Are PIMs Linked to Frailty in Older Adults?

A recent study looking at older adults in Japan found a link between polypharmacy and greater frailty.

However, the authors said more research is needed in order to fully understand the association between potentially inappropriate medications (PIMs) and the age group studied—adults aged 69 to 74.

With the aging of the world’s population, frailty is a growing concern, as is polypharmacy, which is defined as the concurrent use of 5 or more medications. The researchers said the relationship between frailty and number and types of medications in this age group is not well studied; it is also unclear if prescriptions may have a role in preventing frailty.

In this study, information was gathered from adults visiting their local pharmacy (11 pharmacies in 1 prefecture in Japan). Pharmacists assessed the adults for frailty using a questionnaire that asked about 5 items (fatigue, resistance, ambulation, inactivity, and loss of weight) requiring yes or no answers. Total score ranged from 0 (no frailty) to 5 (extreme frailty). A score of 1 or 2 indicated “prefrailty” while a score of 3 or higher indicated frailty.

The association between frailty and number of medications was analyzed by age and compared between those who used PIMs and those who did not, called the use and nonuse groups. The proportion of patients who used PIMs was also analyzed by frailty score.

Of 923 older outpatients, 49 (5.3%) and 318 (34.5%) patients were considered frail or prefrail, respectively. Patients in those 2 categories used a significantly higher number of medications than those without frailty (P < .001 for categories).

Patients aged 69 to 71 and 72 to 74 years had a similar increase if they used PIMs; patients aged 65 to 68 years who used PIMs did not have a link to frailty, nor did patients across all age groups without PIM use.

An increasing linear trend was seen for the relationship between the proportion of patients who used any PIM, as well as some subcategories of PIMs (such as nonsteroidal anti-inflammatory drugs, benzodiazepines, loop diuretics, and antithrombotic drugs) and frailty score.

One takeaway from the study is that patients aged 69 years or older with PIM use and polypharmacy may need to be watched for unnecessary and prolonged usage.

This cross-sectional study needs “careful interpretation,” the authors cautioned, noting that “a direct causal relationship between the use of PIMs and many medications and frailty for early-stage older outpatients” cannot be assumed, due to the many factors that influence frailty, including nutrition, physical activity, and different diseases.

The authors also noted that they were unable to find previous work that indicates that frailty can be prevented by adjusting medication use. But in Japan, as in other countries around the world, both frailty and the use of polypharmacy increases with advancing age, as does the rate of polypharmacy.

"Further research is needed to confirm these findings and to analyze whether reducing the number of medications and reviewing the use of PIMs from the early stage of older age can help prevent the onset of frailty and control its progression," the authors concluded.

Reference

Uragami Y, Takikawa K, Kareki H, Kimura K, Tamamoto K, Iihara N. Effect of number of medications and use of potentially inappropriate medications on frailty among early-stage older outpatients. J Pharm Health Care Sci. Published online May 3, 2021. doi:10.1186/s40780-021-00195-x