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      Evidence of association between the use of drugs and community-dwelling older people frailty: a cross-sectional study

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          Abstract

          ABSTRACT BACKGROUND: The scientific literature has shown that an association between polypharmacy and frailty exists. However, few studies have also considered drug interactions and the use of potentially inappropriate medications. OBJECTIVE: To evaluate the association between the use of drugs and frailty among community-dwelling older people. DESIGN AND SETTING: Cross-sectional study carried out among 580 older people in Uberaba (MG). METHODS: Data were collected at these older people's homes using instruments validated in Brazil. Descriptive, bivariate and binary logistic regression analyses were performed (P < 0.05). RESULTS: Most of these individuals were classified as pre-frail (55.7%), while 13.1% were frail. It was found that 31.7% of them presented polypharmacy, 41.7% had drug interactions and 43.8% were using potentially inappropriate medications. In the initial model, polypharmacy (odds ratio, OR = 1.91; confidence interval, CI = 1.27-2.86) and use of potentially inappropriate medications (OR = 2.45; CI = 1.68-3.57) increased the chance that these older people would be pre-frail or frail. In the final adjusted model, use of potentially inappropriate drugs remained associated with the outcome (OR = 2.26; CI = 1.43-3.57). CONCLUSION: Use of potentially inappropriate medications was the independent variable that explained the occurrence of frailty in a representative sample of community-dwelling older adults.

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          Frailty in Older Adults: Evidence for a Phenotype

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            Frailty consensus: a call to action.

            Frailty is a clinical state in which there is an increase in an individual's vulnerability for developing increased dependency and/or mortality when exposed to a stressor. Frailty can occur as the result of a range of diseases and medical conditions. A consensus group consisting of delegates from 6 major international, European, and US societies created 4 major consensus points on a specific form of frailty: physical frailty. 1. Physical frailty is an important medical syndrome. The group defined physical frailty as "a medical syndrome with multiple causes and contributors that is characterized by diminished strength, endurance, and reduced physiologic function that increases an individual's vulnerability for developing increased dependency and/or death." 2. Physical frailty can potentially be prevented or treated with specific modalities, such as exercise, protein-calorie supplementation, vitamin D, and reduction of polypharmacy. 3. Simple, rapid screening tests have been developed and validated, such as the simple FRAIL scale, to allow physicians to objectively recognize frail persons. 4. For the purposes of optimally managing individuals with physical frailty, all persons older than 70 years and all individuals with significant weight loss (>5%) due to chronic disease should be screened for frailty. Copyright © 2013 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.
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              Prevalence of frailty in community-dwelling older persons: a systematic review.

              To systematically compare and pool the prevalence of frailty, including prefrailty, reported in community-dwelling older people overall and according to sex, age, and definition of frailty used. Systematic review of the literature using the key words elderly, aged, frailty, prevalence, and epidemiology. Cross-sectional data from community-based cohorts. Community-dwelling adults aged 65 and older. In the studies that were found, frailty and prefrailty were measured according to physical phenotype and broad phenotype, the first defining frailty as a purely physical condition and the second also including psychosocial aspects. Reported prevalence in the community varies enormously (range 4.0-59.1%). The overall weighted prevalence of frailty was 10.7% (95% confidence interval (CI) = 10.5-10.9; 21 studies; 61,500 participants). The weighted prevalence was 9.9% for physical frailty (95% CI = 9.6-10.2; 15 studies; 44,894 participants) and 13.6% for the broad phenotype of frailty (95% CI = 13.2-14.0; 8 studies; 24,072 participants) (chi-square (χ(2) ) = 217.7, degrees of freedom (df)=1, P < .001). Prevalence increased with age (χ(2) = 6067, df = 1, P < .001) and was higher in women (9.6%, 95% CI = 9.2-10.0%) than in men (5.2%, 95% CI = 4.9-5.5%; χ(2) = 298.9 df = 1, P < .001). Frailty is common in later life, but different operationalization of frailty status results in widely differing prevalence between studies. Improving the comparability of epidemiological and clinical studies constitutes an important step forward. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.
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                Author and article information

                Journal
                spmj
                Sao Paulo Medical Journal
                Sao Paulo Med. J.
                Associação Paulista de Medicina - APM (São Paulo, SP, Brazil )
                1516-3180
                1806-9460
                December 2020
                : 138
                : 6
                : 465-474
                Affiliations
                [5] Brasília Distrito Federal orgnameUniversidade de Brasília orgdiv1Campus Darcy Ribeiro Brazil
                [4] Uberaba Minas Gerais orgnameUniversidade Federal do Triângulo Mineiro orgdiv1Department of Nursing Education and Community Health Nursing Undergraduate Program Brazil
                [6] Brasília Distrito Federal orgnameUniversidade de Brasília orgdiv1Campus Darcy Ribeiro Brazil
                [1] Brasília Distrito Federal orgnameUniversidade de Brasília orgdiv1Campus Darcy Ribeiro Brazil
                [3] Macapá Amapá orgnameUniversidade Federal do Amapá Brazil
                [2] Uberaba Minas Gerais orgnameUniversidade Federal do Triângulo Mineiro Brazil
                Article
                S1516-31802020000600465 S1516-3180(20)13800600465
                10.1590/1516-3180.2020.0205.r1.06082020
                8b26e4c1-16fa-4b9a-8415-4b90552d54d5

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 06 August 2020
                : 01 May 2020
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 54, Pages: 10
                Product

                SciELO Brazil

                Self URI: Full text available only in PDF format (EN)
                Categories
                Original Articles

                Potentially inappropriate medication list,Polypharmacy among older people,Frail older people,Older people,Drug interactions,Polypharmacy

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