For older adults with heart failure: Can taking too many medications reduce abilities?

As we age, we tend to develop a number of chronic health conditions and concerns. Often, managing health problems can mean that older adults may take many different medications. When older adults take five or more medicines (a scenario health experts call "polypharmacy", it can increase the risk of harmful side effects.

Polypharmacy can contribute to serious problems including falls, disability, and hospitalizations. Taking more than five medications is especially common among older adults with heart failure, which is the leading cause of hospitalization for people age 65 and older. Doctors often prescribe several different drugs to improve heart failure, but this can increase your risk of harmful side effects and interactions between your medications. Older adults who have trouble performing routine daily activities are at a particularly high risk for the negative effects of taking a large number of medications.

In a new study, researchers examined whether limitations in older adults' abilities to perform their routine daily activities were linked to taking multiple medications for heart failure. They published their study in the Journal of the American Geriatrics Society.

The researchers examined data from 2003-2014 from the National Health and Nutrition Examination Survey (NHANES). They looked at whether limitations in performing routine daily activities were linked to the number of drugs taken by people aged 50 and older with heart failure.

People in the study (most of whom were around age 70) had multiple chronic conditions, which included high blood pressure, diabetes, anemia, asthma, chronic bronchitis, emphysema, coronary artery disease, prior heart attack, prior stroke, thyroid disease, liver disease, cancer, chronic kidney disease, dialysis, high cholesterol, and arthritis. They were also considered to be frail. People who are frail can be weak, have less endurance, feel exhausted, and be less able to function well.

Nearly 25 percent of the people in the study had trouble thinking and making decisions (also known as cognitive impairment). Cognitive difficulties were more common among people who also had problems performing their routine daily activities.

In the study, 74 percent of the participants took five or more medications. People who had difficulty performing their daily activities took more medications and were more likely to take more than five medications compared to people who didn't have trouble performing their routine daily activities.

The authors suggested that health care providers might not be taking limitations in performing routine daily activities into account when prescribing drugs for people with heart failure. This may unnecessarily expose older people with heart failure to a higher risk of harmful side effects associated with their prescriptions.

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This summary is from "Association Between Functional Impairment and Medication Burden Among Adults with Heart Failure." It appears online ahead of print in the Journal of the American Geriatrics Society. The study authors are Parag Goyal, MD, MSc; Joanna Bryan, MPH; Jerard Kneifati-Hayek, MD; Madeline R. Sterling, MD, MPH; Samprit Banerjee, PhD; Mathew S. Maurer, MD; Mark S. Lachs, MD, MPH; and Monika M. Safford MD.

This research summary was developed as a public education tool by the Health in Aging Foundation. The Foundation is a national non-profit established in 1999 by the American Geriatrics Society to bring the knowledge and expertise of geriatrics healthcare professionals to the public. We are committed to ensuring that people are empowered to advocate for high-quality care by providing them with trustworthy information and reliable resources. Last year, we reached nearly 1 million people with our resources through HealthinAging.org. We also help nurture current and future geriatrics leaders by supporting opportunities to attend educational events and increase exposure to principles of excellence on caring for older adults. For more information or to support the Foundation's work, visit http://www.HealthinAgingFoundation.org.

Included in more than 9,000 library collections around the world, the Journal of the American Geriatrics Society (JAGS) highlights emerging insights on principles of aging, approaches to older patients, geriatric syndromes, geriatric psychiatry, and geriatric diseases and disorders. First published in 1953, JAGS is now one of the oldest and most impactful publications on gerontology and geriatrics, according to ISI Journal Citation Reports®. Visit wileyonlinelibrary.com/journal/JGS for more details.

Founded in 1942, the American Geriatrics Society (AGS) is a nationwide, not-for-profit society of geriatrics healthcare professionals that has--for 75 years--worked to improve the health, independence, and quality of life of older people. Its nearly 6,000 members include geriatricians, geriatric nurses, social workers, family practitioners, physician assistants, pharmacists, and internists. The Society provides leadership to healthcare professionals, policymakers, and the public by implementing and advocating for programs in patient care, research, professional and public education, and public policy. For more information, visit AmericanGeriatrics.org.