Polypharmacy Is Associated with Frailty, Nutritional Risk and Chronic Disease in Chilean Older Adults: Remarks from PIEI-ES Study

Figures & data

Table 1 Characteristics of Subjects According to Polypharmacy State

Characteristics	Total Sample	Non-Polypharmacy (0–4 Drugs)	Polypharmacy (5–9 Drugs)	Hyperpolypharmacy (10 or More Drugs)	p-value
Sample size (N, %)	1205 (100.0)	728 (60.4)	453 (37.6)	24 (2.0)	–
Age (mean, SD)	73.1±5.9	73.4±6	73.3±5.7	73.4±5.4	0.8278
Gender (%)					0.0002
Female	68.0 (65.0–70.4)	63.3 (59.8–66.8)	72.9 (69.7–77.8)	83.3 (64.2–93.3)
Male	32.0 (29.7–35.0)	36.7 (33.3–40.2)	27.1 (22.2–30.3)	16.7 (6.7–35.9)
Residential area (%)					0.0828
Urban	79.0 (76.5–82.1)	75.4 (72.2–78.4)	80.13 (76.2–83.6)	87.50 (68.9–95.7)
Rural	21.0 (17.9–23.4)	24.6 (21.6–27.8)	19.9 (16.5–23.8)	12.50 (4.3–31.0)
Education years (mean, SD)	7.2±4.2	7.2±4.4	7.2±4.4	7.3±4.3	0.9907
BMI (mean, SD)	29±5.1	28±50	30±5,10	31±5,40	<0.0001
Mild cognitive impairment	19.0 (16.8–22.4)	16.0 (13.5–18.9)	22.9 (19,3–27,1)	33.3 (17.9–53.3)	0.0025
Comorbidities (%)					<0.0001
Hypertension	73.1	60.0 (56.4–63.5)	92.9 (90.2–94.9)	95.8 (79.8–99.8)
Diabetes	35.4	22.1 (19.3–25.3)	54.5 (49.9–59.1)	75.0 (55.1–88.0)
Respiratory disease	10.9	6.59 (5.0–8.6)	16.56 (13.4–16.6)	37.50 (21.2–37.5)
Frailty status (%)					<0.0001
Non-frail	36.5	40.5 (37.0–44.1)	30.9 (26.8–35.3)	20.8 (9.2–40.5)
Pre-frail	38.9	40.8 (37.3–44.4)	36.2 (31.9–40.7)	33.3 (17.9–53.3)
Frail	24.6	18.7 (16.0–21.7)	32.9 (28.7–37.3)	45.8 (27.9–64.9)

Notes: Chi-Squared test with Yate’s correction was used to assess differences in proportions. ANOVA was used to assess differences in means. The bold text indicates a statistical significant difference between groups.

Abbreviation: BMI, body mass index.

Table 2 Contribution of Frailty Syndrome and Clinical Variables to Polypharmacy Condition

Logistic Regressions
Not-Adjusted Logistic Regression
Variables		Polypharmacy vs Non-Polypharmacy
		OR (95% CI)	p-value
Frail		2.394 (1.768–3.240)	<0.0001
Pre-frail		1.178 (0.896–1.549)	0.240
Cognitive impairment		1.608 (1.203–2.150)	<0.001
Obesity		1.812 (1.429–2.296)	<0.0001
Nutritional risk		1.767 (1.362–2.293)	<0.0001
Current smoker		0.654 (0.406–1.053)	0.080
Depression		3.470 (2.452–4.911)	<0.0001
Hypertension		8.959 (6.106–13.147)	<0.0001
Type 2 diabetes		4.402 (3.423–5.661)	<0.0001
Respiratory disease		3.028 (2.080–4.409)	<0.0001
Multiple Adjusted Logistic Regression
Co-Variables	Tolerance	VIF	OR (IC 95%)
Frail	0.734	1.362	1.533 (1.074–2.190)*
Cognitive impairment	0.859	1.164	1.144 (0.795–1.648)
Nutritional risk	0.873	1.145	1.584 (1.085–2.079)**
Obesity	0.932	1.073	1.476 (1.114–1.956)**
Hypertension	0.931	1.074	8.039 (5.332–12.120)****
T2D	0.942	1.062	4.001 (3.015–5.309)****
Respiratory disease	0.975	1.026	2.930 (1.868–4.595)****

Notes: The regression model was performed using polypharmacy (including higher polypharmacy status) as the dependent variable and clinical conditions as independent variables. Variables were selected according to its significance in the univariate model and the model was also adjusted for sex and age. *p<0.05, **p<0.01, ****p<0.0001. The bold text indicates a statistical significant difference between groups.

Abbreviations: OR, odds ratio; CI, confidence interval; VIF, variance inflation factor; T2D, type 2 diabetes.

Table 3 Contribution of Polypharmacy and Clinical Variables to Frailty Syndrome Condition

Logistic Regressions
Not-Adjusted Logistic Regression
Variables		Frail vs Non-Frail
		OR (95% CI)	p-value
Polypharmacy condition (include hyperpolypharmacy)		2.197 (1.684–2.867)	<0.0001
Cognitive impairment		7.937 (5.221–12.094)	<0.0001
Obesity		1.485 (1.139–1.937)	0.004
Nutritional risk		3.882 (2.678–5.595)	<0.0001
Current smoker		1.008 (0.605–1.681)	0.975
Depression		2.555 (1.811–3.606)	<0.0001
Hypertension		1.698 (1.232–2.339)	0.001
Type 2 diabetes		1.477 (1.128–1.932)	0.004
Respiratory disease		1.901 (1.297–2.785)	0.001
Multiple Adjusted Logistic Regression
Co-Variables	Tolerance	VIF		OR (IC 95%)
Polypharmacy condition (include hyperpolypharmacy)	0.726	1.378		1.510 (1.081–2.108)*
Cognitive impairment	0.940	1.064		3.887 (2.810–5.376)***
Obesity	0.959	1.043		1.560 (1.160–2.099)**
Nutritional risk	0.789	1.267		2.590 (1.856–3.614)***
Depression	0.787	1.270		1.189 (0.780–1.813)
Hypertension	0.850	1.177		1.239 (0.854–1.797)
Type 2 diabetes	0.860	1.163		1.195 (0.872–1.638)

Notes: The bold text indicates a statistical significant difference between groups. The regression model was performed using frailty syndrome (frail vs non-frail as reference) as a dependent variable and clinical conditions as independent variables. Variables were selected according to their significance in the univariate model and the model was also adjusted for sex and age. *p<0.05, **p<0.01, ***p<0.001.

Abbreviations: OR, odds ratio; CI, confidence interval; VIF, variance inflation factor.

Figure 1 Correlation between frailty score and the prevalence of polypharmacy and non-polypharmacy state.

Note: The correlation analysis was performed by Spearman coefficient.

Figure 2 Frailty score by polypharmacy status.

Notes: Kruskal–Wallis Test, one-way ANOVA. The bars represent the median and interquartile range. ***p<0.0001, **p<0.001 (Dunn´s Test).

Figure 3 Number of daily medications consumed according to the state of frailty.

Notes: ****p<0.0001 (Kruskal–Wallis Test, one-way ANOVA). The bars represent the median and interquartile range.