A multidimensional measure of polypharmacy for older adults using the Health and Retirement Study

Ewan Carr; A Federman; Olubanke Dzahini; Richard Dobson; Rebecca Bendayan

doi:10.1038/s41598-021-86331-x

A multidimensional measure of polypharmacy for older adults using the Health and Retirement Study

Ewan Carr, A Federman, Olubanke Dzahini, Richard Dobson, Rebecca Bendayan

SLaM South London and Maudsley NHS Foundation Trust

Research output: Contribution to journal › Article › peer-review

3 Citations (Scopus)

Abstract

Polypharmacy is commonly defined based on the number of medications taken concurrently using standard cut-offs, but several studies have highlighted the need for a multidimensional assessment. We developed a multidimensional measure of polypharmacy and compared with standard cut-offs. Data were extracted for 2141 respondents of the 2007 Prescription Drug Survey, a sub-study of the Health Retirement Study. Latent classes were identified based on multiple indicators of polypharmacy, including quantity, temporality and risk profile. A four-class model was selected based on fit statistics and clinical interpretability: ‘High risk, long-term’ (Class 1), ‘Low risk, long-term’ (Class 2), ‘High risk, short-term’ (Class 3), and ‘High risk for drug interactions, medium-term, regular’ (Class 4). Classes differed regarding sex, cohabitation, disability and multimorbidity. Participants in the ‘low risk’ class tended to be male, cohabitating, and reported fewer health conditions, compared to ‘high risk’ classes. Polypharmacy classes were compared to standard cut-offs (5+ or 9+ medications) in terms of overlap and mortality risk. The three ‘high risk’ classes overlapped with the groups concurrently taking 5+ and 9+ medications per month. However, the multidimensional measure further differentiated individuals in terms of risk profile and temporality of medication taking, thus offering a richer assessment of polypharmacy.

Original language	English
Article number	8783
Journal	Scientific Reports
Volume	11
Issue number	1
DOIs	https://doi.org/10.1038/s41598-021-86331-x
Publication status	Published - 22 Apr 2021

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title = "A multidimensional measure of polypharmacy for older adults using the Health and Retirement Study",

abstract = "Polypharmacy is commonly defined based on the number of medications taken concurrently using standard cut-offs, but several studies have highlighted the need for a multidimensional assessment. We developed a multidimensional measure of polypharmacy and compared with standard cut-offs. Data were extracted for 2141 respondents of the 2007 Prescription Drug Survey, a sub-study of the Health Retirement Study. Latent classes were identified based on multiple indicators of polypharmacy, including quantity, temporality and risk profile. A four-class model was selected based on fit statistics and clinical interpretability: {\textquoteleft}High risk, long-term{\textquoteright} (Class 1), {\textquoteleft}Low risk, long-term{\textquoteright} (Class 2), {\textquoteleft}High risk, short-term{\textquoteright} (Class 3), and {\textquoteleft}High risk for drug interactions, medium-term, regular{\textquoteright} (Class 4). Classes differed regarding sex, cohabitation, disability and multimorbidity. Participants in the {\textquoteleft}low risk{\textquoteright} class tended to be male, cohabitating, and reported fewer health conditions, compared to {\textquoteleft}high risk{\textquoteright} classes. Polypharmacy classes were compared to standard cut-offs (5+ or 9+ medications) in terms of overlap and mortality risk. The three {\textquoteleft}high risk{\textquoteright} classes overlapped with the groups concurrently taking 5+ and 9+ medications per month. However, the multidimensional measure further differentiated individuals in terms of risk profile and temporality of medication taking, thus offering a richer assessment of polypharmacy.",

author = "Ewan Carr and A Federman and Olubanke Dzahini and Richard Dobson and Rebecca Bendayan",

note = "Funding Information: RB is funded in part by Grant MR/R016372/1 for the King{\textquoteright}s College London MRC Skills Development Fellowship programme funded by the UK Medical Research Council (MRC) and by grant IS-BRC-1215-20018 for the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King{\textquoteright}s College London. EC is funded by the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King{\textquoteright}s College London. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. The HRS (Health and Retirement Study) is sponsored by the National Institute on Aging (Grant number NIA U01AG009740) and is conducted by the University of Michigan. Publisher Copyright: {\textcopyright} 2021, The Author(s). Copyright: Copyright 2021 Elsevier B.V., All rights reserved.",

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N1 - Funding Information: RB is funded in part by Grant MR/R016372/1 for the King’s College London MRC Skills Development Fellowship programme funded by the UK Medical Research Council (MRC) and by grant IS-BRC-1215-20018 for the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London. EC is funded by the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. The HRS (Health and Retirement Study) is sponsored by the National Institute on Aging (Grant number NIA U01AG009740) and is conducted by the University of Michigan. Publisher Copyright: © 2021, The Author(s). Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

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A multidimensional measure of polypharmacy for older adults using the Health and Retirement Study

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