Takeshima Eisuke, Kimura Akira
Department of Physical Therapy, Faculty of Medical and Health Sciences, Hokuriku University, Kanazawa, Ishikawa, Japan.
Department of Health Science, Graduate School of Health Sciences, Gunma PAZ University, Takasaki, Gunma, Japan.
Medicine (Baltimore). 2025 Sep 12;104(37):e44481. doi: 10.1097/MD.0000000000044481.
Polypharmacy is a risk factor for falls and decreased functional ability in older adults; however, its age-specific impact during rehabilitation remains unclear. This study was conducted at Tsurugi Hospital, located in Ishikawa, Japan. This study aimed to investigate the association between polypharmacy and outcomes such as in-hospital falls and activities of daily living at discharge in elderly patients hospitalized for proximal femoral fractures, focusing on age-group differences. This retrospective cohort study was conducted at a comprehensive rehabilitation ward. Patients aged ≥75 years admitted between April 2020 and March 2022 were included in the study. Participants were stratified into 2 age groups (75-89 and ≥90 years). Polypharmacy was assessed using 2 definitions: ≥5 medications (conventional) and age group-specific median cutoffs. The functional independence measure (FIM) scores and fall incidence were analyzed using appropriate statistical methods, including multiple regression and Bonferroni correction. Eighty-six patients (mean age 89.3 ± 5.2 years) were analyzed. In the 75-89 years age group, polypharmacy defined as taking ≥8 medications at discharge was significantly associated with lower cognitive FIM scores (median: 23 vs 32; r = -0.384, P = .016). Subscale analyses revealed significant negative associations in comprehension (r = -0.463, P = .004), problem-solving (r = -0.325, P = .047), and memory (r = -0.360, P = .026). In the same age group, multiple regression analysis further confirmed that taking ≥9 medications at discharge was an independent predictor of lower cognitive FIM scores (β = -0.466, P = .003). In contrast, in the ≥90 years group, cognitive FIM scores were significantly negatively predicted by the presence of dementia (β = -0.376, P = .005). In the overall sample, body mass index (β = 0.284, P = .007) and shorter postoperative hospitalization duration (β = -0.274, P = .010) were also associated with better cognitive FIM scores. The relationship between polypharmacy and functional outcomes varied by age group. These findings highlight the need for individualized discharge planning and medication management based on patient age and background.
多重用药是老年人跌倒和功能能力下降的一个风险因素；然而，其在康复过程中因年龄而异的影响仍不明确。本研究在位于日本石川县的剑医院进行。本研究旨在调查多重用药与因股骨近端骨折住院的老年患者的院内跌倒及出院时日常生活活动等结局之间的关联，重点关注年龄组差异。这项回顾性队列研究在一个综合康复病房进行。纳入了2020年4月至2022年3月期间入院的年龄≥75岁的患者。参与者被分为两个年龄组（75 - 89岁和≥90岁）。使用两种定义评估多重用药情况：≥5种药物（传统定义）和特定年龄组的中位数临界值。使用适当的统计方法，包括多元回归和Bonferroni校正，分析功能独立性测量（FIM）评分和跌倒发生率。对86名患者（平均年龄89.3±5.2岁）进行了分析。在75 - 89岁年龄组中，出院时服用≥8种药物定义的多重用药与较低的认知FIM评分显著相关（中位数：23对32；r = -0.384，P = 0.016）。子量表分析显示在理解（r = -0.463，P = 0.004）、问题解决（r = -0.325，P = 0.047）和记忆（r = -0.360，P = 0.026）方面存在显著负相关。在同一年龄组中，多元回归分析进一步证实出院时服用≥9种药物是较低认知FIM评分的独立预测因素（β = -0.466，P = 0.003）。相比之下，在≥90岁年龄组中，痴呆的存在显著负向预测认知FIM评分（β = -0.376，P = 0.005）。在总体样本中，体重指数（β = 0.284，P = 0.007）和较短的术后住院时间（β = -0.274，P = 0.010）也与较好的认知FIM评分相关。多重用药与功能结局之间的关系因年龄组而异。这些发现凸显了根据患者年龄和背景进行个性化出院计划和药物管理的必要性。
