Frailty modifies the effect of polypharmacy and multimorbidity on the risk of death among nursing home residents: Results from the SHELTER study
BackgroundFrailty, disability, and polypharmacy are prevalent in nursing home (NH) residents, often co-occurring with multimorbidity. There may be a complex interplay among them in terms of outcomes such as mortality. Aims of the study were to (i) assess whether nursing home residents with polypharm...
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Frontiers Media S.A.
2023-02-01
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| Series: | Frontiers in Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2023.1091246/full |
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| author | Maria Beatrice Zazzara Emanuele Rocco Villani Katie Palmer Daniela Fialova Andrea Corsonello Luca Soraci Domenico Fusco Maria Camilla Cipriani Michael Denkinger Graziano Onder Graziano Onder Rosa Liperoti Rosa Liperoti |
| author_facet | Maria Beatrice Zazzara Emanuele Rocco Villani Katie Palmer Daniela Fialova Andrea Corsonello Luca Soraci Domenico Fusco Maria Camilla Cipriani Michael Denkinger Graziano Onder Graziano Onder Rosa Liperoti Rosa Liperoti |
| author_sort | Maria Beatrice Zazzara |
| collection | DOAJ |
| description | BackgroundFrailty, disability, and polypharmacy are prevalent in nursing home (NH) residents, often co-occurring with multimorbidity. There may be a complex interplay among them in terms of outcomes such as mortality. Aims of the study were to (i) assess whether nursing home residents with polypharmacy (5–9 medications) or hyperpolypharmacy (≥10 drugs), have an increased risk of death and (ii) whether any association is modified by the co-presence of frailty or disability.MethodsCohort study with longitudinal mortality data including 4,023 residents from 50 European and 7 Israeli NH facilities (mean age = 83.6 years, 73.2% female) in The Services and Health for Elderly in Long Term care (SHELTER) cohort study. Participants were evaluated with the interRAI-LongTerm Care assessment tool. Frailty was evaluated with the FRAIL-NH scale. Hazard ratio (HR) of death over 12 months was assessed with stratified Cox proportional hazards models adjusted for demographics, facilities, and cognitive status.Results1,042 (25.9%) participants were not on polypharmacy, 49.8% (n = 2,002) were on polypharmacy, and 24.3% (n = 979) on hyperpolypharmacy. Frailty and disability mostly increased risk of death in the study population (frailty: HR = 1.85, 95%CI 1.49–2.28; disability: HR = 2.10, 95%CI 1.86–2.47). Among non-frail participants, multimorbidity (HR = 1.34, 95%CI = 1.01–1.82) and hyperpolypharmacy (HR = 1.61, 95%CI = 1.09–2.40) were associated with higher risk of death. Among frail participants, no other factors were associated with mortality. Polypharmacy and multimorbidity were not associated with mortality after stratification for disability.ConclusionsFrailty and disability are the strongest predictors of death in NH residents. Multimorbidity and hyperpolypharmacy increase mortality only in people without frailty. These findings may be relevant to identify patients who could benefit from tailored deprescription. |
| first_indexed | 2024-04-10T18:51:04Z |
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| id | doaj.art-1c66000254fc46ac8d683baa5ab71bbf |
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| language | English |
| last_indexed | 2024-04-10T18:51:04Z |
| publishDate | 2023-02-01 |
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| spelling | doaj.art-1c66000254fc46ac8d683baa5ab71bbf2023-02-01T06:33:37ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2023-02-011010.3389/fmed.2023.10912461091246Frailty modifies the effect of polypharmacy and multimorbidity on the risk of death among nursing home residents: Results from the SHELTER studyMaria Beatrice Zazzara0Emanuele Rocco Villani1Katie Palmer2Daniela Fialova3Andrea Corsonello4Luca Soraci5Domenico Fusco6Maria Camilla Cipriani7Michael Denkinger8Graziano Onder9Graziano Onder10Rosa Liperoti11Rosa Liperoti12Fondazione Policlinico Universitario A. Gemelli IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Polo Interdipartimentale Scienze Dell'Invecchiamento, Neuroscienze, Testa-collo ed Ortopedia, Rome, ItalyUniversità Cattolica del Sacro Cuore, Polo Interdipartimentale Scienze Dell'Invecchiamento, Neuroscienze, Testa-collo ed Ortopedia, Rome, ItalyUniversità Cattolica del Sacro Cuore, Polo Interdipartimentale Scienze Dell'Invecchiamento, Neuroscienze, Testa-collo ed Ortopedia, Rome, ItalyDepartment of Geriatrics and Gerontology, 1st Faculty of Medicine, Charles University, Prague, CzechiaUnit of Geriatric Medicine, IRCCS INRCA (Istituto Nazionale Ricovero e Cura Anziani), Dipartimento di Medicina Interna e Terapia Medica, Cosenza, ItalyUnit of Geriatric Medicine, IRCCS INRCA (Istituto Nazionale Ricovero e Cura Anziani), Dipartimento di Medicina Interna e