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Impact of inappropriate drug use on physical performance among a frail elderly population living in the community

  • Pharmacoepidemiology and Prescription
  • Published:
European Journal of Clinical Pharmacology Aims and scope Submit manuscript

Abstract

Objective The criteria for inappropriate drug use developed by Beers have been widely used in drug utilization reviews to assess the quality of prescribing, but there is still inconclusive evidence that these criteria can impact on patient outcomes. The aim of the present study was to evaluate the relationship between the use of inappropriate drugs and measures of physical performance, muscle strength and functional status in an elderly population (80+ years).

Methods Data are from the baseline evaluation of 364 subjects enrolled in the ilSIRENTE study, a prospective cohort study performed in a mountain community living in the Sirente geographic area (L’Aquila, Abruzzo) in Central Italy. Physical performance was assessed using the physical performance battery score (SPPB), which is based on three timed tests: 4-m walking speed, balance and chair stand tests. Muscle strength was measured by hand grip strength. Inappropriate drug use was defined by the 2003 Beers criteria. Analyses of covariance were performed to evaluate the relationship of inappropriate drugs with physical function.

Results In the unadjusted model, all of the physical performance, muscle strength and functional measures showed significant associations with inappropriate drug use. Following adjustment for potential confounders, which included age, gender, physical activity level, cognitive performance scale, comorbidity, lung diseases and diabetes, these associations were still statistically significant for the physical performance battery score [non-users inappropriate drugs: 7.0; standard error (SE): 0.1; users inappropriate drugs: 6.1; SE: 0.2; p = 0.007] The 4-m walking speed, physical performance battery score and Total Activities of Daily Living (ADL) scale score showed worsening results among subjects using two inappropriate medications compared with subjects using one inappropriate drug or none at all.

Conclusions The use of inappropriate medication (as defined by Beers 2003 criteria) was found to be common among the elderly Italian study cohort living in the community. Our results suggest that among old–old subjects the use of inappropriate drugs is associated with impaired physical performance.

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References

  1. Guralnik JM, Fried LP, Salive ME. (1996) Disability as a public health outcome in the aging population. Annu Rev Public Health 17:25–46

    Article  PubMed  CAS  Google Scholar 

  2. Fried TR, Bradley EH, Williams CS, Tinetti ME (2001) Functional disability and health care expenditures for older persons. Arch Intern Med 161:2602–2607

    Article  PubMed  CAS  Google Scholar 

  3. Ustun TB, Rehm J, Chatterji S, Saxena S, Trotter R, Room R, Bickenbach J (1999) Multiple-informant ranking of the disabling effects of different health conditions in 14 countries. WHO/NIH Joint Project CAR Study Group. Lancet 354:111–115

    Article  PubMed  CAS  Google Scholar 

  4. Onder G, Pedone C, Landi F, Cesari M, Della Vedova C, Bernabei R, Gambassi G (2002) Adverse drug reactions as cause of hospital admissions: results from the Italian Group of Pharmacoepidemiology in the Elderly (GIFA). J Am Geriatr Soc 50:1962–1968

    Article  PubMed  Google Scholar 

  5. Bates DW (1998) Drugs and adverse drug reactions: how worried should we be? JAMA 279:1216–1217

    Article  PubMed  CAS  Google Scholar 

  6. Beers MH, Ouslander JG, Rollingher I, Reuben DB, Brooks J, Beck JC (1991) Explicit criteria for determining inappropriate medication use in nursing home residents. UCLA Division of Geriatric Medicine. Arch Intern Med 151:1825–1832

    Article  PubMed  CAS  Google Scholar 

  7. Beers MH (1997) Explicit criteria for determining potentially inappropriate medication use by the elderly. An update. Arch Intern Med 157:1531–1536

    Article  PubMed  CAS  Google Scholar 

  8. Fick DM, Cooper JW, Wade WE, Waller JL, Maclean JR, Beers MH (2003) Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. Arch Intern Med 163:2716–2724

    Article  PubMed  Google Scholar 

  9. Aparasu RR, Mort JR (2000) Inappropriate prescribing for the elderly: Beers criteria-based review. Ann Pharmacother 34:338–346

    Article  PubMed  CAS  Google Scholar 

  10. Willcox S, Himmelstein D, Woolhandler S (1994) Inappropriate drug prescribing for the community-dwelling elderly. JAMA 272:292–296

    Article  PubMed  CAS  Google Scholar 

  11. Spore D, Mor V, Larrat P, Hawes C, Hiris J (1997) Inappropriate drug prescriptions for elderly residents of board and care facilities. Am J Public Health 87:404–409

