Polypharmacy cutoff and outcomes: five or more medicines were used to identify community-dwelling older men at risk of different adverse outcomes
Abstract Objective This study aimed to determine an optimal discriminating number of concomitant medications associated with geriatric syndromes, functional outcomes, and mortality in community-dwelling older men. Study Design and Setting Older men aged ≥70 years ( n = 1,705), enrolled in the Concor...
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| Veröffentlicht in: | Journal of clinical epidemiology 2012-09, Vol.65 (9), p.989-995 |
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| creator | Gnjidic, Danijela Hilmer, Sarah N Blyth, Fiona M Naganathan, Vasi Waite, Louise Seibel, Markus J McLachlan, Andrew J Cumming, Robert G Handelsman, David J Le Couteur, David G |
| description | Abstract Objective This study aimed to determine an optimal discriminating number of concomitant medications associated with geriatric syndromes, functional outcomes, and mortality in community-dwelling older men. Study Design and Setting Older men aged ≥70 years ( n = 1,705), enrolled in the Concord Health and Aging in Men Project were studied. Receiver operating characteristic curve analysis using the Youden Index and the area under the curve was performed to determine discriminating number of medications in relation to each outcome. Results The highest value of the Youden Index for frailty was obtained for a cutoff point of 6.5 medications compared with a cutoff of 5.5 for disability and 3.5 for cognitive impairment. For mortality and incident falls, the highest value of Youden Index was obtained for a cutoff of 4.5 medications. For every one increase in number of medications, the adjusted odds ratios were 1.13 (95% confidence interval [CI] = 1.06–1.21) for frailty, 1.08 (95% CI = 1.00–1.15) for disability, 1.09 (95% CI = 1.04–1.15) for mortality, and 1.07 (95% CI = 1.03–1.12) for incident falls. There was no association between increasing number of medications and cognitive impairment. Conclusion The study supports the use of five or more medications in the current definition of polypharmacy to estimate the medication-related adverse effects for frailty, disability, mortality, and falls. |
| doi_str_mv | 10.1016/j.jclinepi.2012.02.018 |
| format | Article |
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Study Design and Setting Older men aged ≥70 years ( n = 1,705), enrolled in the Concord Health and Aging in Men Project were studied. Receiver operating characteristic curve analysis using the Youden Index and the area under the curve was performed to determine discriminating number of medications in relation to each outcome. Results The highest value of the Youden Index for frailty was obtained for a cutoff point of 6.5 medications compared with a cutoff of 5.5 for disability and 3.5 for cognitive impairment. For mortality and incident falls, the highest value of Youden Index was obtained for a cutoff of 4.5 medications. For every one increase in number of medications, the adjusted odds ratios were 1.13 (95% confidence interval [CI] = 1.06–1.21) for frailty, 1.08 (95% CI = 1.00–1.15) for disability, 1.09 (95% CI = 1.04–1.15) for mortality, and 1.07 (95% CI = 1.03–1.12) for incident falls. There was no association between increasing number of medications and cognitive impairment. Conclusion The study supports the use of five or more medications in the current definition of polypharmacy to estimate the medication-related adverse effects for frailty, disability, mortality, and falls.</description><identifier>ISSN: 0895-4356</identifier><identifier>EISSN: 1878-5921</identifier><identifier>DOI: 10.1016/j.jclinepi.2012.02.018</identifier><identifier>PMID: 22742913</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Accidental Falls - statistics & numerical data ; Aged ; Aged, 80 and over ; Biological and medical sciences ; Cognition Disorders - diagnosis ; Cognitive ability ; Disability Evaluation ; Epidemiology ; Frail Elderly ; Frailty ; Functional outcomes ; General aspects ; Geriatric Assessment - methods ; Geriatric syndromes ; Health risk assessment ; Humans ; Internal Medicine ; Male ; Medical sciences ; Medications ; Mortality ; Odds Ratio ; Older adults ; Older people ; Outcome Assessment (Health Care) - methods ; Polypharmacy ; Polypharmacy cutoff ; Prescription Drugs - adverse effects ; Public health. Hygiene ; Public health. Hygiene-occupational medicine ; ROC Curve ; Studies ; Survival Analysis</subject><ispartof>Journal of clinical epidemiology, 2012-09, Vol.65 (9), p.989-995</ispartof><rights>2012</rights><rights>2015 INIST-CNRS</rights><rights>Crown Copyright © 2012. Published by Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited Sep 2012</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c534t-702aa73de59d899df331ec468c97fef58ca4255b3242dc52e37f378b2d51392a3</citedby><cites>FETCH-LOGICAL-c534t-702aa73de59d899df331ec468c97fef58ca4255b3242dc52e37f378b2d51392a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/1036963937?