OpenLB
Open Library of Bioscience
Advanced Search
Drugs & aging
Mar 19, 2025;

Prescription and Non-prescription Medication Pill Burdens and Their Associations with Health-Related Quality of Life in Older Adults: A Cross-Sectional Study.

Josephine M Vonderhaar, Michael E Ernst, Michelle A Fravel, Suzanne G Orchard, Alice J Owen, Robyn L Woods, Rory Wolfe, Nigel Stocks, Julia Gilmartin-Thomas
Author Information
  1. Josephine M Vonderhaar: Department of Pharmacy Practice and Science, College of Pharmacy, The University of Iowa, 180 S. Grand Ave, Iowa City, IA, 52242, USA.
  2. Michael E Ernst: Department of Pharmacy Practice and Science, College of Pharmacy, The University of Iowa, 180 S. Grand Ave, Iowa City, IA, 52242, USA. michael-ernst@uiowa.edu. ORCID
  3. Michelle A Fravel: Department of Pharmacy Practice and Science, College of Pharmacy, The University of Iowa, 180 S. Grand Ave, Iowa City, IA, 52242, USA.
  4. Suzanne G Orchard: School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
  5. Alice J Owen: School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
  6. Robyn L Woods: School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
  7. Rory Wolfe: School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
  8. Nigel Stocks: Discipline of General Practice, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia.
  9. Julia Gilmartin-Thomas: School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
PMID: 40106218 DOI: 10.1007/s40266-025-01199-0

Abstract

BACKGROUND: Polypharmacy is associated with reduced health-related quality of life (HRQoL). This study explores the association between prescription and non-prescription medication pill burdens, independent of underlying morbidity, on HRQoL in an older adult population.
METHODS: Data from the final intervention year of the ASPirin in Reducing Events in the Elderly (ASPREE) randomized trial in older adults from Australia and the USA, were analyzed cross-sectionally. Participants reported daily prescription and non-prescription pill counts at the final trial visit. HRQoL was assessed using the 12-Item Short-Form instrument (SF-12) and summarized into the physical component summary (PCS) score and mental component summary (MCS) score, where lower scores reflect poorer HRQoL. Multivariable regression, adjusted for covariates, was used to examine the relationships of categorized prescription and non-prescription pill counts with PCS and MCS separately.
RESULTS: 15,165 participants responded to the question about prescription use and 15,727 for non-prescriptions (mean age = 80 years). Compared with non-users of prescription medications, lower mean PCS scores and larger reductions in scores were seen as prescription medication pill burden increased from 1-3, 4-6, 7-9, to ��� 10 pills (- 1.7, - 4.5, - 7.6, and - 10.9, respectively, p < 0.001). A similar relationship, but of lesser magnitude, was observed with non-prescription medication pill burden, where the mean PCS was lower by - 0.2 for 1-3 pills (p = 0.494), - 1.8 for 4-6 (p < 0.001), and - 1.9 for ��� 7 pills (p < 0.001), compared with non-users. No significant association was observed between prescription or non-prescription medication pill burdens and MCS.
CONCLUSIONS: Prescription and non-prescription medication pill burdens are independently associated with reduced physical, but not mental, HRQoL in older adults.

