Abstract
This work examines whether the increased all-cause and cardiovascular disease (CVD) mortality associated with polypharmacy could be offset by a healthy lifestyle. We included a prospective cohort of 3,925 individuals representative of the Spanish population aged ≥60 years, who were recruited in 2000–2001 and followed up through 2014. Polypharmacy was defined as treatment with ≥5 medications. The following lifestyle behaviors were considered healthy: not smoking, eating a healthy diet, being physically active, moderate alcohol consumption, low sitting time, and adequate sleep duration. Individuals were classified into three lifestyle categories s: unfavorable (0–2), intermediate (3–4) favorable (5–6). Over a median 13.8-y follow-up, 1,822 all-cause and 675 CVD deaths occurred. Among individuals with polypharmacy, intermediate and favorable lifestyles were associated with an all-cause mortality reduction (95% confidence interval [CI]) of 47% (34–58%) and 54% (37–66%), respectively; 37% (9–56%) and 60% (33–76%) for CVD death, respectively. The theoretical adjusted hazard ratio (95%CI) associated with replacing 1 medication with 1 healthy lifestyle behavior was 0.73 (0.66–0.81) for all-cause death and 0.69 (0.59–0.82) for CVD death. The theoretical adjusted hazard ratio (95%CI) for all-cause and CVD mortality associated with simply reducing 1 medication was 0.88 (0.83–0.94) and 0.83 (0.76–0.91), respectively. Hence, adherence to a healthy lifestyle behavior can reduce mortality risk associated with polypharmacy in older adults.
Highlights
Improvements in the effectiveness and coverage of health care, including pharmacological treatments, have substantially contributed to recent gains in health expectancy in old age in high-income countries[1]
After multivariable adjustment, and compared to taking 0–1 medications, the adjusted hazard ratios (HRs) (95%confidence intervals (CIs)) of all-cause death was 1.32 (1.15–1.51) for 3–4 medications and 1.75 (1.49–2.06) for ≥5 medications; corresponding results for cardiovascular disease (CVD) mortality were 1.50 (1.17–1.92) and 2.11 (1.60–2.78). Those with intermediate and favorable vs unfavorable lifestyle had an adjusted HR (95%CI) of 0.58 (0.51–0.67) and 0.48 (0.40–0.57) for all-cause mortality, and of 0.55 (0.43–0.70) and 0.45 (0.32–0.59) for CVD mortality (Table 2). Both medications and healthy lifestyles showed a clear dose-response with mortality (Figure S2); the adjusted HR (95%CI) for all-cause and CVD mortality associated with 1-medication increase were 1.12 (1.09–1.14) and 1.15 (1.10–1.19), respectively, and with 1-healthy lifestyle behavior increase were 0.81 (0.77–0.85) and 0.78 (0.72– 0.85), respectively (Table 2)
In a population-based cohort of older adults in Spain, adherence to a healthier lifestyle was linked to a reduction of all-cause and CVD mortality associated with polypharmacy
Summary
Improvements in the effectiveness and coverage of health care, including pharmacological treatments, have substantially contributed to recent gains in health expectancy in old age in high-income countries[1]. Polypharmacy, defined as the use of multiple medications or the administration of an excessive number of medications[4], is very frequent in the elderly and has been associated with many adverse health outcomes, including poor treatment adherence, adverse drug reactions, drug-drug interactions, drug-disease interactions, falls, fractures, frailty, hospitalizations, physical and cognitive functional impairments, and medical errors which, in turn, increase the risk of death[5]. These findings might represent an important shift in the approach to provide health in among older adults because the objectives go beyond preventing deaths exclusively through pharmacology treatments. We used data from a cohort of older adults in Spain to examine whether the increased all-cause and cardiovascular disease (CVD) mortality associated with polypharmacy could be offset by a healthy lifestyle. We assessed the theoretical mortality benefits that could be obtained by replacing medications with healthy lifestyle behaviors in individuals with polypharmacy
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