Study, 2019: "How do potentially inappropriate medications and polypharmacy...."

The full title of this UK study is "How do potentially inappropriate medications and polypharmacy affect mortality in frail and non-frail cognitively impaired older adults? A cohort study".

 

Full Study:

 

https://bmjopen.bmj.com/content/9/5/e026171

 

 

Abstract

 

Objectives To test whether the use of potentially inappropriate central nervous system acting medications, proton pump inhibitors (PPIs) or polypharmacy are associated with mortality in cognitively impaired older adults and whether frailer people are at greater risk of harm.

 

Setting A cohort study nested within the Cognitive Function and Ageing Study II, a population representative cohort study of the older population in Cambridgeshire, Nottingham and Newcastle, UK.

 

Participants A total of 1154 cognitively impaired participants, aged 65 years or older.

 

Exposures Any use of antipsychotics, antidepressants, other anticholinergic medication, benzodiazepines or PPIs, polypharmacy (5–9) and hyperpolypharmacy (≥10 reported medications) were ascertained at baseline. Frailty was assessed using the Fried criteria.

 

Primary outcome Mortality up to 8 years follow-up. HRs associated with potentially inappropriate medication (PIM), frailty and their interaction were estimated adjusting for covariates.

 

Results Within the sample, 44% were taking one or more PIM. Apart from antipsychotics (adjusted HR=3.24, 95% CI 1.83 to 5.73), use of specific PIM was not associated with greater subsequent mortality. Polypharmacy (HR=1.17, 95% CI 0.95 to 1.45) and hyperpolypharmacy were associated with mortality (HR=1.60, 95% CI 1.16 to 2.22). Being frail (HR=1.90, 95% CI 1.32 to 2.72) or prefrail (HR=1.56, 95% CI 1.10 to 2.20) was associated with increased mortality. There was some evidence that the HR for polypharmacy on mortality was lower among frailer individuals, but the overall polypharmacy by frailty interaction was not statistically significant (p=0.102).

 

Conclusions For those with cognitive impairment, greater concern should be afforded to the number of medications than the prescription of specific classes. Frailer individuals may have a lower relative risk of mortality associated with polypharmacy than less frail individuals. 

The full title of this UK study is "How do potentially inappropriate medications and polypharmacy affect mortality in frail and non-frail cognitively impaired older adults? A cohort study".

Full Study:

https://bmjopen.bmj.com/content/9/5/e026171

Participants A total of 1154 cognitively impaired participants, aged 65 years or older.

 

Exposures Any use of antipsychotics, antidepressants, other anticholinergic medication, benzodiazepines or PPIs, polypharmacy (5–9) and hyperpolypharmacy (≥10 reported medications) were ascertained at baseline. Frailty was assessed using the Fried criteria.

 

Results Within the sample, 44% were taking one or more PIM. Apart from antipsychotics (adjusted HR=3.24, 95% CI 1.83 to 5.73), use of specific PIM was not associated with greater subsequent mortality. Polypharmacy (HR=1.17, 95% CI 0.95 to 1.45) and hyperpolypharmacy were associated with mortality (HR=1.60, 95% CI 1.16 to 2.22). Being frail (HR=1.90, 95% CI 1.32 to 2.72) or prefrail (HR=1.56, 95% CI 1.10 to 2.20) was associated with increased mortality. There was some evidence that the HR for polypharmacy on mortality was lower among frailer individuals, but the overall polypharmacy by frailty interaction was not statistically significant (p=0.102).

 

 

the most disturbing part of this was:

polypharmacy (5–9) and hyperpolypharmacy (≥10 reported medications)

like really? hyperpolypharmacy?? good lord and i thought I had it bad. i'm just polypharmed. not hyperpolypharmed.

 

I know! It's just mind-boggling to me. Even two medications can interact. If you just keep adding more chemicals to the mix, then you've got chemical soup. How can any doctor prescribe so many meds in good conscience? Perhaps it's because there are numerous doctors prescribing to one patient.

I know! It's just mind-boggling to me. Even two medications can interact. If you just keep adding more chemicals to the mix, then you've got chemical soup. How can any doctor prescribe so many meds in good conscience? Perhaps it's because there are numerous doctors prescribing to one patient.

yeah Lapis i think you nailed it. my Grandma's medicine cabinet had a different botle from a different dr and different pharmacy on almost every bottle RX!

 

it's shameful. 

Do you think the doctors do it to cover their backsides? Is that it? It's so, so frightening.

 

I guess I should have known, though, because when I was in high school I worked at a convalescent hospital. On the evening round I counted the pills given to one patient: 14! I still remember this because another woman was explaining what they were all for. Mind-boggling is right!!!

I think the issue of multiple prescribers probably plays a role. However, if any one doctor prescribes multiple medications, and a person goes to one, single pharmacy to fill the prescriptions, then a pharmacist should be checking the interactions and flagging any issues....that is, if the system is working properly.

 

This is a UK study, and I have no idea how things work there. I'm sure there are differences between various countries (as well as states, provinces, cities, towns, etc., etc.).

I have never had a pharmacist call me, even when I was taking 8 pills. It was all put in my court based on my symptoms.

