Underuse of medications for chronic diseases in the oldest of community-dwelling older frail Japanese

OBJECTIVES: To test the following hypotheses: (1) the rate of polypharmacy, defined as six or more prescribing medications, is lower in the oldest old (≥85) than in younger older people (65-84); (2) beneficial medication use is lower in the oldest old; (3) the underuse of these medications in the oldest old is associated with physical or cognitive impairment or comorbid conditions. DESIGN: A cross-sectional study of the baseline data from the Nagoya Longitudinal Study for Frail Elderly. SETTING: Community-based. PARTICIPANTS: One thousand eight hundred seventy-five community-dwelling older people (632 men, 1,243 women). MEASUREMENTS: The data, which were collected at the patients' homes or from care-managing center records, included the clients' demographic characteristics, depression status as assessed using the short version of the Geriatric Depression Scale, a rating for basic activities of daily living (ADLs), prescribed medications, and physician-diagnosed chronic diseases. RESULTS: The oldest old had less polypharmacy even after controlling for ADLs and comorbid conditions. The underuse of beneficial medications for the oldest old was observed after adjusting for ADLs, cognitive impairment, comorbid conditions, antithrombotic agents for subjects with a history of cardiovascular diseases, acetylcholinesterase inhibitors for those with dementia, and antidepressants for those with depression. However, being aged 85 and older was not associated with the underuse of hypoglycemic and antihypertensive agents by those with diabetes mellitus and hypertension, respectively. CONCLUSION: Among community-dwelling frail older people, the rate of polypharmacy is lower in the oldest members than in the younger ones. The underuse of prescribed medications for chronic diseases/conditions of frail older people is common but not for all conditions.