Weiss Jordan, Beydoun May A, Georgescu Michael F, Maldonado Ana I, Beydoun Hind A, Noren Hooten Nicole, Tsai Jack, Song Minkyo, Nieva Allen, Evans Michele K, Zonderman Alan B
Optimal Aging Institute, New York University Grossman School of Medicine, New York, NY, USA.
Division of Precision Medicine, Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA.
Geroscience. 2025 Mar 13. doi: 10.1007/s11357-025-01586-w.
Polypharmacy is common among older adults and has been linked to adverse outcomes such as dementia, Parkinson's disease (PD), and mortality. However, its influence on transitions between these health states remains understudied in large, population-based cohorts. Using data from 361,970 UK Biobank participants aged 50 and older with up to 15 years of follow-up, we examined the association between polypharmacy, defined as the use of five or more medications, and transitions between health states: healthy, dementia, PD, and mortality. Multistate parametric models, including Weibull regression, were employed to estimate these associations, adjusting for demographics, socioeconomic status, cardiovascular health, and comorbidities. Latent class analysis was used to identify specific medication combinations associated with health transitions. Polypharmacy was significantly associated with higher risks of transitioning from healthy to dementia (hazard ratio [HR], 1.15; 95% CI, 1.07-1.23) and from healthy to death (HR, 1.11; 95% CI, 1.08-1.09). Women exhibited better cardiovascular health but higher polypharmacy prevalence compared to men. Latent class analysis revealed that certain medication combinations, such as omega-3 fatty acids and multivitamins, were inversely associated with dementia and mortality, independent of polypharmacy status. These findings highlight the complex relationship between polypharmacy and health transitions in older adults. Careful medication management may mitigate risks associated with polypharmacy, particularly among individuals at risk for neurodegenerative diseases. Further research is warranted to investigate the potential protective effects of specific medication combinations on health outcomes.
多重用药在老年人中很常见，并且与痴呆症、帕金森病（PD）和死亡率等不良后果有关。然而，在大型的基于人群的队列研究中，其对这些健康状态之间转变的影响仍未得到充分研究。我们使用来自英国生物银行361,970名年龄在50岁及以上、随访时间长达15年参与者的数据，研究了多重用药（定义为使用五种或更多药物）与健康状态转变之间的关联：健康、痴呆症、PD和死亡。采用包括威布尔回归在内的多状态参数模型来估计这些关联，并对人口统计学、社会经济地位、心血管健康和合并症进行了调整。使用潜在类别分析来识别与健康转变相关的特定药物组合。多重用药与从健康转变为痴呆症（风险比[HR]，1.15；95%置信区间，1.07 - 1.23）以及从健康转变为死亡（HR，1.11；95%置信区间，1.08 - 1.09）的较高风险显著相关。与男性相比，女性表现出更好的心血管健康，但多重用药的患病率更高。潜在类别分析显示，某些药物组合，如ω-3脂肪酸和多种维生素，与痴呆症和死亡率呈负相关，且与多重用药状态无关。这些发现凸显了老年人多重用药与健康转变之间的复杂关系。谨慎的药物管理可能会降低与多重用药相关的风险，尤其是在神经退行性疾病风险人群中。有必要进行进一步研究，以调查特定药物组合对健康结果的潜在保护作用。
