Polypharmacy, commonly defined as taking five or more medications daily, is a major health care problem that affects more than 30% of older adults. It is associated with poor health outcomes such as falls, drug interactions, hospitalizations and even death. Older adults are at increased risk for polypharmacy if they have multiple chronic conditions. While older adults with Alzheimer’s disease and related dementias are more likely to take more than five medications, there is little research examining the impact of multiple daily medications on symptoms, health outcomes, and physical functioning in older adults with Alzheimer’s disease and related dementias of dementia.
Researchers from Drexel University’s College of Nursing and Health Professions recently published a study in Biological research for nursing examining symptoms, health outcomes, and physical functioning over time in older adults with and without Alzheimer’s disease and related dementias and polypharmacy.
Led by Martha Coates, PhD, a postdoctoral researcher at the College, the research team found that individuals who experience polypharmacy and have Alzheimer’s disease and related dementias experience more symptoms, falls, hospitalizations, mortality, and have lower physical functioning – which points out that polypharmacy can also negatively impact the quality of life of older adults with Alzheimer’s disease and related dementias.
The limit of five or more medications per day has been linked to adverse health outcomes in previous research, and as the number of medications increases, the risk of side effects and harm increases.
Martha Coates, PhD, Postdoctoral Fellow, Drexel University’s College of Nursing and Health Professions
The research team used a publicly available dataset from the National Health and Aging Trends Study – a nationally representative sample of Medicare beneficiaries in the United States from Johns Hopkins University. Since 2011, data have been collected annually to examine social, physical, technological and functional domains important in aging.
For this study, the research team used data from 2016 through 2019 to compare changes in symptoms, health outcomes, and physical functioning among four groups: 1) people with Alzheimer’s disease and related dementias and polypharmacy; 2) only people with Alzheimer’s disease and related forms of dementia; 3) only people with polypharmacy; and 4) those without Alzheimer’s disease and related dementias or polypharmacy.
Coates explained that the researchers used analytical weights to analyze the data, which provides national estimates, making the sample of 2,052 individuals representative of 12 million Medicare beneficiaries in the US, increasing the generalizability of the findings.
“We found that older adults with Alzheimer’s disease and related dementias and polypharmacy experienced more unpleasant symptoms, a greater likelihood of falls, hospitalization, and mortality compared to those without Alzheimer’s disease and related dementias and polypharmacy,” said Coates. “They also experienced more functional decline, required more assistance with daily activities such as eating, bathing and dressing, and were more likely to require an assistive device such as a cane or walker.”
Coates noted that there are tools available to help health care providers assess and manage medication regimens for older adults who experience polypharmacy and may be taking medications that may be inappropriate or no longer provide benefit. However, there are currently no specific resources for older adults with Alzheimer’s disease and related dementias.
The findings from this study shed light on the negative impact polypharmacy can have on older adults with Alzheimer’s disease and related dementias. But Coates added that further research is needed to develop strategies to reduce the occurrence of polypharmacy in people with Alzheimer’s disease and related dementias.
“The older adult population in the U.S. is growing, with an estimated 80 million people over age 65 by 2040,” Coates said. “This means that the number of older adults diagnosed with Alzheimer’s disease and related dementias will also increase, and there is currently no cure. Avoiding adverse outcomes associated with polypharmacy may improve quality of life and prevent excessive disability in older adults with Alzheimer’s disease and related forms. dementia.”
The research team expects that this study will help guide future analyzes of the impact of specific medications on health outcomes in individuals with Alzheimer’s disease and related dementias and provide a foundation to support the development of medication optimization interventions in older adults with Alzheimer’s disease and related dementias. and polypharmacy.
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Magazine reference:
Coates, M.C., et al. (2024). Impact of polypharmacy on symptoms and health outcomes in older adults with and without Alzheimer’s disease and related dementias. Biological research for nursing. doi.org/10.1177/10998004241289942.