References

  1. World Health Organization. Ageing and health. World Health Organization. 2022. https://libguides.liberty.edu/ama/whoreports . Accessed 30 June 2024.
  2. Health AIo, Welfare. Older Australians. 2023. https://www.aihw.gov.au/reports/older-people/older-australians . Accessed 30 June 2024.
  3. Caplan Z. US older population grew from 2010 to 2020 at fastest rate since 1880 to 1890. United States Census Bureau. 2023. 2020 Census: 1 in 6 People in the United States Were 65 and Over. Accessed 30 June 2024.
  4. World Health Organization. Life expectancy and healthy life expectancy. World Health Organization. 2020. https://www.who.int/data/gho/data/indicators/indicator-details/GHO/life-expectancy-at-birth-(years) . Accessed 30 June 2024.
  5. Malani P, Kullgren J, Solway E, et al. National poll on healthy aging: older adults��� preparedness to age in place. April 2022. https://doi.org/10.7302/4278 .
  6. US. Dept of Health and Human Services. 2023 profile of older Americans. The Administration for Community Living; 2024. https://acl.gov/sites/default/files/Profile%20of%20OA/ACL_ProfileOlderAmericans2023_508.pdf . Accessed 30 June 2024.
  7. Kantor ED, Rehm CD, Haas JS, Chan AT, Giovannucci EL. Trends in prescription drug use among adults in the United States from 1999���2012. JAMA. 2015;314(17):1818���31. https://doi.org/10.1001/jama.2015.13766 . [DOI: 10.1001/jama.2015.13766]
  8. Innes GK, Ogden CL, Crentsil V, Concato J, Fakhouri TH. Prescription medication use among older adults in the US. JAMA Intern Med. Published online July 1, 2024. https://doi.org/10.1001/jamainternmed.2024.2781 .
  9. Sirois C, Domingues NS, Laroche ML, et al. Polypharmacy definitions for multimorbid older adults need stronger foundations to guide research, clinical practice and public health. Pharmacy (Basel). 2019. https://doi.org/10.3390/pharmacy7030126 . [DOI: 10.3390/pharmacy7030126]
  10. Gebreyohannes EA, Gebresillassie BM, Mulugeta F, Dessu E, Abebe TB. Treatment burden and health-related quality of life of patients with multimorbidity: a cross-sectional study. Qual Life Res. 2023;32(11):3269���77. https://doi.org/10.1007/s11136-023-03473-3 . [DOI: 10.1007/s11136-023-03473-3]
  11. Van Wilder L, Devleesschauwer B, Clays E, Pype P, Vandepitte S, De Smedt D. Polypharmacy and health-related quality of life/psychological distress among patients with chronic disease. Prev Chronic Dis. 2022;19:E50. https://doi.org/10.5888/pcd19.220062 . [DOI: 10.5888/pcd19.220062]
  12. Yue Z, Xue X, Qian J. The association between polypharmacy and health-related quality of life among older adults with prostate cancer. J Geriatr Oncol. 2024;15(5): 101772. https://doi.org/10.1016/j.jgo.2024.101772 . [DOI: 10.1016/j.jgo.2024.101772]
  13. Shalihin SE, Fauzi A, Zulkifli NA, Aziz AA. Anti-diabetic medication burden amongst older persons with diabetes and associated quality of life. Med J Malays. 2020;75(5):525���30.
  14. Al-Mansouri A, Hamad AI, Al-Ali FS, et al. Pill-burden and its association with treatment burden among patients with advanced stages of chronic kidney disease. Saudi Pharm J. 2023;31(5):678���86. https://doi.org/10.1016/j.jsps.2023.03.008 . [DOI: 10.1016/j.jsps.2023.03.008]
  15. Hughes CM, Cooper JA, Ryan C. Going beyond the numbers���a call to redefine polypharmacy. Br J Clin Pharmacol. 2014;77(6):915���6. https://doi.org/10.1111/bcp.12284 . [DOI: 10.1111/bcp.12284]
  16. Vyas A, Kang F, Barbour M. Association between polypharmacy and health-related quality of life among US adults with cardiometabolic risk factors. Qual Life Res. 2020;29(4):977���86. https://doi.org/10.1007/s11136-019-02377-5 . [DOI: 10.1007/s11136-019-02377-5]
  17. Babcock ZR, Kogut SJ, Vyas A. Association between polypharmacy and health-related quality of life among cancer survivors in the United States. J Cancer Surviv. 2020;14(1):89���99. https://doi.org/10.1007/s11764-019-00837-y . [DOI: 10.1007/s11764-019-00837-y]
  18. Aljeaidi MS, Haaksma ML, Tan ECK. Polypharmacy and trajectories of health-related quality of life in older adults: an Australian cohort study. Qual Life Res. 2022;31(9):2663���71. https://doi.org/10.1007/s11136-022-03136-9 . [DOI: 10.1007/s11136-022-03136-9]
  19. McNeil JJ, Woods RL, Nelson MR, et al. Baseline characteristics of participants in the ASPREE (ASPirin in Reducing Events in the Elderly) study. J Gerontol A Biol Sci Med Sci. 2017;72(11):1586���93. https://doi.org/10.1093/gerona/glw342 . [DOI: 10.1093/gerona/glw342]
  20. ASPREE Investigator Group. Study design of ASPirin in Reducing Events in the Elderly (ASPREE): a randomized, controlled trial. Contemp Clinl Trials. 2013;36(2):555���64. https://doi.org/10.1016/j.cct.2013.09.014 . [DOI: 10.1016/j.cct.2013.09.014]
  21. Ernst ME, Broder JC, Wolfe R, et al. Health characteristics and aspirin use in participants at the baseline of the ASPirin in Reducing Events in the Elderly-eXTension (ASPREE-XT) observational study. Contemp Clin Trials. 2023;130: 107231. https://doi.org/10.1016/j.cct.2023.107231 . [DOI: 10.1016/j.cct.2023.107231]
  22. McNeil JJ, Woods RL, Nelson MR, et al. Effect of aspirin on disability-free survival in the healthy elderly. N Engl J Med. 2018;379(16):1499���508. https://doi.org/10.1056/nejmoa1800722 . [DOI: 10.1056/nejmoa1800722]
  23. McNeil JJ, Wolfe R, Woods RL, et al. Effect of aspirin on cardiovascular events and bleeding in the healthy elderly. N Engl J Med. 2018;379(16):1509���18. https://doi.org/10.1056/nejmoa1805819 . [DOI: 10.1056/nejmoa1805819]