    Article  PubMed  CAS  Google Scholar 

  12. Hanlon JT, Schmader KE, Boult C, Artz MB, Gross CR, Fillenbaum GG, Ruby CM, Garrard J (2002) Use of inappropriate prescription drugs by older people. J Am Geriatr Soc 50:26–34

    Article  PubMed  Google Scholar 

  13. Onder G, Landi F, Liperoti R, Fialova D, Gambassi G, Bernabei R (2005) Impact of inappropriate drug use among hospitalized older adults. Eur J Clin Pharmacol 61:453–459

    Article  PubMed  Google Scholar 

  14. Onder G, Landi F, Cesari M, Gambassi G, Carbonin P, Bernabei R (2003) Investigators of the GIFA Study. Inappropriate medication use among hospitalized older adults in Italy: results from the Italian Group of Pharmacoepidemiology in the Elderly. Eur J Clin Pharmacol 59:157–162

    PubMed  Google Scholar 

  15. Jano E, Aparasu RR (2007) Healthcare outcomes associated with Beers criteria: a systematic review. Ann Pharmacother 41:438–447

    Article  PubMed  Google Scholar 

  16. Landi F, Russo A, Cesari M, Barillaro C, Onder G, Zamboni V, De Santis A, Pahor M, Ferrucci L, Bernabei R (2005) The ilSIRENTE study: a prospective cohort study on persons aged 80 years and older living in a mountain community of Central Italy. Aging Clin Exp Res 17:486–493

    PubMed  Google Scholar 

  17. Morris JN, Fries BE, Bernabei R, Ikegami N, Gilgen R, Steel K, Carpenter I (1996) RAI-home care assessment manual. InterRAI Corporation, Washington D.C.

    Google Scholar 

  18. Morris JN, Fries BE, Steel K, Ikegami N, Bernabei R, Carpenter GI, Gilgen R, Hirdes JP, Topinkova E (1997) Comprehensive clinical assessment in community setting: applicability of the MDS-HC. J Am Geriatr Soc 45:1017–1024

    PubMed  CAS  Google Scholar 

  19. Ferrucci L, Bandinelli S, Benvenuti E, Di Iorio A, Macchi C, Harris TB (2000) Subsystems contributing to the decline in ability to walk: bridging the gap between epidemiology and geriatric practice in the InCHIANTI study. J Am Geriatr Soc 48:1618–1625

    PubMed  CAS  Google Scholar 

  20. Hawes C, Morris JN, Phillips CD, Mor V, Fries BE, Nonemaker S (1995) Reliability estimates for the Minimum Data Set for nursing home resident assessment and care screening (MDS). Gerontologist 35:172–178

    Article  PubMed  CAS  Google Scholar 

  21. Guralnik JM, Ferrucci L, Simonsick EM, Salive ME, Wallace RB (1995) Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability. N Engl J Med 332:556–561

    Article  PubMed  CAS  Google Scholar 

  22. Guralnik JM, Ferrucci L, Pieper CF, Leveille SG, Markides KS, Ostir GV (2000) Lower extremity function and subsequent disability: consistency across studies, predictive models, and value of gait speed alone compared with the short physical performance battery. J Gerontol A Biol Sci Med Sci 55:M221–M231

    PubMed  CAS  Google Scholar 

  23. Rantanen T, Guralnik JM, Foley D, Masaki K, Leveille SG, Curb JD (1999) Midlife hand grip strength as a predictor of old age disability. JAMA 281:558–560

    Article  PubMed  CAS  Google Scholar 

  24. Pitkala KH, Strandberg TE, Tilvis RS (2002) Inappropriate drug prescribing in home-dwelling, elderly patients: a population-based survey. Arch Intern Med 162:1707–1712

    Article  PubMed  Google Scholar 

  25. Gurwitz JH, Rochon P (2002) Improving the quality of medication use in elderly patients: a not-so-simple prescription. Arch Intern Med 162:1670–1672

    Article  PubMed  Google Scholar 

  26. Fialova´ D, Topinkova´ E, Gambassi G, Finne-Soveri H, Jo´ nsson PV, Carpenter I, Schroll M, Onder G, Sørbye LW, Wagner C, Reissigova´ J, Bernabei R, for AdHOC project research group (2005) Potentially inappropriate medication use among home care elderly patients in Europe. JAMA 293:1348–1358

    Article  PubMed  CAS  Google Scholar 

  27. Hanlon JT, Fillenbaum GG, Kuchibhatla M, Artz MB, Boult C, Gross CR, Garrard J, Schmader KE (2002) Impact of inappropriate drug use on mortality and functional status in representative community dwelling elders. Med Care 40:166–176

