There is a critical gap in understanding the symptom experience and health outcomes of older adults with and without Alzheimer’s Disease and related dementias (ADRD) and polypharmacy (PPY). The primary aim of the study was to compare the number of symptoms experienced over time in older adults with and without ADRD by polypharmacy status. The secondary aim was to examine the trajectory of physical function and health outcomes over time in each group.
Methods
This study utilized longitudinal data from the National Health and Aging Trends Study, a nationally representative sample of Medicare beneficiaries from 2016–2019. The sample was separated into four groups (N = 2,052): neither ADRD or PPY (n = 1,048), PPY only (n = 761), ADRD only (n = 116), and both ADRD and PPY(n = 127).
Results
The overall sample was predominately female (57.9%), White (70.9%), aged 84 or younger (75%), married (46%), and had some college or a college degree (50%). Participants with both ADRD and PPY experienced more symptoms on average, had higher odds of falls, hospitalizations, and mortality than all other groups. Older adults with both ADRD and PPY had lower physical function, needed more assistance with activities of daily living and higher assistive device utilization compared to the other three groups.
Conclusions
Findings indicate that older adults with both ADRD and PPY experience more symptoms, negative health outcomes and physical function decline that can negatively impact their quality of life. Further research is needed to identify strategies for reducing PPY in people with ADRD.
Afonso-ArgilésF. J.MeyerG.StephanA.ComasM.WübkerA.Leino-KilpiH.LethinC.SaksK.Soto-MartinM.SutcliffeC.VerbeekH.ZabaleguiA.Renom-GuiterasA.RightTimePlaceCare Consortium. (2020). Emergency department and hospital admissions among people with dementia living at home or in nursing homes: Results of the European RightTimePlaceCare project on their frequency, associated factors and costs. BMC Geriatrics, 20(1), 453. https://doi.org/10.1186/s12877-020-01835-x
3.
AliT.McAvayG. J.MoninJ. K.GillT. M. (2022). Patterns of caregiving among older adults with and without dementia: A latent class analysis. The Journals of Gerontology: Series B, 77(Suppl_1), S74–S85. https://doi.org/10.1093/geronb/gbab237
AmjadH.SnyderS. H.WolffJ. L.OhE.SamusQ. M. (2019). Before hospice: Symptom burden, dementia, and social participation in the last year of life. Journal of Palliative Medicine, 22(9), 1106–1114. https://doi.org/10.1089/jpm.2018.0479
6.
BohannonR. W. (2019). Grip strength: An indispensable biomarker for older adults. Clinical Interventions in Aging, 14(1681), 1681–1691. https://doi.org/10.2147/cia.s194543
7.
BordaM. G.Castellanos-PerillaN.Tovar-RiosD. A.OesterhusR.SoennesynH.AarslandD. (2021). Polypharmacy is associated with functional decline in Alzheimer’s disease and Lewy body dementia. Archives of Gerontology and Geriatrics, 96, 104459. https://doi.org/10.1016/j.archger.2021.104459
8.
BudnitzD. S.LovegroveM. C.ShehabN.RichardsC. L. (2011). Emergency hospitalizations for adverse drug events in older Americans. New England Journal of Medicine, 365(21), 2002–2012. https://doi.org/10.1056/NEJMsa1103053
9.
CahirC.BennettK.TeljeurC.FaheyT. (2014). Potentially inappropriate prescribing and adverse health outcomes in community dwelling older patients. British Journal of Clinical Pharmacology, 77(1), 201–210. https://doi.org/10.1111/bcp.12161
ChuangH. Y.WenY. W.ChenL. K.HsiaoF. Y. (2017). Medication appropriateness for patients with dementia approaching the end of their life. Geriatrics and Gerontology International, 17(Suppl 1), 65–74. https://doi.org/10.1111/ggi.13038
12.
ClagueF.MercerS. W.McLeanG.ReynishE.GuthrieB. (2017, Jan 13). Comorbidity and polypharmacy in people with dementia: Insights from a large, population-based cross-sectional analysis of primary care data. Age and Ageing, 46(1), 33–39. https://doi.org/10.1093/ageing/afw176
13.
