Relationship Between Frailty and Drug Use Among Nursing Homes Residents: Results from the SHELTER Study

Overview

Journal Aging Clin Exp Res

Publisher Springer

Specialty Geriatrics

Date 2021 Feb 16

PMID 33590468

Citations 9

Authors

Emanuele Rocco Villani

Davide Liborio Vetrano

Rosa Liperoti

Katie Palmer

Michael Denkinger

Henriette G van der Roest

Roberto Bernabei

Graziano Onder

Affiliations

Soon will be listed here.

Abstract

Background: 1.5-8% of older adults live in nursing homes (NHs), presenting a high prevalence of frailty and polypharmacy.

Aims: To investigate the association of frailty with polypharmacy and drug prescription patterns in a sample of European Nursing Home (NH) residents.

Methods: Cross-sectional study based on the data from the Services and Health for Elderly in Long TERm care (SHELTER) study. 4121 NH residents in Europe and Israel. Residents' clinical, cognitive, social, and physical status were evaluated with the InterRAI LTCF tool, which allows comprehensive, standardized evaluation of persons living in NH. Polypharmacy and hyperpolypharmacy were defined as the concurrent use of ≥ 5 and ≥ 10 medications. Frailty was defined according to the FRAIL-NH scale.

Results: Of 4121 participants, 46.6% were frail (mean age 84.6 ± 9.2 years; 76.4% female). Polypharmacy and hyperpolypharmacy were associated with a lower likelihood of frailty (Odds Ratio = 0.72; 95% CI = 0.59-0.87 and OR = 0.75; 95% CI = 0.60-0.94, respectively). Patterns of drug prescriptions were different between frail and non-frail residents. Symptomatic drugs (laxatives, paracetamol, and opioids) were more frequently prescribed among frail residents, while preventive drugs (bisphosphonates, vitamin D, and acetylsalicylic acid) were more frequently prescribed among non-frail residents.

Conclusions: Frailty is associated with less polypharmacy and with higher prevalence of symptomatic drugs use among NH residents. Further studies are needed to define appropriateness of drug prescription in frail individuals.

Citing Articles

Prevalence of potentially inappropriate medications according to STOPP-Frail criteria in nursing home residents, the SHELTER study.

Malek Makan A, van Hout H, Onder G, Finne-Soveri H, Fialova D, van Marum R BMC Geriatr. 2024; 24(1):882.

PMID: 39462318 PMC: 11515093. DOI: 10.1186/s12877-024-05450-y.

Polypharmacy and Antibody Response to SARS-CoV-2 Vaccination in Residents of Long-Term Care Facilities: The GeroCovid Vax Study.

Trevisan C, Haxhiaj L, Malara A, Abbatecola A, Fedele G, Palmieri A Drugs Aging. 2023; 40(12):1133-1141.

PMID: 37938521 DOI: 10.1007/s40266-023-01075-9.

Symptomatic and preventive medication use according to age and frailty in Australian and Japanese nursing homes.

Liau S, Hamada S, Jadczak A, Sakata N, Lalic S, Tsuchiya-Ito R Aging Clin Exp Res. 2023; 35(12):3047-3057.

PMID: 37934399 PMC: 10721681. DOI: 10.1007/s40520-023-02600-x.

Frailty modifies the effect of polypharmacy and multimorbidity on the risk of death among nursing home residents: Results from the SHELTER study.

Zazzara M, Villani E, Palmer K, Fialova D, Corsonello A, Soraci L Front Med (Lausanne). 2023; 10:1091246.

PMID: 36817789 PMC: 9929152. DOI: 10.3389/fmed.2023.1091246.

Sarcopenia is associated with a greater risk of polypharmacy and number of medications: a systematic review and meta-analysis.

Prokopidis K, Giannos P, Reginster J, Bruyere O, Petrovic M, Cherubini A J Cachexia Sarcopenia Muscle. 2023; 14(2):671-683.

PMID: 36781175 PMC: 10067503. DOI: 10.1002/jcsm.13190.

References

Kojima G . Frailty as a Predictor of Nursing Home Placement Among Community-Dwelling Older Adults: A Systematic Review and Meta-analysis. J Geriatr Phys Ther. 2016; 41(1):42-48. DOI: 10.1519/JPT.0000000000000097. View

Morley J, Vellas B, Abellan van Kan G, Anker S, Bauer J, Bernabei R . Frailty consensus: a call to action. J Am Med Dir Assoc. 2013; 14(6):392-7. PMC: 4084863. DOI: 10.1016/j.jamda.2013.03.022. View

Collard R, Boter H, Schoevers R, Oude Voshaar R . Prevalence of frailty in community-dwelling older persons: a systematic review. J Am Geriatr Soc. 2012; 60(8):1487-92. DOI: 10.1111/j.1532-5415.2012.04054.x. View

Cesari M, Calvani R, Marzetti E . Frailty in Older Persons. Clin Geriatr Med. 2017; 33(3):293-303. DOI: 10.1016/j.cger.2017.02.002. View

