 0.337 |