    Article  PubMed  Google Scholar 

  28. Fu AZ, Liu GG, Christensen DB (2004) Inappropriate medication use and health outcomes in the elderly. J Am Geriatr Soc 52:1934–1939

    Article  PubMed  Google Scholar 

  29. Fillenbaum GG, Hanlon JT, Landerman LR, Artz MB, O'Connor H, Dowd B, Gross CR, Boult C, Garrard J, Schmader KE (2004) Impact of inappropriate drug use on health services utilization among representative older community-dwelling residents. Am J Geriatr Pharmacother 2:92–101

    Article  PubMed  Google Scholar 

  30. Onder G, Gambassi G, Scales CJ, Cesari M, Della Vedova C, Landi F, Bernabei R (2002) Adverse drug reactions and cognitive function among hospitalized older adults. Eur J Clin Pharmacol 58:371–377

    Article  PubMed  Google Scholar 

  31. Vlahovic-Palcevski V, Bergman U (2004) Quality of prescribing for the elderly in Croatia-computerized pharmacy data can be used to screen for potentially inappropriate prescribing. Eur J Clin Pharmacol 60:217–220

    Article  PubMed  Google Scholar 

  32. Lechevallier-Michel N, Gautier-Bertrand M, Alperovitch A, Berr C, Belmin JI, Legrain S, Saint-Jean O, Tavernier B, Dartigues JF, Fourrier-Reglat A (2005) Frequency and risk factors of potentially inappropriate medication use in a community-dwelling elderly population: results from the 3C Study. Eur J Clin Pharmacol 60:813–819

    Article  PubMed  Google Scholar 

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Acknowledgements

First of all, we thank all the participants for their enthusiasm in participating to the project and their patience during the assessments. We are grateful to all the persons working as volunteers in the “Protezione Civile” and in the Italian Red Cross of Abruzzo Region for their support. We sincerely thank the “Comunità Montana Sirentina” and, in particular, its President, who promoted and strongly supported the development of the project. The ilSIRENTE Study Group is made up of the "Steering Committee" (R. Bernabei, F. Landi); "Coordination" (A. Russo, M. Valeri, G. Venta); "Writing Panel" (C. Barillaro, M. Cesari, L. Ferrucci, G. Onder, M. Pahor, V. Zamboni, E. Capoluongo); "Participants" (Comune di Fontecchio: P. Melonio, G. Bernabei, A. Benedetti; Comune di Fagnano: N. Scarsella, A. Fattore, M. Fattore; Comune di Tione: M. Gizzi; Comune di Ovindoli: S. oltellate, E. Chiuchiarelli; Comune di Rocca di Mezzo: S. Pescatore; Comune di Rocca di Cambio: G. Scoccia; Comune di Secinaro: G. Pizzocchia; Comune di Molina Aterno: P. Di Fiore; Comune di Castelvecchio: A. Leone; Comune di Gagliano Aterno: A. Petriglia; Comune di Acciano: A. Di Benedetto; Comune di Goriano Sicoli: N. Coltella; Comune di Castel di Ieri: S. Battista; RSA Opera Santa Maria della Pace: A. De Santis, G. Filieri, C. Gobbi, G. Gorga, F. Cocco, P. Graziani).

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Authors and Affiliations

  1. Department of Gerontology, Geriatrics and Physiatry, Catholic University of Sacred Heart, Rome, Italy

    Francesco Landi, Andrea Russo, Rosa Liperoti, Christian Barillaro, Paola Danese, Roberto Bernabei & Graziano Onder

  2. Department of Aging and Geriatric Research, College of Medicine, University of Florida, Gainesville, FL, USA

    Marco Pahor

  3. Geriatric Research, Education and Clinical Center (GRECC), Malcom Randall Veteran’s Affairs Medical Center, North Florida/South Georgia Veterans Health System, Gainesville, FL, USA

    Marco Pahor

  4. Centro Medicina dell’Invecchiamento (CEMI), Istituto di Medicina Interna e Geriatria, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168, Roma, Italy

    Francesco Landi

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  1. Francesco Landi
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Correspondence to Francesco Landi.

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Landi, F., Russo, A., Liperoti, R. et al. Impact of inappropriate drug use on physical performance among a frail elderly population living in the community. Eur J Clin Pharmacol 63, 791–799 (2007). https://doi.org/10.1007/s00228-007-0321-5

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  • DOI: https://doi.org/10.1007/s00228-007-0321-5

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