CleelandC. S. (2007). Symptom burden: Multiple symptoms and their impact as patient-reported outcomes. Journal of the National Cancer Institutes Monographs, 2007(37), 16–21. https://doi.org/10.1093/jncimonographs/lgm005
DenholmR.MorrisR.PayneR. (2019). Polypharmacy patterns in the last year of life in patients with dementia. European Journal of Clinical Pharmacology, 75(11), 1583–1591. https://doi.org/10.1007/s00228-019-02721-1
16.
EllenbogenM. I.WangP.OvertonH. N.FahimC.ParkA.BruhnW. E.CarnahanJ. L.LinskyA. M.BalogunS. A.MakaryM. A. (2020). Frequency and predictors of polypharmacy in US Medicare patients: A cross-sectional analysis at the patient and physician levels. Drugs and Aging, 37(1), 57–65. https://doi.org/10.1007/s40266-019-00726-0
17.
FreedmanV. A.Bandeen-RocheK.CornmanJ. C.SpillmanB. C.KasperJ. D.WolffJ. L. (2022). Incident care trajectories for older adults with and without dementia. The Journals of Gerontology: Series B, 77(Suppl_1), S21–S30. https://doi.org/10.1093/geronb/gbab185
FriedT. R.O’LearyJ.TowleV.GoldsteinM. K.TrentalangeM.MartinD. K. (2014). Health outcomes associated with polypharmacy in community-dwelling older adults: A systematic review. Journal of the American Geriatrics Society, 62(12), 2261–2272. https://doi.org/10.1111/jgs.13153
GrowdonM. E.GanS.YaffeK.SteinmanM. A. (2021). Polypharmacy among older adults with dementia compared with those without dementia in the United States. Journal of the American Geriatrics Societ, 69(9), 2464–2475. https://doi.org/10.1111/jgs.17291
23.
GuralnikJ. M.FerrucciL.PieperC. F.LeveilleS. G.MarkidesK. S.OstirG. V.StudenskiS.BerkmanL. F.WallaceR. B. (2000). Lower extremity function and subsequent disability: Consistency across studies, predictive models, and value of gait speed alone compared with the short physical performance battery. Series A, Biological Sciences and Medical Sciences, 55(4), M221–M231. https://doi.org/10.1093/gerona/55.4.m221
24.
IBM Corp (2021). IBM SPSS statistics for MAC, version 28.0. In (version 28) [Computer software]. IBM Corp.
KatsimprisA.LinseisenJ.MeisingerC.VolaklisK. (2019, Sep). The association between polypharmacy and physical function in older adults: A systematic review. Journal of General Internal Medicine, 34(9), 1865–1873. https://doi.org/10.1007/s11606-019-05106-3
28.
KhezrianM.McNeilC. J.MyintP. K.MurrayA. D. (2019). The association between polypharmacy and late life deficits in cognitive, physical and emotional capability: A cohort study. International Journal of Clinical Pharmacology, 41(1), 251–257. https://doi.org/10.1007/s11096-018-0761-2
29.
KimJ.ParishA. L. (2017, Sep). Polypharmacy and medication management in older adults. Nursing Clinics of North America, 52(3), 457–468. https://doi.org/10.1016/j.cnur.2017.04.007
30.
LairdN. M.WareJ. H. (1982). Random-effects models for longitudinal data. Biometrics, 38(4), 963–974. https://doi.org/10.2307/2529876
31.
LauD. T.MercaldoN. D.ShegaJ. W.RademakerA.WeintraubS. (2011). Functional decline associated with polypharmacy and potentially inappropriate medications in community-dwelling older adults with dementia. American Journal of Alzheimers Diease and Other Dementias, 26(8), 606–615. https://doi.org/10.1177/1533317511432734
32.
LenzE. R.PughL. C.MilliganR. A.GiftA.SuppeF. (1997). The middle-range theory of unpleasant symptoms: An update. Advances in Nursing Science, 19(3), 14–27. https://doi.org/10.1097/00012272-199703000-00003
33.
LenzE. R.SuppeF.GiftA. G.PughL. C.MilliganR. A. (1995). Collaborative development of middle-range nursing theories: Toward a theory of unpleasant symptoms. Advances in Nursing Science, 17(3), 1–13. https://doi.org/10.1097/00012272-199503000-00003
34.
