Frailty Status and Polypharmacy Predict All-Cause Mortality in Community Dwelling Older Adults in Europe

The European population has been growing old over the last decades and this is expected to continue, due to better quality of life and increased life expectancy. Higher longevity leads to a greater expression of ageing related conditions, such as chronic diseases, comorbidities, and geriatric syndromes, which poses a serious challenge at economic and health care systems levels. Polypharmacy, usually as a result of the treatment of comorbidities, and frailty, a geriatric syndrome common among the older population, are both associated with higher rates of mortality.

This study aimed to evaluate the impact of frailty and polypharmacy, on mortality rates, within 30 months, using a cohort of SHARE participants aged 65 years old or more. Frailty was assessed using a version of Fried’s phenotype criteria operationalized to SHARE while polypharmacy was defined as taking five or more drugs per day.

We found a prevalence of 40.4% non-frail, 47.3% pre-frail and 12.3% frail participants. Moreover, a prevalence of polypharmacy of 31.3% was observed, being 3 times more prevalent in frail individuals and two times in pre-frail individuals, when compared with non-frail. Among frail and pre-frail individuals, the mortality rates were higher, comparing with non-frail ones (15.6%, 5.3% and 2.0%, respectively), and within each group, even higher for polymedicated participants. Survival analysis showed significant differences between non-frail non-polymedicated and polymedicated individuals (Log-rank p=0.035) and between pre-frail non-polymedicated and polymedicated individuals (Log-rank p<0.001). On the contrary, no significant differences were found between frail non-polymedicated and polymedicated individuals (Log-rank p=0.785). Mortality rates were also higher in polymedicated individuals (7.8%), in male (6.7% vs. 4.1%, in female), in older participants (2.5%, 6.2%, 17.4%, for those age 65–74, 75–84 and 85+, respectively). Survival analysis showed significant differences between non-polymedicated and polymedicated individuals within gender (Log-rank p<0.001) and age (Log-rank p<0.001). A significant association was also found between polypharmacy and frailty with mortality, except for the non-frail polymedicated individuals. Comparing with non-polymedicated non-frail individuals, polymedicated frail individuals are 7 times, non-polymedicated frail individuals are 6 times, polymedicated pre-frail individuals are 2.9 times and non-polymedicated pre-frail individuals are 2.1 times more prone to die with 30 months.

Polypharmacy and frailty are two very prevalent conditions in Europe and represent serious health issues that lead to lower quality of life, higher healthcare expenditures and a problem to society in general. With this work, and through the use of a cohort of SHARE participants, it was possible to understand the trajectory of almost 25,000 people aged 65 or over, in Europe. This work reinforces the high prevalence of polypharmacy and frailty in the older population and clearly shows the prevalence of polypharmacy in non-frail, pre-frail, and frail individuals, in 17 European countries, and Israel. At the same time, we were able to understand the 30-month mortality rates for the different groups. It becomes clear and evident that interventions are needed to decrease polypharmacy (especially if not necessary), and frailty, since it will impact society, health systems, caregivers, and older people, improving their quality of life, well-being, functional independence, and autonomy.

 

More information can be found at:
Midão, L.; Brochado, P.; Almada, M.; Duarte, M.; Paúl, C.; Costa, E. Frailty Status and Polypharmacy Predict All-Cause Mortality in Community Dwelling Older Adults in Europe. Int. J. Environ. Res. Public Health 2021, 18, 3580. https://doi.org/10.3390/ijerph18073580