Self‐Reported Prescription Drug Use for Pain and for Sleep and Incident Frailty

• Published in: Journal of the American Geriatrics Society (JAGS) 2019-12, Vol.67 (12), p.2474-2481
• Main Authors: Cil, Gulcan, Park, Juyoung, Bergen, Andrew W.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; AGS Beers Criteria; analgesic; Chronic illnesses; Drug development; Drug use; Female; Frailty; Frailty - epidemiology; Humans; Incidence; longitudinal analysis; Longitudinal Studies; Male; Middle Aged; Pain; Pain - drug therapy; physical frailty; Potentially Inappropriate Medication List; Prescription drugs; Prescription Drugs - therapeutic use; Prevalence; sedative; Self Report; Sensitivity analysis; Sleep; Substance use; Substance-Related Disorders - psychology; United States - epidemiology
• ISSN: 0002-8614; 1532-5415
• DOI: 10.1111/jgs.16214

OBJECTIVES We aimed to estimate incident frailty risks of prescription drugs for pain and for sleep in older US adults. DESIGN Longitudinal cohort. SETTING Health and Retirement Study. PARTICIPANTS Community‐living respondents aged 65 years and older, excluding individuals who received recent treatment for cancer (N = 14 208). Our longitudinal analysis sample included respondents who were not frail at baseline and had at least one follow‐up wave with complete information on both prescription drug use and frailty, or date of death (N = 7201). MEASUREMENTS Prescription drug use for pain and sleep, sociodemographics, other drug and substance use, and Burden frailty model components. Multivariable drug use stratified hazard models with death as a competing risk evaluated frailty risks associated with co‐use and single use of prescription drugs for pain and for sleep. RESULTS Proportions endorsing prescription drug use were 22.1% for pain only, 6.8% for sleep only, and 7.7% for both indications. Burden frailty model prevalence was 41.0% and varied significantly by drug use. Among non‐frail individuals at baseline, proportions endorsing prescription drug use were 14.9%, 5.6%, and 2.2% for the three indications. Prescription drug use was associated with increased risk of frailty (co‐use adjusted subhazard ratio [sHR] = 1.95; 95% confidence interval [CI] = 1.6‐2.4; pain only adjusted sHR = 1.58; CI = 1.4‐1.8; sleep‐only adjusted sHR = 1.35; CI = 1.1‐1.6; no use = reference group). Cumulative incidence of frailty over 8 years for the four groups was 60.6%, 50.9%, 45.8%, and 34.1%. Sensitivity analyses controlling for chronic diseases associated with persistent pain resulted in minor risk reductions. CONCLUSION Prescription pain and sleep drug use is significantly associated with increased incidence of frailty. Research to estimate effects of pain and sleep indications and of drug class–specific dosage and duration on incident frailty is indicated before advocating deprescribing based on these findings. J Am Geriatr Soc 67:2474–2481, 2019 See related editorial by Paula Rochon and related article by Shahar Shmuel