title: Polypharmacy in older adults: Association Rule and Frequent-Set Analysis to evaluate concomitant medication use.
abstract: The aim of this study was to apply Association Rule and Frequent-Set analysis, and novel means of data visualisation to ascertain patterns of medication use and medication combinations contributing to medication group clusters according to geriatric syndrome status in older adults. Participants were community-dwelling men (aged ≥70 years, n=1686), Sydney, Australia. Medication exposure was categorised at medication class level and data were analysed according to geriatric syndrome status (presence of at least one syndrome including frailty, falls, cognitive impairment and urinary incontinence). Association Rule and Frequent-Set analysis were performed to identify "interesting" patterns of medication combinations that occur together. This analysis involves advanced computer algorithms that investigated all possible combinations of medications in the dataset in order to identify those which are observed more or much less frequently than expected. Frequent-Set Analysis demonstrated one unexpected medication combination, antiulcer and antidiabetic medications (3.5% of participants) in the overall population (n=1687). Frequency of medication combinations was similar in participants with (n=666) and without (n=1020) geriatric syndromes. Among participants with geriatric syndromes, the most frequent combinations included antigout with lipid-lowering agents (5.7%) followed by angiotensin II and diuretics combination (22%). This novel methodology can be used to detect common medication combinations overall by data visualisation, and against specific adverse drug reactions such as geriatric syndromes. This methodology may be a valuable pharmacovigilance approach to monitor large databases for the safety of medications.
authors.affiliation: Charles Perkins Centre, University of Sydney, Sydney NSW, Australia.
authors.forename: Fabian
authors.initials: F
authors.lastname: Held
authors.affiliation: Charles Perkins Centre, University of Sydney, Sydney NSW, Australia; Centre for Education and Research on Ageing, the Ageing and Alzheimers Institute, Concord Hospital and University of Sydney, Sydney NSW, Australia; ANZAC Research Institute, University of Sydney, New South Wales, Australia.
authors.forename: David G
authors.initials: DG
authors.lastname: Le Couteur
authors.affiliation: Centre for Education and Research on Ageing, the Ageing and Alzheimers Institute, Concord Hospital and University of Sydney, Sydney NSW, Australia; School of Public Health, University of Sydney, Sydney NSW, Australia.
authors.forename: Fiona M
authors.initials: FM
authors.lastname: Blyth
authors.affiliation: Centre for Education and Research on Ageing, the Ageing and Alzheimers Institute, Concord Hospital and University of Sydney, Sydney NSW, Australia.
authors.forename: Vasant
authors.initials: V
authors.lastname: Hirani
authors.affiliation: Centre for Education and Research on Ageing, the Ageing and Alzheimers Institute, Concord Hospital and University of Sydney, Sydney NSW, Australia.
authors.forename: Vasi
authors.initials: V
authors.lastname: Naganathan
authors.affiliation: Centre for Education and Research on Ageing, the Ageing and Alzheimers Institute, Concord Hospital and University of Sydney, Sydney NSW, Australia.
authors.forename: Louise M
authors.initials: LM
authors.lastname: Waite
authors.affiliation: ANZAC Research Institute, University of Sydney, New South Wales, Australia.
authors.forename: Markus J
authors.initials: MJ
authors.lastname: Seibel
authors.affiliation: ANZAC Research Institute, University of Sydney, New South Wales, Australia.
authors.forename: David J
authors.initials: DJ
authors.lastname: Handelsman
authors.affiliation: Centre for Education and Research on Ageing, the Ageing and Alzheimers Institute, Concord Hospital and University of Sydney, Sydney NSW, Australia; School of Public Health, University of Sydney, Sydney NSW, Australia.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Cumming
authors.affiliation: Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
authors.forename: Heather G
authors.initials: HG
authors.lastname: Allore
authors.affiliation: Charles Perkins Centre, University of Sydney, Sydney NSW, Australia; Faculty of Pharmacy, University of Sydney, Sydney NSW, Australia. Electronic address: danijela.gnjidic@sydney.edu.au.
authors.forename: Danijela
authors.initials: D
authors.lastname: Gnjidic
mesh_terms: D000368:Aged; D001315:Australia; D064420:Drug-Related Side Effects and Adverse Reactions / Q000209:etiology*; D015577:Geriatric Assessment / Q000379:methods; D006801:Humans; D008297:Male; D004364:Pharmaceutical Preparations / Q000008:administration & dosage*; D019338:Polypharmacy; D013577:Syndrome
chemical_list: D004364:Pharmaceutical Preparations
keywords: Association rule analysis; Medications; Older adults; Pharmacoepidemiological studies