Terapia Medica, Cosenza, ItalyFondazione Policlinico Universitario A. Gemelli IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Polo Interdipartimentale Scienze Dell'Invecchiamento, Neuroscienze, Testa-collo ed Ortopedia, Rome, ItalyFondazione Policlinico Universitario A. Gemelli IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Polo Interdipartimentale Scienze Dell'Invecchiamento, Neuroscienze, Testa-collo ed Ortopedia, Rome, ItalyAGAPLESION Bethesda Ulm, Geriatric Research Ulm University and Geriatric Center Ulm/Alb Donau, Ulm, GermanyFondazione Policlinico Universitario A. Gemelli IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Polo Interdipartimentale Scienze Dell'Invecchiamento, Neuroscienze, Testa-collo ed Ortopedia, Rome, ItalyUniversità Cattolica del Sacro Cuore, Polo Interdipartimentale Scienze Dell'Invecchiamento, Neuroscienze, Testa-collo ed Ortopedia, Rome, ItalyFondazione Policlinico Universitario A. Gemelli IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Polo Interdipartimentale Scienze Dell'Invecchiamento, Neuroscienze, Testa-collo ed Ortopedia, Rome, ItalyUniversità Cattolica del Sacro Cuore, Polo Interdipartimentale Scienze Dell'Invecchiamento, Neuroscienze, Testa-collo ed Ortopedia, Rome, ItalyBackgroundFrailty, disability, and polypharmacy are prevalent in nursing home (NH) residents, often co-occurring with multimorbidity. There may be a complex interplay among them in terms of outcomes such as mortality. Aims of the study were to (i) assess whether nursing home residents with polypharmacy (5–9 medications) or hyperpolypharmacy (≥10 drugs), have an increased risk of death and (ii) whether any association is modified by the co-presence of frailty or disability.MethodsCohort study with longitudinal mortality data including 4,023 residents from 50 European and 7 Israeli NH facilities (mean age = 83.6 years, 73.2% female) in The Services and Health for Elderly in Long Term care (SHELTER) cohort study. Participants were evaluated with the interRAI-LongTerm Care assessment tool. Frailty was evaluated with the FRAIL-NH scale. Hazard ratio (HR) of death over 12 months was assessed with stratified Cox proportional hazards models adjusted for demographics, facilities, and cognitive status.Results1,042 (25.9%) participants were not on polypharmacy, 49.8% (n = 2,002) were on polypharmacy, and 24.3% (n = 979) on hyperpolypharmacy. Frailty and disability mostly increased risk of death in the study population (frailty: HR = 1.85, 95%CI 1.49–2.28; disability: HR = 2.10, 95%CI 1.86–2.47). Among non-frail participants, multimorbidity (HR = 1.34, 95%CI = 1.01–1.82) and hyperpolypharmacy (HR = 1.61, 95%CI = 1.09–2.40) were associated with higher risk of death. Among frail participants, no other factors were associated with mortality. Polypharmacy and multimorbidity were not associated with mortality after stratification for disability.ConclusionsFrailty and disability are the strongest predictors of death in NH residents. Multimorbidity and hyperpolypharmacy increase mortality only in people without frailty. These findings may be relevant to identify patients who could benefit from tailored deprescription.https://www.frontiersin.org/articles/10.3389/fmed.2023.1091246/fulldrugshyperpolypharmacyfrailtylong-term care facilitymortality |
| spellingShingle | Maria Beatrice Zazzara Emanuele Rocco Villani Katie Palmer Daniela Fialova Andrea Corsonello Luca Soraci Domenico Fusco Maria Camilla Cipriani Michael Denkinger Graziano Onder Graziano Onder Rosa Liperoti Rosa Liperoti Frailty modifies the effect of polypharmacy and multimorbidity on the risk of death among nursing home residents: Results from the SHELTER study Frontiers in Medicine drugs hyperpolypharmacy frailty long-term care facility mortality |
| title | Frailty modifies the effect of polypharmacy and multimorbidity on the risk of death among nursing home residents: Results from the SHELTER study |
| title_full | Frailty modifies the effect of polypharmacy and multimorbidity on the risk of death among nursing home residents: Results from the SHELTER study |
| title_fullStr | Frailty modifies the effect of polypharmacy and multimorbidity on the risk of death among nursing home residents: Results from the SHELTER study |
| title_full_unstemmed | Frailty modifies the effect of polypharmacy and multimorbidity on the risk of death among nursing home residents: Results from the SHELTER study |
| title_short | Frailty modifies the effect of polypharmacy and multimorbidity on the risk of death among nursing home residents: Results from the SHELTER study |
| title_sort | frailty modifies the effect of polypharmacy and multimorbidity on the risk of death among nursing home residents results from the shelter study |
| topic | drugs hyperpolypharmacy frailty long-term care facility mortality |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2023.1091246/full |
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