Multiple medications can trigger frailty and death: study

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Photo: Half of Australians over 65 years old take at least five different types of medicine. (AAP: Melanie Foster)

Older people who take multiple medications face an increased risk of frailty and death, according to new Australian research.

Half of Australians over 65 years of age take at least five different types of medicine. Among over 75-year-olds, the numbers are even higher.

It is a paradox that as you get older, it becomes more likely you will need multiple medications to keep you alive and healthy, but the more you take, the more likely your drugs will conflict with one another or cancel each other out.

Associate Professor Simon Bell, from Monash University’s Centre for Medicine Use and Safety, is the co-author of the research.

“We investigated what’s called polypharmacy, or taking multiple medicines,” he said.

“And we also investigated the effect of taking certain types of medicines, and those medicines were the sedative medicines and the anticholinergic medicines.

“What we found was that [for] people who took a higher number of medicines, for each additional medicine there was a 22 per cent increase [in the] risk of transitioning from a state of robust health to dying over the study period.

“And we also found those men who use sedative and anticholinergic medicines to a great degree or to a high extent were also more likely to become pre-frail or to develop frailty over the study period.”

The study followed about about 1,700 community-dwelling men aged 70 years and older over a nine-year period.

‘Frailty, disability… increased risk of mortality’

Co-author Dr Danijela Gnjidic, a researcher with the Faculty of Pharmacy at the University of Sydney, has found there are several reasons why polypharmacy poses risks.

“An older person will have many other diseases for which they’ll be using other medications,” she said.

“We know that our health or quality of life changes over time as well.

“We tend to be exposed to many other medications and the way our body handles these medications will be different compared to younger individuals, who typically are more resilient and will have the capacity to handle these medications.

“So typically we know that there’s a number of studies that as we age, the way medicine are handled by our bodies will have different effects, which may consequently lead to a number of different sort of clinical consequences, including development of frailty, disability, which will then lead to increased risk of mortality.”

Dr Gnjidic hopes studies like this will lead to better treatments where possible.

“For many older Australians, they’ll have many other conditions that will require for them to take these medicines,” she said.

“But we also know that we sometimes can come up with a better alternative and perhaps think about reducing of those or stopping the medication altogether to minimise drug related problems.

“And in fact in Australia there is ongoing research trying to identify efforts of intervention, so how do we go about minimising these medications to really improve clinical outcomes in older people.”

Associate Professor Bell said reviewing medicines could help prevent the risk of death and frailty and improve quality of life among older Australians.

The message for older people and their carers is clear: keep a regular check on the number of medications in use, and if more than one doctor is involved, make sure they all know what the others are prescribing.

The research findings have been published in the Journal of the American Geriatric Society.