The impact of high-risk medications on mortality risk among older adults with polypharmacy: evidence from the English Longitudinal Study of Ageing
Abstract Background Polypharmacy is common among older people and is associated with an increased mortality risk. However, little is known about whether the mortality risk is related to specific medications among older adults with polypharmacy. This study therefore aimed to investigate associations...
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2021-12-01
|
| Series: | BMC Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12916-021-02192-1 |
| _version_ | 1819096275019104256 |
|---|---|
| author | Yun-Ting Huang Andrew Steptoe Li Wei Paola Zaninotto |
| author_facet | Yun-Ting Huang Andrew Steptoe Li Wei Paola Zaninotto |
| author_sort | Yun-Ting Huang |
| collection | DOAJ |
| description | Abstract Background Polypharmacy is common among older people and is associated with an increased mortality risk. However, little is known about whether the mortality risk is related to specific medications among older adults with polypharmacy. This study therefore aimed to investigate associations between high-risk medications and all-cause and cause-specific mortality among older adults with polypharmacy. Methods This study included 1356 older adults with polypharmacy (5+ long-term medications a day for conditions or symptoms) from Wave 6 (2012/2013) of the English Longitudinal Study of Ageing. First, using the agglomerative hierarchical clustering method, participants were grouped according to the use of 14 high-risk medication categories. Next, the relationship between the high-risk medication patterns and all-cause and cause-specific mortality (followed up to April 2018) was examined. All-cause mortality was assessed by Cox proportional hazards model and competing-risk regression was employed for cause-specific mortality. Results Five high-risk medication patterns—a renin-angiotensin-aldosterone system (RAAS) inhibitors cluster, a mental health drugs cluster, a central nervous system (CNS) drugs cluster, a RAAS inhibitors and antithrombotics cluster, and an antithrombotics cluster—were identified. The mental health drugs cluster showed increased risks of all-cause (HR = 1.55, 95%CI = 1.05, 2.28) and cardiovascular disease (CVD) (SHR = 2.11, 95%CI = 1.10, 4.05) mortality compared with the CNS drug cluster over 6 years, while others showed no differences in mortality. Among these patterns, the mental health drugs cluster showed the highest prevalence of antidepressants (64.1%), benzodiazepines (10.4%), antipsychotics (2.4%), antimanic agents (0.7%), opioids (33.2%), and muscle relaxants (21.5%). The findings suggested that older adults with polypharmacy who took mental health drugs (primarily antidepressants), opioids, and muscle relaxants were at higher risk of all-cause and CVD mortality, compared with those who did not take these types of medications. Conclusions This study supports the inclusion of opioids in the current guidance on structured medication reviews, but it also suggests that older adults with polypharmacy who take psychotropic medications and muscle relaxants are prone to adverse outcomes and therefore may need more attention. The reinforcement of structured medication reviews would contribute to early intervention in medication use which may consequently reduce medication-related problems and bring clinical benefits to older adults with polypharmacy. |
| first_indexed | 2024-12-21T23:56:36Z |
| format | Article |
| id | doaj.art-6dc349b235b04e7c906fb9e5379f709a |
| institution | Directory Open Access Journal |
| issn | 1741-7015 |
| language | English |
| last_indexed | 2024-12-21T23:56:36Z |
| publishDate | 2021-12-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Medicine |
| spelling | doaj.art-6dc349b235b04e7c906fb9e5379f709a2022-12-21T18:45:48ZengBMCBMC Medicine1741-70152021-12-0119111310.1186/s12916-021-02192-1The impact of high-risk medications on mortality risk among older adults with polypharmacy: evidence from the English Longitudinal Study of AgeingYun-Ting Huang0Andrew Steptoe1Li Wei2Paola Zaninotto3Department of Epidemiology and Public Health, University College LondonDepartment of Behavioural Science and Health, University College LondonSchool of Pharmacy, University College LondonDepartment of Epidemiology and Public Health, University College LondonAbstract Background Polypharmacy is common among older people and is associated with an increased mortality risk. However, little is known about whether the mortality risk is related to specific medications among older adults with polypharmacy. This study therefore aimed to investigate associations between high-risk medications and all-cause and cause-specific mortality among older adults with polypharmacy. Methods This study included 1356 older adults with