  24. McNeil JJ, Nelson MR, Woods RL, et al. Effect of aspirin on all-cause mortality in the healthy elderly. N Engl J Med. 2018;379(16):1519���28. https://doi.org/10.1056/nejmoa1803955 . [DOI: 10.1056/nejmoa1803955]
  25. Ware J Jr, Kosinski M, Keller SD. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34(3):220���33. https://doi.org/10.1097/00005650-199603000-00003 . [DOI: 10.1097/00005650-199603000-00003]
  26. Ware JE, Kosinski M, Keller SD. SF-12: how to score the SF-12 Physical and Mental Health Summary Score. 2nd ed. Boston: The Health Institute, New England Medical Center; 1995.
  27. Irwin M, Artin KH, Oxman MN. Screening for depression in the older adult: criterion validity of the 10-item Center for Epidemiological Studies Depression Scale (CES-D). Arch Intern Med. 1999;159(15):1701���4. https://doi.org/10.1001/archinte.159.15.1701 . [DOI: 10.1001/archinte.159.15.1701]
  28. Andresen EM, Malmgren JA, Carter WB, Patrick DL. Screening for depression in well older adults: evaluation of a short form of the CES-D (Center for Epidemiologic Studies Depression Scale). Am J Prev Med. 1994;10(2):77���84. https://doi.org/10.1016/S07493797(18)30622-6 . [DOI: 10.1016/S07493797(18)30622-6]
  29. Wang L, Palmer AJ, Cocker F, Sanderson K. Multimorbidity and health-related quality of life (HRQoL) in a nationally representative population sample: implications of count versus cluster method for defining multimorbidity on HRQoL. Health Qual Life Outcomes. 2017;15(1):7. https://doi.org/10.1186/s12955-016-0580-x . [DOI: 10.1186/s12955-016-0580-x]
  30. Mauvais-Jarvis F, Bairey Merz N, Barnes PJ, Brinton RD, Carrero JJ, DeMeo DL, De Vries GJ, Epperson CN, Govindan R, Klein SL, Lonardo A, Maki PM, McCullough LD, Regitz-Zagrosek V, Regensteiner JG, Rubin JB, Sandberg K, Suzuki A. Sex and gender: modifiers of health, disease, and medicine. Lancet. 2020;396(10250):565���82. https://doi.org/10.1016/S0140-6736(20)31561-0 . [DOI: 10.1016/S0140-6736(20)31561-0]
  31. Tian F, Chen Z, Zeng Y, Feng Q, Chen X. Prevalence of use of potentially inappropriate medications among older adults worldwide: a systematic review and meta-Analysis. JAMA Netw Open. 2023;6(8): e2326910. https://doi.org/10.1007/s11096-024-01769-z . [DOI: 10.1007/s11096-024-01769-z]
  32. Hughes JE, Bennett KE, Cahir C. Drug���drug interactions and their association with adverse health outcomes in the older community-dwelling population: a prospective cohort study. Clin Drug Investig. 2024;44(6):439���53. https://doi.org/10.1007/s40261-024-01369-9 . [DOI: 10.1007/s40261-024-01369-9]
  33. Gebreyohannes EA, Shibe BS, Taye WA, Lee K, Abdela OA, Ayele EM, Belachew EA, Mengistu SB, Myint PK, Soiza RL. Anticholinergic burden and health-related quality of life among adult patients in a resource-limited setting: a cross-sectional study. Int J Clin Pharm. 2024;46(6):1352���61. https://doi.org/10.1007/s11096-024-01769-z . (Epub 2024 Jul 15). [DOI: 10.1007/s11096-024-01769-z]
  34. Ironson G, Hylton E, Verhagen R. A new attitude towards treatment measure predicts survival over 17 years. J Gen Intern Med. 2022;37(10):2351���7. https://doi.org/10.1007/s11606-021-07245-y . [DOI: 10.1007/s11606-021-07245-y]
  35. Te Paske R, Vervloet M, Linn AJ, Brabers AEM, van Boven JFM, van Dijk L. The impact of trust in healthcare and medication, and beliefs about medication on medication adherence in a Dutch medication-using population. J Psychosom Res. 2023;174: 111472. https://doi.org/10.1016/j.jpsychores.2023.111472 . [DOI: 10.1016/j.jpsychores.2023.111472]
  36. Stocks NP, Gonz��lez-Chica DA, Woods RL, et al. Quality of life for 19,114 participants in the ASPREE (ASPirin in Reducing Events in the Elderly) study and their association with sociodemographic and modifiable lifestyle risk factors. Qual Life Res. 2019;28(4):935���46. https://doi.org/10.1007/s11136-018-2040-z . [DOI: 10.1007/s11136-018-2040-z]
  37. Verdoorn S, Kwint HF, Blom JW, Gussekloo J, Bouvy ML. Effects of a clinical medication review focused on personal goals, quality of life, and health problems in older persons with polypharmacy: a randomised controlled trial (DREAMeR-study). PLoS Med. 2019;16(5): e1002798. https://doi.org/10.1371/journal.pmed.1002798 . [DOI: 10.1371/journal.pmed.1002798]
  38. Romskaug R, Skovlund E, Straand J, Molden E, Kersten H, Pitkala KH, Lundqvist C, Wyller TB. Effect of clinical geriatric assessments and collaborative medication reviews by geriatrician and family physician for improving health-related quality of life in home-dwelling older patients receiving polypharmacy: a cluster randomized clinical trial. JAMA Intern Med. 2020;180(2):181���9. https://doi.org/10.1001/jamainternmed.2019.5096 . [DOI: 10.1001/jamainternmed.2019.5096]
  39. Barrenberg E, Garbe E. Use of over-the-counter (OTC) drugs and perceptions of OTC drug safety among German adults. Eur J Clin Pharmacol. 2015;71(11):1389���96. https://doi.org/10.1007/s00228-015-1929-5 . [DOI: 10.1007/s00228-015-1929-5]
  40. Tesfamariam S, Anand IS, Kaleab G, et al. Self-medication with over the counter drugs, prevalence of risky practice and its associated factors in pharmacy outlets of Asmara, Eritrea. BMC Public Health. 2019;19(1):159. https://doi.org/10.1186/s12889-019-6470-5 . [DOI: 10.1186/s12889-019-6470-5]
  41. Fravel MA, Ernst ME, Gilmartin-Thomas J, et al. Dietary supplement and complementary and alternative medicine use among older adults in Australia and the United States. J Am Geriatr Soc. 2023;71(7):2219���28. https://doi.org/10.1111/jgs.18305 . [DOI: 10.1111/jgs.18305]

