title: Effects of Changes in Number of Medications and Drug Burden Index Exposure on Transitions Between Frailty States and Death: The Concord Health and Ageing in Men Project Cohort Study.
abstract: OBJECTIVE
  To investigate the effects of number of medications and Drug Burden Index (DBI) on transitions between frailty stages and death in community-dwelling older men.
  
  
  METHODS
  Cohort study.
  
  
  METHODS
  Sydney, Australia.
  
  
  METHODS
  Community-dwelling men aged 70 and older (N=1,705).
  
  
  METHODS
  Self-reported questionnaires and clinic visits were conducted at baseline and 2 and 5 years. Frailty was assessed at all three waves according to the modified Fried frailty phenotype. The total number of regular prescription medications and DBI (a measure of exposure to sedative and anticholinergic medications) were calculated over the three waves. Data on mortality over 9 years were obtained. Multistate modeling was used to characterize the transitions across three frailty states (robust, prefrail, frail) and death.
  
  
  RESULTS
  Each additional medication was associated with a 22% greater risk of transitioning from the robust state to death (adjusted 95% confidence interval (CI)=1.06-1.41). Every unit increase in DBI was associated with a 73% greater risk of transitioning from the robust state to the prefrail state (adjusted 95% CI=1.30-2.31) and a 2.75 times greater risk of transitioning from the robust state to death (adjusted 95% CI=1.60-4.75). There was no evidence of an adjusted association between total number of medications or DBI and the other transitions.
  
  
  CONCLUSIONS
  Although the possibility of confounding by indication cannot be excluded, additional medications were associated with greater risk of mortality in robust community-dwelling older men. Greater DBI was also associated with greater risk of death and transitioning from the robust state to the prefrail state.
authors.affiliation: Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia.|Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia.
authors.forename: Kris M
authors.initials: KM
authors.lastname: Jamsen
authors.affiliation: Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia.|Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia.|Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia.
authors.forename: J Simon
authors.initials: JS
authors.lastname: Bell
authors.affiliation: Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia.|Kolling Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Sarah N
authors.initials: SN
authors.lastname: Hilmer
authors.affiliation: Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia.
authors.forename: Carl M J
authors.initials: CM
authors.lastname: Kirkpatrick
authors.affiliation: Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia.
authors.forename: Jenni
authors.initials: J
authors.lastname: Ilomäki
authors.affiliation: Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.|Centre for Education and Research on Ageing, Concord, New South Wales, Australia.|ANZAC Institute, Concord Hospital, Concord, New South Wales, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Le Couteur
authors.affiliation: Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.|Centre for Education and Research on Ageing, Concord, New South Wales, Australia.
authors.forename: Fiona M
authors.initials: FM
authors.lastname: Blyth
authors.affiliation: Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.|ANZAC Institute, Concord Hospital, Concord, New South Wales, Australia.
authors.forename: David J
authors.initials: DJ
authors.lastname: Handelsman
authors.affiliation: ANZAC Institute, Concord Hospital, Concord, New South Wales, Australia.
authors.forename: Louise
authors.initials: L
authors.lastname: Waite
authors.affiliation: Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.|Centre for Education and Research on Ageing, Concord, New South Wales, Australia.
authors.forename: Vasi
authors.initials: V
authors.lastname: Naganathan
authors.affiliation: Centre for Education and Research on Ageing, Concord, New South Wales, Australia.|Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Cumming
authors.affiliation: Centre for Education and Research on Ageing, Concord, New South Wales, Australia.|Faculty of Pharmacy, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Danijela
authors.initials: D
authors.lastname: Gnjidic
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D003704:Dementia / Q000188:drug therapy* / Q000453:epidemiology; D005500:Follow-Up Studies; D016330:Frail Elderly / Q000706:statistics & numerical data*; D006304:Health Status; D006801:Humans; D008297:Male; D009017:Morbidity / Q000639:trends; D009517:New South Wales / Q000453:epidemiology; D055553:Prescription Drugs / Q000600:supply & distribution*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires
chemical_list: D055553:Prescription Drugs
keywords: epidemiological methods; frail elderly; medication; mortality