CHANGE-Rx: Frailty, Falls, Polypharmacy, and Inappropriate Medication Use in a Canadian Cohort of People Aged 65 and Older Living With HIV

Abstract

Objective: To characterize the prevalence of polypharmacy, potentially inappropriate medication (PIMs), anticholinergic burden (ACB) and sedative burden (SB) and their association with the risk of frailty and falls in a Canadian cohort of older people with HIV. Design: CHANGE-Rx is a cross-sectional analysis of baseline data from CHANGE-HIV, a Canadian cohort of people with HIV aged 65 years and older. Methods: Information on prescription, over-the-counter/natural-health product use, comorbidities, HIV-specific factors, frailty and fall history were assessed at the baseline visit at cohort entry. Proportion of people with polypharmacy (≥5 non-antiretroviral (ARV) drugs), severe polypharmacy (≥10 non-ARV drugs), PIMs, ACB and SB were determined. Chi-square tests and multivariate regression analysis were used to assess the association between medication factors and the risk of frailty and falls. Results: 440 participants were included: median age 69 years (range: 65-89), 16.4% were classified as frail, 20.7% experienced a fall (last six months), 53.2% had polypharmacy, 14.8% had severe polypharmacy, 49.3% had ≥1 PIM. For prescribed comedications, 16.5% and 55.7% of participants had high ACB and SB, respectively. The odds ratio (OR) for frailty were 3.3, 2.6 and 2.9 among patients with high ACB, high SB and severe polypharmacy, respectively. The OR for falls were 1.9 and 1.8 for patients with high SB and ≥1 PIM, respectively. Conclusion: Polypharmacy, PIMs and high ACB and SB are common among older adults living with HIV in Canada. It remains to be determined if interventions addressing polypharmacy/PIMs would reduce falls and frailty.