Potentially inappropriate medication and frailty in older adults: A systematic review and meta-analysis

• Published in: Archives of gerontology and geriatrics 2023-11, Vol.114, p.105087-105087, Article 105087
• Main Authors: Ma, Wenlian, Wang, Hongyan, Wen, Zhifei, Liu, Linfeng, Zhang, Xiangeng
• Format: Article
• Language: English
• Subjects: Bidirectional association; Frailty; Meta-analysis; Pim; Systematic review
• ISSN: 0167-4943; 1872-6976
• DOI: 10.1016/j.archger.2023.105087

•This study provides the latest evidence on the potential bidirectional association between frailty and PIM.•Comorbidities and polypharmacy are the mechanisms of the bidirectional association between frailty and PIM.•The use of ≥ 2 PIMs and nervous system and anticholinergic PIMs show strong associations with frailty.•Future research should focus on prescription reduction for safe medication management and early identification of frailty.•The mechanism of how frailty or elements of frailty affect the use of PIM is not clear, which is a gap that future research needs to address. The purpose of this study was to systematically assess existing studies to demonstrate the association between potentially inappropriate medication (PIM) and frailty. Systematic review and meta-analysis. We searched major electronic databases (PubMed, Web of Science, the Cochrane Library, Embase, CINHAL, PsycInfo, China National Knowledge Infrastructure, China Biology Medicine disk, Weipu, and Wanfang) from their inception until February 25, 2023 (data updated on May 4, 2023), for observational studies investigating PIM and frailty. I2 was used to measure the heterogeneity between studies quantitatively. A random effect model calculated pooled effect size owing to high heterogeneity. Subgroup analysis was conducted to explore sources of heterogeneity. Additionally, the studies’ quality was evaluated using the Newcastle Ottawa Scale (a modified Newcastle Ottawa Scale was used to evaluate cross-sectional studies). Twenty-four studies were included for systematic review, 14 of which were included in the meta-analysis. After pooling the effect size, the odds ratio with PIM as the dependent variable was 1.12 (95%CI: 1.01–1.25), and that with frailty as the dependent variable was 1.75 (95%CI: 1.25–2.43), indicating a bidirectional association between PIM and frailty. PIM and frailty interact with each other and have a bidirectional association, thus providing additional information for early clinical identification and prevention of frailty, and medication safety management.