The prevalence of multimorbidity—defined as the presence of two or more chronic health conditions—remains alarmingly high among older adults, with recent research indicating it affects more than 77 percent of this population group. Alongside this, polypharmacy, the concurrent use of five or more medications, is prevalent, affecting over half of older adults attending medical clinics. These conditions are particularly concerning due to their complicated interactions, which can exacerbate the risk of falls and influence cognitive function.
Conducted across four tertiary care hospitals in Sri Lanka, this multicenter study involved 704 older adults, with data collected between August 2021 and August 2022. The research aimed to investigate the associations between multimorbidity, the use of Falls Risk Increasing Drugs (FRIDs), anti-cholinergic burden (ACB), and adverse outcomes, including falls, physical activity, and cognitive functions.
Among the participants, 305 individuals (43.5%) reported experiencing at least one fall after the age of 65, and 220 (31.3%) fell within the last year. Despite these concerning statistics, researchers noted no significant associations between multimorbidity, polypharmacy, or the use of FRIDs with negative health outcomes. A noteworthy finding was the prevalence of polypharmacy at 51.2%, yet only 70.5% of participants were using at least one FRID, with 5.4% experiencing higher ACB. Contributing factors to these findings may include the fast-paced clinical settings often inhabited by older patients, making it challenging to adequately review prescriptions.
“Falls are prevalent among older adults and lead to increased morbidity, mortality, and healthcare costs,” noted the authors of the article. With nearly one-third of older adults experiencing falls annually, this research serves as a clarion call for healthcare systems to reassess their prescribing practices actively.
Despite the high prevalence of multimorbidity and polypharmacy identified by the study, researchers found no direct correlation between these factors and falls, physical activity, or cognitive performance. This contrasts with numerous previous studies highlighting the adverse effects of such health conditions on older adults.
The relationship between medication use, particularly polypharmacy, and falls remains elusive, as noted research across different countries has reported varied findings. For example, some studies show polypharmacy as significantly contributing to fall risks, especially when associated with specific FRIDs like antihypertensives, antidepressants, and opioids. Yet, this study refutes these earlier claims within the Sri Lankan population.
Another significant factor raised by the research revolves around medication adherence—a recurring theme among older adults. Many older patients struggle to comply with complex medication regimens, which can lead to either under- or over-medication. Concurrently, the study indicated poor adherence may mask the fraught relationship between medications and falls.
“This study highlights the high prevalence of multimorbidity and polypharmacy among older adults; yet, no significant associations with adverse health outcomes were found,” stated the authors, underscoring the complexity of these interactions.
This comprehensive analysis reinforces the necessity for health professionals to undergo specialized training related to prescribing practices for geriatrics. By prioritizing deprescribing potentially harmful medications, clinicians can help mitigate unintended consequences of polypharmacy.
While the data was gathered through self-reported methods, which can sometimes lead to inaccuracies, the underlying message remains clear: urgent attention to medication management among older adults is warranted. Future research should focus on longitudinal studies to interpret nuanced relationships concerning individual medication classes and investigate effective deprescribing strategies to improve health outcomes for older adults.