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995,64385,64387,64389,72469</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=26200654$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22742913$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gnjidic, Danijela</creatorcontrib><creatorcontrib>Hilmer, Sarah N</creatorcontrib><creatorcontrib>Blyth, Fiona M</creatorcontrib><creatorcontrib>Naganathan, Vasi</creatorcontrib><creatorcontrib>Waite, Louise</creatorcontrib><creatorcontrib>Seibel, Markus J</creatorcontrib><creatorcontrib>McLachlan, Andrew J</creatorcontrib><creatorcontrib>Cumming, Robert G</creatorcontrib><creatorcontrib>Handelsman, David J</creatorcontrib><creatorcontrib>Le Couteur, David G</creatorcontrib><title>Polypharmacy cutoff and outcomes: five or more medicines were used to identify community-dwelling older men at risk of different adverse outcomes</title><title>Journal of clinical epidemiology</title><addtitle>J Clin Epidemiol</addtitle><description>Abstract Objective This study aimed to determine an optimal discriminating number of concomitant medications associated with geriatric syndromes, functional outcomes, and mortality in community-dwelling older men. Study Design and Setting Older men aged ≥70 years ( n = 1,705), enrolled in the Concord Health and Aging in Men Project were studied. Receiver operating characteristic curve analysis using the Youden Index and the area under the curve was performed to determine discriminating number of medications in relation to each outcome. Results The highest value of the Youden Index for frailty was obtained for a cutoff point of 6.5 medications compared with a cutoff of 5.5 for disability and 3.5 for cognitive impairment. For mortality and incident falls, the highest value of Youden Index was obtained for a cutoff of 4.5 medications. For every one increase in number of medications, the adjusted odds ratios were 1.13 (95% confidence interval [CI] = 1.06–1.21) for frailty, 1.08 (95% CI = 1.00–1.15) for disability, 1.09 (95% CI = 1.04–1.15) for mortality, and 1.07 (95% CI = 1.03–1.12) for incident falls. There was no association between increasing number of medications and cognitive impairment. Conclusion The study supports the use of five or more medications in the current definition of polypharmacy to estimate the medication-related adverse effects for frailty, disability, mortality, and falls.</description><subject>Accidental Falls - statistics & numerical data</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biological and medical sciences</subject><subject>Cognition Disorders - diagnosis</subject><subject>Cognitive ability</subject><subject>Disability Evaluation</subject><subject>Epidemiology</subject><subject>Frail Elderly</subject><subject>Frailty</subject><subject>Functional outcomes</subject><subject>General aspects</subject><subject>Geriatric Assessment - methods</subject><subject>Geriatric syndromes</subject><subject>Health risk assessment</subject><subject>Humans</subject><subject>Internal Medicine</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Medications</subject><subject>Mortality</subject><subject>Odds Ratio</subject><subject>Older adults</subject><subject>Older people</subject><subject>Outcome Assessment (Health Care) - methods</subject><subject>Polypharmacy</subject><subject>Polypharmacy cutoff</subject><subject>Prescription Drugs - adverse effects</subject><subject>Public health. 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Study Design and Setting Older men aged ≥70 years ( n = 1,705), enrolled in the Concord Health and Aging in Men Project were studied. Receiver operating characteristic curve analysis using the Youden Index and the area under the curve was performed to determine discriminating number of medications in relation to each outcome. Results The highest value of the Youden Index for frailty was obtained for a cutoff point of 6.5 medications compared with a cutoff of 5.5 for disability and 3.5 for cognitive impairment. For mortality and incident falls, the highest value of Youden Index was obtained for a cutoff of 4.5 medications. For every one increase in number of medications, the adjusted odds ratios were 1.13 (95% confidence interval [CI] = 1.06–1.21) for frailty, 1.08 (95% CI = 1.00–1.15) for disability, 1.09 (95% CI = 1.04–1.15) for mortality, and 1.07 (95% CI = 1.03–1.12) for incident falls. There was no association between increasing number of medications and cognitive impairment. Conclusion The study supports the use of five or more medications in the current definition of polypharmacy to estimate the medication-related adverse effects for frailty, disability, mortality, and falls.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>22742913</pmid><doi>10.1016/j.jclinepi.2012.02.018</doi><tpages>7</tpages></addata></record> |
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| ispartof | Journal of clinical epidemiology, 2012-09, Vol.65 (9), p.989-995 |
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| source | MEDLINE; ScienceDirect Journals (5 years ago - present); ProQuest Central UK/Ireland |
| subjects | Accidental Falls - statistics & numerical data Aged Aged, 80 and over Biological and medical sciences Cognition Disorders - diagnosis Cognitive ability Disability Evaluation Epidemiology Frail Elderly Frailty Functional outcomes General aspects Geriatric Assessment - methods Geriatric syndromes Health risk assessment Humans Internal Medicine Male Medical sciences Medications Mortality Odds Ratio Older adults Older people Outcome Assessment (Health Care) - methods Polypharmacy Polypharmacy cutoff Prescription Drugs - adverse effects Public health. Hygiene Public health. Hygiene-occupational medicine ROC Curve Studies Survival Analysis |
| title | Polypharmacy cutoff and outcomes: five or more medicines were used to identify community-dwelling older men at risk of different adverse outcomes |
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