The Effect of Polypharmacy on Fall Risk, Cognitive Status, Activities of Daily Living, and Mobility in Elderly Residents

Year 2023, Volume: 37 Issue: 2, 133 - 140, 06.09.2023

Bülent Abut Özsezikli , Gizem Ergezen

https://doi.org/10.18614/deutip.1272175

Abstract

Objective: The aim of this study is to examine the polypharmacy status of elderly people staying in nursing homes and to investigate the effects of polypharmacy on fall risk, cognition, activities of daily living (ADL), mobility and peripheral muscle strength.
Material and Method: Thirty-nine volunteer elderly individuals aged 65-80 years, staying in a nursing home and having a mini-mental test score above 24, were included in the study. After the age, gender, and drug types of the individuals were noted, evaluations were made for cognition, activities of daily living, risk of falling, mobility and peripheral muscle strength. Individuals using 5 or more drugs were assigned to the polypharmacy group (PFG)(n=21); Those who used 0-3 drugs were included in the non-polypharmacy group (N-PFG)(n=19).
Results: The groups were similar in terms of age and gender (p>0.05). Individuals in the polypharmacy group had significantly lower ADL and mobility than the non-polypharmacy group (p<0.05). There was no difference between the groups in terms of cognition, fall risk and peripheral muscle strength (p>0.05).
Conclusion: As a result, it was observed that only ADL and mobility of those who use multiple drugs are lower than those who do not use them. There was no effect of multi-drug use on cognition, fall risk, and peripheral muscle strength between the groups. In future studies, it is recommended to analyze according to the duration of drug use and to include more objective tests on balance.

Keywords

Multiple Drug Use, Fall Risk, Activity of Daily Living, Mobility, Polypharmacy

Polifarmasinin Huzurevinde Kalan Yaşlı Bireylerde Düşme Riski, Kognitif Durum, Günlük Yaşam Aktiviteleri ve Mobilite Üzerine Etkisi

Abstract

Amaç: Bu çalışmanın amacı, huzurevinde konaklayan yaşlı bireylerin polifarmasi durumunu incelemek ve polifarmasinin düşme riski, kognisyon, günlük yaşam aktiviteleri (GYA), mobilite ve periferik kas kuvvetine olan etkisini araştırmayı amaçlamaktadır.
Gereç ve Yöntem: Çalışmaya 65-80 yaş aralığında huzur evinde konaklayan, mini menmtal test skoru 24’ün üzerinde olan 39 gönüllü yaşlı birey dahil edildi. Bireylerin yaş, cinsiyet ve kullandıkları ilaç tipleri not edildikten sonra kognisyon, günlük yaşam aktivitesi, düşme riski, mobilite ve periferik kas kuvvetine yönelik değerlendirmeler yapıldı. Bireylerden 5 ve üzeri ilaç kullananlar polifarmasi grubuna (PFG)(n=21); 0-3 ilaç kullananlar ise non-polifarmasi grubuna (N-PFG)(n=19) alındı.
Bulgular: Gruplar yaş ve cinsiyet açısından benzerdi (p>0.05). Polifarmasi grubundaki bireylerde GYA ve mobilite non-polifarmasi grubundan anlamlı olarak daha düşüktü (p<0.05). Kognisyon, düşme riski ve periferik kas kuvveti açısından gruplar arasında farklılık bulunmamaktaydı (p>0.05).
Sonuç: Sonuç olarak, çoklu ilaç kullananların kullanmayanlara göre yalnızca GYA ve mobilitelerinin daha düşük olduğu görülmüştür. Çoklu ilaç kullanımının kognisyon, düşme riski ve periferik kas kuvveti üzerine gruplar arasında bir etkisi bulunmamıştır. İleriki çalışmalarda ilaç kullanım sürelerine göre analiz yapılması ve denge ile ilgili daha objektif testlemelerin dahil edilmesi önerilmektedir.

Keywords

Çoklu İlaç Kullanımı, Düşme Riski, Günlük Yaşam Aktivitesi, Mobilite, Polifarmasi