MasnoonN.ShakibS.Kalisch-EllettL.CaugheyG. E. (2017). What is polypharmacy? A systematic review of definitions. BMC Geriatrics, 17(1), 230. https://doi.org/10.1186/s12877-017-0621-2
35.
MaxwellC. J.MondorL.Pefoyo KonéA. J.HoganD. B.WodchisW. P. (2021). Sex differences in multimorbidity and polypharmacy trends: A repeated cross-sectional study of older adults in Ontario, Canada. PLoS One, 16(4), Article e0250567. https://doi.org/10.1371/journal.pone.0250567
36.
MuellerC.MolokhiaM.PereraG.VeroneseN.StubbsB.ShettyH.CodlingD.HuntleyJ.StewartR. (2018). Polypharmacy in people with dementia: Associations with adverse health outcomes. Experimental Gerontology, 106, 240–245. https://doi.org/10.1016/j.exger.2018.02.011
ParsonsC. (2017). Polypharmacy and inappropriate medication use in patients with dementia: An underresearched problem. Therapeutic Advances in Drug Safety, 8(1), 31–46. https://doi.org/10.1177/2042098616670798
39.
PatelK. V.GuralnikJ. M.PhelanE. A.GellN. M.WallaceR. B.SullivanM. D.TurkD. C. (2019). Symptom burden among community-dwelling older adults in the United States. Journal of the American Geriatrics Society, 67(2), 223–231. https://doi.org/10.1111/jgs.15673
40.
PeronE. P. P.GrayS. L. P. M. S.HanlonJ. T. P. M. S. (2011). Medication use and functional status decline in older adults: A narrative review. The American Journal of Geriatric Pharmacotherapy, 9(6), 378–391. https://doi.org/10.1016/j.amjopharm.2011.10.002
41.
R Core Team. (2023). R: A language and environment for statistical computing. R foundation for statistical computing. [Computer Software]. https://www.R-project.org/
42.
ReeveE.BellJ. S.HilmerS. N. (2015). Barriers to optimising prescribing and deprescribing in older adults with dementia: A narrative review. Current Clinical Pharmacology, 10(3), 168–177. https://doi.org/10.2174/157488471003150820150330
43.
RiedlL.KieselE.HartmannJ.FischerJ.RoßmeierC.HallerB.KehlV.PrillerJ.TrojanM.Diehl-SchmidJ. (2022). A bitter pill to swallow - polypharmacy and psychotropic treatment in people with advanced dementia. BMC Geriatrics, 22(1), 214. https://doi.org/10.1186/s12877-022-02914-x
44.
ScheelJ.LuttenbergerK.GraesselE.KratzerA.DonathC. (2022). Predictors of falls and hospital admissions in people with cognitive impairment in day-care: Role of multimorbidity, polypharmacy, and potentially inappropriate medication. BMC Geriatrics, 22(1), 682. https://doi.org/10.1186/s12877-022-03346-3
45.
SchenkerY.ParkS. Y.JeongK.PruskowskiJ.KavalieratosD.ResickJ.AbernethyA.KutnerJ. S. (2019). Associations between polypharmacy, symptom burden, and quality of life in patients with advanced, life-limiting illness. Journal of General Internal Medicine, 34(4), 559–566. https://doi.org/10.1007/s11606-019-04837-7
46.
SmithM. J.LiehrP. R. (2014). Middle range theory for nursing (3rd ed.). Springer Pub. Co.
47.
TanS. X.CameronS. C.SamL. M.EigelandH.HayK.EelesE.NatarajanK. (2021, Sep). A delicate balance: Psychotropic polypharmacy and anti-cholinergic use are correlated with fall incidence in Australian inpatients with dementia. Aging Med (Milton), 4(3), 193–200. https://doi.org/10.1002/agm2.12175
48.
Von ElmE.AltmanD. G.EggerM.PocockS. J.GøtzscheP. C.VandenbrouckeJ. P.STROBE Initiative. (2007). The strengthening the reporting of observational studies in epidemiology (STROBE) statement: Guidelines for reporting observational studies. Annals of Internal Medicine, 147(8), 573–577. https://doi.org/10.7326/0003-4819-147-8-200710160-00010, https://core.ac.uk/download/33050540.pdf
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