Vetrano D, Villani E, Grande G, Giovannini S, Cipriani M, Manes-Gravina E . Association of Polypharmacy With 1-Year Trajectories of Cognitive and Physical Function in Nursing Home Residents: Results From a Multicenter European Study. J Am Med Dir Assoc. 2018; 19(8):710-713. DOI: 10.1016/j.jamda.2018.04.008. View

Maher R, Hanlon J, Hajjar E . Clinical consequences of polypharmacy in elderly. Expert Opin Drug Saf. 2013; 13(1):57-65. PMC: 3864987. DOI: 10.1517/14740338.2013.827660. View

Palmer K, Villani E, Vetrano D, Cherubini A, Cruz-Jentoft A, Curtin D . Association of polypharmacy and hyperpolypharmacy with frailty states: a systematic review and meta-analysis. Eur Geriatr Med. 2020; 10(1):9-36. DOI: 10.1007/s41999-018-0124-5. View

Shmuel S, Lund J, Alvarez C, Hsu C, Palta P, Kucharska-Newton A . Polypharmacy and Incident Frailty in a Longitudinal Community-Based Cohort Study. J Am Geriatr Soc. 2019; 67(12):2482-2489. DOI: 10.1111/jgs.16212. View

Hasan S, Kow C, Thiruchelvam K, Chong D, Ahmed S . An Evaluation of the Central Nervous System Medication Use and Frailty among Residents of Aged Care Homes in Malaysia. Neuroepidemiology. 2017; 49(1-2):82-90. DOI: 10.1159/000480433. View

10.

Gutierrez-Valencia M, Izquierdo M, Lacalle-Fabo E, Marin-Epelde I, Ramon-Espinoza M, Domene-Domene T . Relationship between frailty, polypharmacy, and underprescription in older adults living in nursing homes. Eur J Clin Pharmacol. 2018; 74(7):961-970. DOI: 10.1007/s00228-018-2452-2. View

11.

Maclagan L, Maxwell C, Gandhi S, Guan J, Bell C, Hogan D . Frailty and Potentially Inappropriate Medication Use at Nursing Home Transition. J Am Geriatr Soc. 2017; 65(10):2205-2212. DOI: 10.1111/jgs.15016. View

12.

Onder G, Carpenter I, Finne-Soveri H, Gindin J, Frijters D, Henrard J . Assessment of nursing home residents in Europe: the Services and Health for Elderly in Long TERm care (SHELTER) study. BMC Health Serv Res. 2012; 12:5. PMC: 3286368. DOI: 10.1186/1472-6963-12-5. View

13.

Kaehr E, Visvanathan R, Malmstrom T, Morley J . Frailty in nursing homes: the FRAIL-NH Scale. J Am Med Dir Assoc. 2015; 16(2):87-9. DOI: 10.1016/j.jamda.2014.12.002. View

14.

De Silva T, Theou O, Vellas B, Cesari M, Visvanathan R . Frailty Screening (FRAIL-NH) and Mortality in French Nursing Homes: Results From the Incidence of Pneumonia and Related Consequences in Nursing Home Residents Study. J Am Med Dir Assoc. 2018; 19(5):411-414. DOI: 10.1016/j.jamda.2017.12.101. View

15.

Buckinx F, Croisier J, Reginster J, Lenaerts C, Brunois T, Rygaert X . Prediction of the Incidence of Falls and Deaths Among Elderly Nursing Home Residents: The SENIOR Study. J Am Med Dir Assoc. 2017; 19(1):18-24. DOI: 10.1016/j.jamda.2017.06.014. View

16.

Si H, Jin Y, Qiao X, Tian X, Liu X, Wang C . Comparing Diagnostic Properties of the FRAIL-NH Scale and 4 Frailty Screening Instruments among Chinese Institutionalized Older Adults. J Nutr Health Aging. 2020; 24(2):188-193. DOI: 10.1007/s12603-019-1301-z. View

17.

Burrows A, Morris J, SIMON S, Hirdes J, Phillips C . Development of a minimum data set-based depression rating scale for use in nursing homes. Age Ageing. 2000; 29(2):165-72. DOI: 10.1093/ageing/29.2.165. View

18.

Buckinx F, Reginster J, Gillain S, Petermans J, Brunois T, Bruyere O . Prevalence of Frailty in Nursing Home Residents According to Various Diagnostic Tools. J Frailty Aging. 2017; 6(3):122-128. DOI: 10.14283/jfa.2017.20. View

19.

Luppa M, Luck T, Weyerer S, Konig H, Riedel-Heller S . Gender differences in predictors of nursing home placement in the elderly: a systematic review. Int Psychogeriatr. 2009; 21(6):1015-25. DOI: 10.1017/S1041610209990238. View

20.

Abate M, Di Iorio A, Di Renzo D, Paganelli R, Saggini R, Abate G . Frailty in the elderly: the physical dimension. Eura Medicophys. 2006; 43(3):407-15. View