An Exploration of the Association Between Polypharmacy and Frailty Among Hospitalized Older Adult Patients

Abstract

Purpose/Objective The study's main purpose is to explore the association between polypharmacy and frailty among hospitalized older adults.

Significance

Polypharmacy is considered a matter of concern in many U.S. geriatric healthcare settings. Frail older adults are at special risk of experiencing higher rates of medication-related complications, such as drug–drug interactions, worsening morbidity, falls, delirium, and rehospitalization due to physiological changes. Most studies investigated the relationship among community-dwelling older adults. However, the relationship between polypharmacy and frailty among hospitalized older adults has not yet been well described. Design/Methods This retrospective cross-sectional study offers a secondary data analysis of the EHR in adults aged 50 years or older (N=46,645) hospitalized in medical-surgical units in a healthcare system between 2013 and 2017. Polypharmacy was defined as the concurrent use of seven or more prescribed medications. Potential Inappropriate Medications/High-Risk Medications (PIMs/HRMs) were classified using AGS Beers criteria® 2023 and HIDES, and then grouped into 10 classes (Lekan et al., 2022). A Frailty Index (FI) was created based on the accumulation of a deficit theoretical framework (Mitnitski et al., 2001). After a detailed review of components contributing to frailty, the FI was constructed following the guidance provided by Searle et al. (2008) and Theou et al. (2023). This study’s FI was unique because it included indicators from nursing flowsheets, ICD-10 codes, laboratory blood biomarkers, as well as indicators more customarily used, including comorbidities, and functional status, activities of daily living, and psychosocial indicators. The indicators were coded as “1” for present and “0” for absent. FI-35 was calculated by dividing the number of indices in an individual by the total number of indices measured, with frailty defined by a cut-off point of ≥ 0.25. Findings/Outcomes The average age of patients upon admission was 70.0 years (SD=11.4). The prevalence of polypharmacy was 49.6% (n=19,072). Out of the total number of patients included in the study (25,961), 42.0% were identified as frail. The study showed a significant association between polypharmacy and frailty with 54.5% of individuals with polypharmacy classified as frail. The multivariable logistic regression yielded a significant association between polypharmacy and frailty. The odds of frailty were 53.1 % higher for those in the polypharmacy groups relative to non-polypharmacy groups, adjusting for age and ECI score (AOR = 1.531, 95% CI = [1.437, 1.631], p < 0.001). The study found a significant association between 8 PIMs/HRMs classes and frailty (P<0.001) and with using one or more PIMs/HRMs. However, no significant association was found between genitourinary or anti-infective PIMs/HRMs class and frailty (P > 0.05). Conclusion/Implications for Practice By using EHR data, nurses can identify patients at high risk of adverse outcomes. Including measures of frailty and polypharmacy in assessments can aid in reducing these risks and guide interventions by nurses to prevent negative health outcomes. Identifying frail older adults with Frailty, polypharmacy and exposure to PIMs/HRMs is important, emphasizing the need for specialized care, medication review, de-prescribing, and frailty screening. Post-discharge care plans for frail patients with complex medication regimes help ensure recovery and prevent hospital readmission.