Effects of Changes in Number of Medications and Drug Burden Index Exposure on Transitions Between Frailty States and Death: The Concord Health and Ageing in Men Project Cohort Study.
OBJECTIVES
To investigate the effects of number of medications and Drug Burden Index (DBI) on transitions between frailty stages and death in community-dwelling older men.


DESIGN
Cohort study.


SETTING
Sydney, Australia.


PARTICIPANTS
Community-dwelling men aged 70 and older (N=1,705).


MEASUREMENTS
Self-reported questionnaires and clinic visits were conducted at baseline and 2 and 5 years. Frailty was assessed at all three waves according to the modified Fried frailty phenotype. The total number of regular prescription medications and DBI (a measure of exposure to sedative and anticholinergic medications) were calculated over the three waves. Data on mortality over 9 years were obtained. Multistate modeling was used to characterize the transitions across three frailty states (robust, prefrail, frail) and death.


RESULTS
Each additional medication was associated with a 22% greater risk of transitioning from the robust state to death (adjusted 95% confidence interval (CI)=1.06-1.41). Every unit increase in DBI was associated with a 73% greater risk of transitioning from the robust state to the prefrail state (adjusted 95% CI=1.30-2.31) and a 2.75 times greater risk of transitioning from the robust state to death (adjusted 95% CI=1.60-4.75). There was no evidence of an adjusted association between total number of medications or DBI and the other transitions.


CONCLUSION
Although the possibility of confounding by indication cannot be excluded, additional medications were associated with greater risk of mortality in robust community-dwelling older men. Greater DBI was also associated with greater risk of death and transitioning from the robust state to the prefrail state.
['Jamsen|Kris M|KM|', 'Bell|J Simon|JS|', 'Hilmer|Sarah N|SN|', 'Kirkpatrick|Carl M J|CM|', 'Ilomäki|Jenni|J|', 'Le Couteur|David|D|', 'Blyth|Fiona M|FM|', 'Handelsman|David J|DJ|', 'Waite|Louise|L|', 'Naganathan|Vasi|V|', 'Cumming|Robert G|RG|', 'Gnjidic|Danijela|D|']
D000368:Aged D000369:Aged, 80 and over D000375:Aging D003704:Dementia D005500:Follow-Up Studies D016330:Frail Elderly D006304:Health Status D006801:Humans D008297:Male D009017:Morbidity D009517:New South Wales D055553:Prescription Drugs D012189:Retrospective Studies D011795:Surveys and Questionnaires
medication mortality epidemiological methods frail elderly