Polypharmacy ups death risk in older adults

Polypharmacy appears to be common among older adults and aggravates mortality risk, reports a recent Denmark study.

Researchers conducted a nationwide registry-based study including 1,338,058 elderly adults (age ≥65 years, 53.8 percent women). Polypharmacy was defined as the concurrent monthly intake of ≥5 different medications. Excessive polypharmacy, on the other hand, was set as the monthly intake of ≥10 different medications. The primary outcome was mortality.

At the time of inclusion, the prevalence of polypharmacy and excessive polypharmacy was 29 percent and 4.7 percent, respectively. Those with multimorbidity, defined as having ≥2 chronic conditions, were nearly 30 times more likely to report polypharmacy (odds ratio [OR], 26.6, 95 percent confidence interval [CI], 26.2–27.1).

Of the participants without polypharmacy at inclusion, 46.9 percent (n=445,947) transitioned into polypharmacy, and 17.7 percent (n=225,357) into excessive polypharmacy, during follow-up. Similarly, older adults with multimorbidity saw significantly higher rates of transitioning into polypharmacy (OR, 3.51, 95 percent CI, 3.48–3.53).

In turn, polypharmacy increased the risk of mortality by nearly fourfold (hazard ratio [HR], 3.95, 95 percent CI, 3.90–4.01), according to Cox regression analysis adjusted for confounders. This effect was only slightly attenuated after propensity score matching but otherwise remained significant (HR, 3.48, 95 percent CI, 3.41–3.54).

“These findings support the notion that polypharmacy in and of itself may have adverse health consequences,” the researchers said. “Future research should aim to describe the appropriateness of polypharmacy in order for us to gain a deeper understanding of the exposure and its relation to death.”