Sloan Caroline E, Ashner Marissa C, McDermott Cara L, Burrows Brett T, Pieper Carl, Bhatt Ankeet S, Gabriel Kelley Pettee, Bowling C Barrett
Duke University School of Medicine, Department of Medicine, Durham, NC, USA.
Duke University School of Medicine, Department of Population Health Sciences, Durham, NC, USA.
J Gen Intern Med. 2025 Jul 7. doi: 10.1007/s11606-025-09692-3.
Polypharmacy (≥ 5 medications) and potentially inappropriate medications (PIM; per Beers criteria) are common in midlife. Polypharmacy and PIM use are associated with poor physical function and adverse health outcomes in older age, but the associations of polypharmacy and PIM use with physical function in middle-age are poorly understood.
Estimate the associations of polypharmacy and PIM use with physical performance in middle-age.
Cross-sectional analysis of the Coronary Artery Risk Development in Young Adults (CARDIA) Function study.
The CARDIA prospective cohort study enrolled 5115 participants aged 18-30 in 1985-1986. We included participants with data on self-reported medication use who completed physical performance testing (gait speed, grip strength, 30-s chair stand, single-leg balance, 6-min walk test) at the year 35 in-person exam (2020-2022).
The CARDIA Physical Performance (CAPP) score was calculated by assigning points to sex-specific quartiles for each test (0 = not attempted, 1-4 per quartile) and summing points across all five tests (0-20). We used multivariable linear regression to estimate the associations of polypharmacy and PIM use with CAPP score, adjusting for sociodemographics, multimorbidity, and physical activity history. For PIM use, a second model further adjusted for polypharmacy.
Among 1842 participants (age 60 years ± 4; 49% female, 44% Black race), 29% had polypharmacy and 25% used ≥ 1 PIM. Estimated CAPP score was 1.24 points lower among participants with polypharmacy vs. no polypharmacy (95% confidence interval [95%CI] -1.58, -0.90; p < 0.001). Estimated CAPP score was 0.88 points lower among participants with PIMs vs. no PIMs after initial adjustment (95%CI -1.22, -0.54; p < 0.001). After adjusting for polypharmacy, PIM use was not associated with CAPP score.
Polypharmacy is associated with lower physical function in middle-aged adults. Clinicians should consider systematically assessing physical function in middle-aged patients who have polypharmacy, to capture physical decline earlier in the lifespan.
多重用药（≥5种药物）和潜在不适当用药（PIM；根据Beers标准）在中年人群中很常见。多重用药和PIM的使用与老年人身体功能差和不良健康结局相关，但多重用药和PIM的使用与中年人群身体功能之间的关联尚不清楚。
评估多重用药和PIM的使用与中年人群身体表现之间的关联。
对青年成人冠状动脉风险发展研究（CARDIA）功能研究进行横断面分析。
CARDIA前瞻性队列研究在1985 - 1986年招募了5115名年龄在18 - 30岁的参与者。我们纳入了在35岁现场检查（2020 - 2022年）时完成身体表现测试（步速、握力、30秒椅子站立试验、单腿平衡、6分钟步行试验）且有自我报告用药数据的参与者。
CARDIA身体表现（CAPP）评分通过为每项测试的性别特异性四分位数分配分数（0 =未尝试，每个四分位数1 - 4分）并将所有五项测试的分数相加（0 - 20分）来计算。我们使用多变量线性回归来评估多重用药和PIM的使用与CAPP评分之间的关联，并对社会人口统计学、多种疾病和身体活动史进行了调整。对于PIM的使用，第二个模型进一步对多重用药进行了调整。
在1842名参与者（年龄60岁±4岁；49%为女性，44%为黑人）中，29%存在多重用药，25%使用≥1种PIM。与未多重用药的参与者相比，多重用药的参与者估计CAPP评分低1.24分（95%置信区间[95%CI] -1.58，-0.90；p < 0.001）。初次调整后，与未使用PIM的参与者相比，使用PIM的参与者估计CAPP评分低0.88分（95%CI -1.22，-0.54；p < 0.001）。在对多重用药进行调整后，PIM的使用与CAPP评分无关。
多重用药与中年成年人身体功能较低有关。临床医生应考虑对多重用药的中年患者系统地评估身体功能，以便在寿命早期发现身体衰退。
