The association between medication use and health-related quality of life in multimorbid older patients with polypharmacy

Charlotte Falke; Fatma Karapinar; Marcel Bouvy; Mariëlle Emmelot; Svetlana Belitser; Benoit Boland; Denis O'Mahony; Kevin D Murphy; Moa Haller; Paola Salari; Matthias Schwenkglenks; Nicolas Rodondi; Toine Egberts; Wilma Knol

doi:10.1007/s41999-024-01036-4

The association between medication use and health-related quality of life in multimorbid older patients with polypharmacy

Eur Geriatr Med. 2024 Aug 20. doi: 10.1007/s41999-024-01036-4. Online ahead of print.

Authors

Charlotte Falke¹, Fatma Karapinar^{2

3}, Marcel Bouvy⁴, Mariëlle Emmelot⁵, Svetlana Belitser⁴, Benoit Boland^{6

7}, Denis O'Mahony^{8

9}, Kevin D Murphy¹⁰, Moa Haller^{11

12}, Paola Salari^{13

14}, Matthias Schwenkglenks¹³, Nicolas Rodondi^{11

12}, Toine Egberts⁴, Wilma Knol⁵

Affiliations

¹ Division of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands. c.m.falke@uu.nl.
² Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center+, Maastricht, the Netherlands.
³ Department of Clinical Pharmacy, CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands.
⁴ Division of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands.
⁵ Geriatric Medicine Department and Expertise Centre Pharmacotherapy in Old Persons, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands.
⁶ Institute of Health and Society (IRSS), Université Catholique de Louvain (UCLouvain), Louvain, Belgium.
⁷ Geriatric Medicine, Cliniques Universitaires Saint-Luc, avenue Hippocrate 10, 1200, Brussels, Belgium.
⁸ Department of Medicine, University College Cork, Cork, Ireland.
⁹ Department of Geriatric and Stroke Medicine, Cork University Hospital, Cork, Ireland.
¹⁰ School of Pharmacy, University College Cork, Cork, Ireland.
¹¹ Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
¹² Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
¹³ Institute of Pharmaceutical Medicine (ECPM), University of Basel, Klingelbergstrasse, 61, 4056, Basel, Switzerland.
¹⁴ Joint Research Centre (JRC), European Commission, Ispra, Italy.

PMID: 39162972
DOI: 10.1007/s41999-024-01036-4

Abstract

Purpose: To explore the association between medication use-related factors and health-related quality of life (HRQoL) in older hospitalised multimorbid patients with polypharmacy.

Methods: This cross-sectional study used the intervention arm data of the OPERAM trial (hospitalised patients ≥ 70 years with polypharmacy). HRQoL was assessed using the visual analogue scale (EQ-VAS) and the EQ-5D index score of the EuroQol questionnaire (EQ-5D-5L). Lower or higher EQ-VAS/EQ-5D was based on the median of the study population. Medication use-related factors included hyperpolypharmacy (≥ 10 medications), anticholinergic and sedative burden, appropriateness of medication (STOPP/START criteria), high-risk medication for hospital (re)admission, medication complexity and adherence. Multivariable logistic regression analysis was used to assess the association between medication use-related factors and HRQoL.

Results: A total of 955 patients were included (mean age 79 years, 46% female, median EQ-VAS of 60, median EQ-5D of 0.60). Opioids use was associated with lower EQ-5D and EQ-VAS (aOR EQ-5D: 2.10; 95% CI 1.34-3.32, EQ-VAS: 1.59; 1.11-2.30). Hyperpolypharmacy (aOR 1.37; 1.05-1.80), antibiotics (aOR 1.64; 1.01-2.68) and high medication complexity (aOR 1.53; 1.10-2.15) were associated with lower EQ-VAS. A high anticholinergic and sedative burden (aOR 1.73; 1.11-2.69), presence of multiple prescribing omissions (aOR 1.94; 1.19-3.17) and benzodiazepine use (aOR 2.01; 1.22-3.35) were associated with lower EQ-5D. Especially in hyperpolypharmacy patients, high anticholinergic and sedative burden and medication complexity were associated with a lower HRQoL.

Conclusion: Several medication use-related factors are significantly associated with a lower HRQoL in hospitalised older patients. Medication complexity is a novel factor, which should be considered when evaluating medication use of older patients with hyperpolypharmacy.

Keywords: HRQoL; Medication complexity; Medication use; Polypharmacy; Quality of life.