Medication use in older men linked to risk of death and frailty

Published in the latest issue of the Journal of the American Geriatric Society, the study supports previously reported risks of both long term and multiple medication use among older people.

The new contribution of this study of 1,705 community-dwelling men is to reveal the incremental risk of death and transition between states of frailty associated with medication use over a five-year period, while adjusting for potential confounders such as age, education, living status, dementia, mild cognitive impairment, and co-morbidities.

The study conducted by University of Sydney and Monash University researchers, measured the use of prescription and non-prescription medications at three time points: baseline, two years and five years.

Medications with clinically significant sedative and anticholinergic effects were included, while complementary medications and medications used only as required were excluded from the study’s analysis. Anticholinergic medications are used to treat asthma, incontinence, and muscular spasms, and sedative medications are commonly prescribed for depression and sleep disorders.

Key findings

• On average, each additional medication was associated with a 22 per cent greater risk of transitioning from robust health to death.
• On average, each additional unit of ‘drug burden’ (a measure of cumulative exposure to anticholinergic and sedative medications) was associated with a 73 per cent greater risk of transitioning from robust health to mild frailty.
• On average, each additional unit of ‘drug burden’ was associated with a 2.75 times greater risk of transitioning from robust health to death.

 “The findings are significant given the high numbers of older people who take multiple medications,” said study co-author, Danijela Gnjidic, Faculty of Pharmacy, University of Sydney. “In Australia, two thirds of people aged over 75 years take five or more medications.

 “It’s especially important to note that a higher drug burden was associated with increasing risk of frailty among high-functioning older men within just two to three years.”

 “Our study highlights the opportunities to educate consumers about the risks associated with multiple medication use, and for consumers and health practitioners to work together to minimise drug-related problems,” Dr Gnjidic said.

 Co-author Associate Professor Simon Bell of Monash University described frailty as a dynamic process, which can lead to a “spiral of decline” if the causes remain unaddressed.

“The development of frailty puts people at greater risk of additional health problems and worsening disability. This decline can lead to additional medications being prescribed, which perpetuates the spiral,” Associate Professor Bell said.

The research was supported by the NHMRC Cognitive Decline Partnership Centre (CDPC) at The University of Sydney.