 

I've got to say that I'm supposed to be on 100 mg. Losartan, and I've gotten off of it but haven't told my doctor. It did nothing for me and just made my legs feel really heavy, like lead, and lowered my GFR and upped my creatinine. Not good for my kidneys.

 

But I'm afraid to say anything because the doctor would want me taking another pill. I've had so many problems with pills! Especially with the benzo symptoms. I'm very dizzy. But I seem to be fine with what I'm taking now. I sometimes feel guilty, but what am I going to do? That's how American medicine seems to work, at least for me. And my anxiety is only situational. The doctor treats it as if I have the same bp at home as in the office, and he refuses to put down in his records that I have PTSD issues and white coat syndrome. 

Terry, i hear ya regarding bp and meds, last week i had to see a new cardiologist, i was just starting an awful wave and my bp was 170/90, normally it's 116/66, you can guess what happened, prescription pad came out but i refused, i told him i was in bwd and didn't need bp pills and that i self managed the bp spikes very well with propranolol. Well that went down like a lead balloon and i could tell he thought i was an alien creature from another universe. I've decided not to fight with these pill pushers, I'm going to smile sweetly, take the prescription and do what many others do - throw it in the bin. I feel i know my body better than anyone but that's ok if you have mental capacity. This study is terrifying in that what happens if you have no-one to advocate against pills for you. I've heard horrible stories of cognitively impaired elderly folk having psych meds put into their food when they refuse the meds prescribed. Really scary stuff.

In these cardiology appointments, is there ever any discussion of lifestyle factors that can influence blood pressure, e.g. diet, exercise, stress reduction, etc.?

Terry, i hear ya regarding bp and meds, last week i had to see a new cardiologist, i was just starting an awful wave and my bp was 170/90, normally it's 116/66, you can guess what happened, prescription pad came out but i refused, i told him i was in bwd and didn't need bp pills and that i self managed the bp spikes very well with propranolol. Well that went down like a lead balloon and i could tell he thought i was an alien creature from another universe. I've decided not to fight with these pill pushers, I'm going to smile sweetly, take the prescription and do what many others do - throw it in the bin. I feel i know my body better than anyone but that's ok if you have mental capacity. This study is terrifying in that what happens if you have no-one to advocate against pills for you. I've heard horrible stories of cognitively impaired elderly folk having psych meds put into their food when they refuse the meds prescribed. Really scary stuff.

:thumbsup:

Hi Lapis, i think most cardiologists will push the lifestyle stuff first but I've had 2 strokes due to bwd and i guess he was just following protocol but i think he should've done longer term bp monitoring before pulling out the prescription pad, i know they push statins for everybody and they're deadly poisons too imo. I worry terribly about cognitively impaired elderly folk because my friend worked in a nursing home and left because of the hundreds of pills she had to give out every day, some people were on 14 pills twice a day, and would cry when she went to give them. The stuff of nightmares.

Oh my goodness, that sounds awful! So sorry to hear about all that.

Terry, i hear ya regarding bp and meds, last week i had to see a new cardiologist, i was just starting an awful wave and my bp was 170/90, normally it's 116/66, you can guess what happened, prescription pad came out but i refused, i told him i was in bwd and didn't need bp pills and that i self managed the bp spikes very well with propranolol. Well that went down like a lead balloon and i could tell he thought i was an alien creature from another universe. I've decided not to fight with these pill pushers, I'm going to smile sweetly, take the prescription and do what many others do - throw it in the bin. I feel i know my body better than anyone but that's ok if you have mental capacity. This study is terrifying in that what happens if you have no-one to advocate against pills for you. I've heard horrible stories of cognitively impaired elderly folk having psych meds put into their food when they refuse the meds prescribed. Really scary stuff.

 

Yes, I totally understand your predicament. We know our bodies. We take our bp every day. We watch ourselves. These doctors see us for maybe 15 minutes!

 

I feel mentally impaired from the 1000 mg. of Labetalol that I'm taking. I'm very dizzy. I'm going to be tapering very slowly off that pill. I did have my doctor's blessing on that. But there are so many others who are being force-fed pills. It's very sad.

 

the most disturbing part of this was:

polypharmacy (5–9) and hyperpolypharmacy (≥10 reported medications)

like really? hyperpolypharmacy?? good lord and i thought I had it bad. i'm just polypharmed. not hyperpolypharmed.

 

This pharmacist says it's "not uncommon" for her to see an older patient on 20-25 drugs (!!).

 

https://podtail.com/en/podcast/best-science-medicine-podcast-bs-without-the/episode-428-deprescribing-is-an-essential-part-of-/

 

the most disturbing part of this was:

polypharmacy (5–9) and hyperpolypharmacy (≥10 reported medications)

like really? hyperpolypharmacy?? good lord and i thought I had it bad. i'm just polypharmed. not hyperpolypharmed.

 

This pharmacist says it's "not uncommon" for her to see an older patient on 20-25 drugs (!!).

 

https://podtail.com/en/podcast/best-science-medicine-podcast-bs-without-the/episode-428-deprescribing-is-an-essential-part-of-/

 

this is so wrong, what can we do? bad enough for us "youngsters", but to do this to the oldsters, damn. i don't think pharmacists should be penalized for reporting drs who overprescribe