polypharmacy (5+ long-term medications a day for conditions or symptoms) from Wave 6 (2012/2013) of the English Longitudinal Study of Ageing. First, using the agglomerative hierarchical clustering method, participants were grouped according to the use of 14 high-risk medication categories. Next, the relationship between the high-risk medication patterns and all-cause and cause-specific mortality (followed up to April 2018) was examined. All-cause mortality was assessed by Cox proportional hazards model and competing-risk regression was employed for cause-specific mortality. Results Five high-risk medication patterns—a renin-angiotensin-aldosterone system (RAAS) inhibitors cluster, a mental health drugs cluster, a central nervous system (CNS) drugs cluster, a RAAS inhibitors and antithrombotics cluster, and an antithrombotics cluster—were identified. The mental health drugs cluster showed increased risks of all-cause (HR = 1.55, 95%CI = 1.05, 2.28) and cardiovascular disease (CVD) (SHR = 2.11, 95%CI = 1.10, 4.05) mortality compared with the CNS drug cluster over 6 years, while others showed no differences in mortality. Among these patterns, the mental health drugs cluster showed the highest prevalence of antidepressants (64.1%), benzodiazepines (10.4%), antipsychotics (2.4%), antimanic agents (0.7%), opioids (33.2%), and muscle relaxants (21.5%). The findings suggested that older adults with polypharmacy who took mental health drugs (primarily antidepressants), opioids, and muscle relaxants were at higher risk of all-cause and CVD mortality, compared with those who did not take these types of medications. Conclusions This study supports the inclusion of opioids in the current guidance on structured medication reviews, but it also suggests that older adults with polypharmacy who take psychotropic medications and muscle relaxants are prone to adverse outcomes and therefore may need more attention. The reinforcement of structured medication reviews would contribute to early intervention in medication use which may consequently reduce medication-related problems and bring clinical benefits to older adults with polypharmacy.https://doi.org/10.1186/s12916-021-02192-1AgeingOlder peopleHigh-risk medicationsMental health drugsOpioidsMuscle relaxants |
| spellingShingle | Yun-Ting Huang Andrew Steptoe Li Wei Paola Zaninotto The impact of high-risk medications on mortality risk among older adults with polypharmacy: evidence from the English Longitudinal Study of Ageing BMC Medicine Ageing Older people High-risk medications Mental health drugs Opioids Muscle relaxants |
| title | The impact of high-risk medications on mortality risk among older adults with polypharmacy: evidence from the English Longitudinal Study of Ageing |
| title_full | The impact of high-risk medications on mortality risk among older adults with polypharmacy: evidence from the English Longitudinal Study of Ageing |
| title_fullStr | The impact of high-risk medications on mortality risk among older adults with polypharmacy: evidence from the English Longitudinal Study of Ageing |
| title_full_unstemmed | The impact of high-risk medications on mortality risk among older adults with polypharmacy: evidence from the English Longitudinal Study of Ageing |
| title_short | The impact of high-risk medications on mortality risk among older adults with polypharmacy: evidence from the English Longitudinal Study of Ageing |
| title_sort | impact of high risk medications on mortality risk among older adults with polypharmacy evidence from the english longitudinal study of ageing |
| topic | Ageing Older people High-risk medications Mental health drugs Opioids Muscle relaxants |
| url | https://doi.org/10.1186/s12916-021-02192-1 |
| work_keys_str_mv | AT yuntinghuang theimpactofhighriskmedicationsonmortalityriskamongolderadultswithpolypharmacyevidencefromtheenglishlongitudinalstudyofageing AT andrewsteptoe theimpactofhighriskmedicationsonmortalityriskamongolderadultswithpolypharmacyevidencefromtheenglishlongitudinalstudyofageing AT liwei theimpactofhighriskmedicationsonmortalityriskamongolderadultswithpolypharmacyevidencefromtheenglishlongitudinalstudyofageing AT paolazaninotto theimpactofhighriskmedicationsonmortalityriskamongolderadultswithpolypharmacyevidencefromtheenglishlongitudinalstudyofageing AT yuntinghuang impactofhighriskmedicationsonmortalityriskamongolderadultswithpolypharmacyevidencefromtheenglishlongitudinalstudyofageing AT andrewsteptoe impactofhighriskmedicationsonmortalityriskamongolderadultswithpolypharmacyevidencefromtheenglishlongitudinalstudyofageing AT liwei impactofhighriskmedicationsonmortalityriskamongolderadultswithpolypharmacyevidencefromtheenglishlongitudinalstudyofageing AT paolazaninotto impactofhighriskmedicationsonmortalityriskamongolderadultswithpolypharmacyevidencefromtheenglishlongitudinalstudyofageing |