Grants

  1. U01AG029824/NIA NIH HHS
  2. U19AG062682/NIA NIH HHS
  3. 334047/National Health and Medical Research Council
  4. 1127060/National Health and Medical Research Council
Journal Article

Word Cloud

Created with Highcharts 10.0.0prescriptionpillnon-prescriptionHRQoLmedicationPCSp0burdensolderMCSlowerscoresmeanpills- 1<001associatedreducedassociationfinaltrialadultscountsphysicalcomponentsummaryscoremental15=non-usersburden1-34-6���79observedPrescriptionBACKGROUND:Polypharmacyhealth-relatedqualitylifestudyexploresindependentunderlyingmorbidityadultpopulationMETHODS:DatainterventionyearASPirinReducingEventsElderlyASPREErandomizedAustraliaUSAanalyzedcross-sectionally Participantsreporteddailyvisitassessedusing12-ItemShort-ForminstrumentSF-12summarizedreflectpoorerMultivariableregressionadjustedcovariatesusedexaminerelationshipscategorizedseparatelyRESULTS:165participantsrespondedquestionuse727non-prescriptionsage80yearsComparedmedicationslargerreductionsseenincreased7-910- 45- 76- 10respectivelysimilarrelationshiplessermagnitude- 024948comparedsignificantCONCLUSIONS:independentlyNon-prescriptionMedicationPillBurdensAssociationsHealth-RelatedQualityLifeOlderAdults:Cross-SectionalStudy

Similar Articles

Cited By