References

• 1. Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. What is polypharmacy? A systematic review of definitions. BMC Geriatr 2017;17:230.
• 2. Melzer D, Tavakoly B, Winder RE, Masoli JA, Henley WE, Ble A, Richards SH. Much more medicine for the oldest old: trends in UK electronic clinical records. Age Ageing. 2015;44(1):46-53. doi: 10.1093/ageing/afu113. Epub 2014 Aug 7. PMID: 25103030; PMCID: PMC4255615.
• 3. Zia A, Kamaruzzaman SB, Tan MP. Polypharmacy and falls in older people: balancing evidence-based medicine against falls risk. Postgrad Med. 2015;127(3):330-337. https://doi.org/10.1080/00325481.2014.996112
• 4. American Geriatrics Society 2015 Beers Criteria Update Expert Panel. American Geriatrics Society 2015 Updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc 2015; 63:2227-46.
• 5. Jokanovic N, Tan EC, Dooley MJ, Kirkpatrick CM, Bell JS. Prevalence and factors associated with polypharmacy in long-term care facilities: a systematic review. J Am Med Dir Assoc. 2015;16(6):535.e1-535.e12.
• 6. Ahmed B, Nanji K, Mujeeb R, Patel MJ. Effects of polypharmacy on adverse drug reactions among geriatric outpatients at a tertiary care hospital in Karachi: a prospective cohort study. PLoS One. 2014;9(11):e112133.
• 7. Maher RL, Hanlon J, Hajjar ER. Clinical consequences of polypharmacy in elderly. Expert Opin Drug Saf. 2014;13:57-65.
• 8. Kadam UT. Potential health impacts of multiple drug prescribing for older people: a case-control study. Br J Gen Pract. 2011; 61: 128–130.
• 9. Zia A, Kamaruzzaman SB, Tan MP. The consumption of two or more fall risk-increasing drugs rather than polypharmacy is as- sociated with falls. Geriatr Gerontol Int. 2017;17(3):463–470. doi:10.1111/ggi.12741
• 10. Shumway-Cook A, Woollacott M, Baldwin M. The effects of cognitive demands on postural sway in young versus older adults (fallers and nonfallers). Neurology Report. 1995;19:44.
• 11. Woolcott JC, Richardson KJ, Wiens MO, Patel B, Marin J, Khan KM, Marra CA. Meta-analysis of the impact of 9 medication classes on falls in elderly persons. Arch Intern Med. 2009;169(21):1952-60.
• 12. Laflamme L, Monárrez-Espino J, Johnell K, Elling B, Möller J.Type, number or both? A population base matched case – control study on the risk of fall injuries among older people and number of medications beyond fall inducing drugs. PLoS ONE. 2015;10:1-12.
• 13. Milos V, Bondesson A, Magnusson M, Jakobsson U, Westerlund T, Midlov P. Fall risk-increasing drugs and falls: a cross-sectional study among elderly patients in primary care. BMC Geriatrics. 2014; 14: 40.
• 14. Nakamura T, Itoh T, Yabe A, Imai S, Nakamura Y, Mizokami Y, Okouchi Y, Ikeshita A, Kominato H. Polypharmacy is associated with malnutrition and activities of daily living disability among daycare facility users: A cross-sectional study. Medicine (Baltimore). 2021;100(34):e27073.
• 15. Bloch F, Thibaud M, Tournoux-Facon C, Brèque C, Rigaud AS, Dugué B, Kemoun G. Estimation of the risk factors for falls in the elderly: can meta-analysis provide a valid answer? Geriatr Gerontol Int. 2013;13(2):250-63.
• 16. Morin L, Johnell K, Laroche ML, Fastbom J, Wastesson JW. The epidemiology of polypharmacy in older adults: Register-based prospective cohort study. Clinical epidemiology. 2018;10:289–298.
• 17. Rawle MJ, Richards M, Davis D, Kuh D. The prevalence and determinants of polypharmacy at age 69: A British birth cohort study. BMC Geriatrics. 2018;18(1):118.
• 18. Rasu RS, Shrestha N, Karpes Matusevich AR, Zalmai R, Large S, Johnson L, O'Bryant SE. Polypharmacy and Cognition Function Among Rural Adults. J Alzheimers Dis. 2021;82(2):607-619.
• 19. Güngen C, Ertan T, Eker E, Yaşar R, Engin F. Standardize Mini Mental Test'in Türk toplumunda hafif demans tanısında geçerlik ve güvenilirliği. Türk Psikiyatri Dergisi. 2002;13:273-281.
• 20. Luis CA, Keegan AP, Mullan M. Cross validation of the Montreal Cognitive Assessment in community dwelling older adults residing in the Southeastern US. Int. J. Geriatr. Psychiatry. 2009;24:197–201.
