Polypharmacy cutoff and outcomes: five or more medicines were used to identify community-dwelling older men at risk of different adverse outcomes

被引：841

作者：

Gnjidic, Danijela ^{[1
,2
,3
,4
]}

Hilmer, Sarah N. ^{[1
,2
,3
]}

Blyth, Fiona M. ^{[3
,4
,5
]}

Naganathan, Vasi ^{[3
,4
]}

Waite, Louise ^{[3
,4
]}

Seibel, Markus J. ^{[3
,6
,7
]}

McLachlan, Andrew J. ^{[4
,8
]}

Cumming, Robert G. ^{[3
,4
,9
]}

Handelsman, David J. ^{[3
,6
]}

Le Couteur, David G. ^{[3
,4
,6
]}

机构：

[1] Univ Sydney, Royal N Shore Hosp, Sydney Med Sch, Dept Clin Pharmacol, St Leonards, NSW 2065, Australia

[2] Royal N Shore Hosp, Dept Aged Care, St Leonards, NSW 2065, Australia

[3] Univ Sydney, Sydney Med Sch, Camperdown, NSW 2006, Australia

[4] Concord Hosp, Ctr Educ & Res Ageing, Concord, NSW 2139, Australia

[5] Sax Inst, Haymarket, NSW 2000, Australia

[6] Concord Hosp, ANZAC Res Inst, Concord, NSW 2139, Australia

[7] Concord Repat Gen Hosp, Dept Endocrinol & Metab, Concord, NSW 2139, Australia

[8] Univ Sydney, Fac Pharm, Camperdown, NSW 2006, Australia

[9] Univ Sydney, Sydney Sch Publ Hlth, Camperdown, NSW 2006, Australia

来源：

JOURNAL OF CLINICAL EPIDEMIOLOGY | 2012年 / 65卷 / 09期

基金：

英国医学研究理事会;

关键词：

Medications; Polypharmacy cutoff; Geriatric syndromes; Functional outcomes; Mortality; Older adults; INTERNATIONAL WORKSHOP; CLINICAL-PHARMACOLOGY; COGNITIVE DECLINE; CONCORD HEALTH; MEDICATION USE; SHORT-FORM; FALLS; FRAILTY; DEMENTIA; DRUGS;

D O I：

10.1016/j.jclinepi.2012.02.018

中图分类号：

R19 [保健组织与事业（卫生事业管理）];

学科分类号：

摘要：

Objective: This study aimed to determine an optimal discriminating number of concomitant medications associated with geriatric syndromes, functional outcomes, and mortality in community-dwelling older men. Study Design and Setting: Older men aged >= 70 years (n = 1,705), enrolled in the Concord Health and Aging in Men Project were studied. Receiver operating characteristic curve analysis using the Youden Index and the area under the curve was performed to determine discriminating number of medications in relation to each outcome. Results: The highest value of the Youden Index for frailty was obtained for a cutoff point of 6.5 medications compared with a cutoff of 5.5 for disability and 3.5 for cognitive impairment. For mortality and incident falls, the highest value of Youden Index was obtained for a cutoff of 4.5 medications. For every one increase in number of medications, the adjusted odds ratios were 1.13 (95% confidence interval [CI] = 1.06-1.21) for frailty, 1.08 (95% CI = 1.00-1.15) for disability, 1.09 (95% CI = 1.04-1.15) for mortality, and 1.07 (95% CI = 1.03-1.12) for incident falls. There was no association between increasing number of medications and cognitive impairment. Conclusion: The study supports the use of five or more medications in the current definition of polypharmacy to estimate the medication-related adverse effects for frailty, disability, mortality, and falls. Crown Copyright (C) 2012 Published by Elsevier Inc. All rights reserved.

引用

页码：989 / 995

页数：7

共 41 条

[21] Association of polypharmacy with nutritional status, functional ability and cognitive capacity over a three-year period in an elderly population [J].