• 21. Selekler K, Cangoz B, Uluç S. Power of discrimination of montreal cognıtıve assessment (MOCA) scale in Turkısh patients wıth mild cognıtıve impairement andalzheımer’s dısease. Turkish Journal of Geriatrics. 2010;13:166-71.
• 22. Küçükdeveci AA, Yavuzer G, Tennant A, Süldür N, Sonel B, Arasil T. Adaptation of the Modified Barthel Index for Use in Physical Medicine and Rehabilitation in Turkey. Scandinavian Journal of Rehabilitation Medicine, 2000, 32(2):87-92.
• 23. Ekşi Uymaz P, Nahcivan N. Yaşlılar İçin Düşme Davranışları Ölçeği'nin Geçerlik ve Güvenirliği. Florence Nightingale Journal of Nursing. 2013;21(1):22-32. Retrieved from https://dergipark.org.tr/tr/pub/fnjn/issue/9009/112293.
• 24. Raîche M, Hébert R, Prince F, Corriveau H. Screening older adults at risk of falling with the Tinetti balance scale. Lancet. 2000; 356(9234):1001-2.
• 25. Scott Bennie, Kathryn Bruner, Allan Dizon, Holly Fritz, Bob Goodman, Saundra Peterson Measurements of Balance: Comparison of the Timed "Up and Go" Test and Functional Reach Test with the Berg Balance Scale 2003;15(2):93-97.
• 26. Bohannon RW. Grip strength: an indispensable biomarker for older adults. Clin Interv Aging. 2019;14:1681–91.
• 27. Peolsson A, Hedlund R, Oberg B. Intra- and inter-tester reliability and reference values for hand strength. J Rehab Med. 2001;33(1):36–41.
• 28. Arslan Ş, Atalay A, Gökçe Kutsal Y. Yaşlılarda ilaç tüketimi. Turk J Geriatrics 2000;3:56-60.
• 29. Şahin G, Baydar T. Use of drugs among older persons. In: Troisi J, Gökçe Kutsal Y (Eds) Aging in Turkey: International Institute on Ageing and Hacettepe University Research Center of Geriatrics Sciences GEBAM,Vertas Pres. pp:55-84, 2006
• 30. Bareis N, Sando TA, Mezuk B, Cohen SA. Association between psychotropic medication polypharmacy and an objective measure of balance impairment among middle-aged adults: results from the US national health and nutrition examination survey. CNS Drugs. 2018;32(9):863- 871.
• 31. Hawk C, Hyland JK, Rupert R, Colonvega M, Hall S. Assessment of balance and risk for falls in a sample of community-dwelling adults aged 65 and older. Chiropr Osteopat. 2006;14(1):1-8.
• 32. Niikawa H, Okamura T, Ito K, Ura C, Miyamae F, Sakuma N, Awata S. Association between polypharmacy and cognitive impairment in an elderly Japanese population residing in an urban community. Geriatrics & gerontology international. 2017; 17(9);1286-1293.
• 33. Esengen Ş, Seçkin Ü, Borman P, Bodur H, Gökçe Kutsal Y, Yücel M. Huzur evinde yaşayan bir grup yaşlıda fonksiyonel-kognitif değerlendirme ve ilaç kullanımı. Turkish Journal of Geriatrics. 2000; 3: 6-10.
• 34. Hosseini SY, Zabihi A, Amiri SYJ, Bijani A. Polypharmacy among the elderly. J Mid-life Health. 9;97-103, 2018., Jyrkkä J, Enlund H, Lavikainen P, Sulkava R, Hartikainen S. Association of polypharmacy with nutritional status, functional ability and cognitive capacity over a three-year period in an elderly population. Pharmacoepidemiology and drug safety. 2011; 20(5);514-522.
• 35. Herr M, Robine JM, Pinot J, Arvieu JJ, Ankri J. Polypharmacy and frailty: prevalence, relationship, and impact on mortality in a French sample of 2350 old people. Pharmacoepidemiology and drug safety. 2015;24(6);637-646.
• 36. Pugh MJV, Palmer RF, Parchman ML, Mortensen E, Markides K, Espino DV. Association of suboptimal prescribing and change in lower extremity physical function over time. Gerontology. 2007;53:445–453.
• 37. Blanco-Reina E, Ariza-Zafra G, Ocaña-Riola R, León-Ortíz M, Bellido- Estévez I. Optimizing elderly pharmacotherapy: polypharmacy vs. undertreatment. Are thesis two concepts related?. European journal of clinical pharmacology. 2015; 71(2):199-207.
• 38. Sganga F, Vetrano DL, Volpato S, Cherubini A, Ruggiero C, Corsonello A, Fabbietti P, Lattanzio F, Bernabei R, Onder G. Physical performance measures and polypharmacy among hospitalized older adults: results from the CRIME study. J Nutr Health Aging. 2014;18(6):616-21.
• 39. Bahşi R, Öztorun HS, Turgut T, Sürmeli DM, Coşarderelioğlu Ç, Atmış V, Aras S, Varlı M. Hastane