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Stopping preventive medicines linked to increased frailty


Older people who stop taking preventive medicine, such as blood pressure and cholesterol lowering drugs, experience more frailty than those who keep taking the medication, a study shows.

Professor Libby Roughead

The study by the University of South Australia’s Quality Use of Medicines and Pharmacy Research Centre, published in the Journal of Pharmacy Practice and Research, says frailty has physical, psychological and social dimensions and is associated with an increased risk of falls, hospital admissions, disability, nursing home admission and death.

While previous research has looked at links between certain medications and fraility, or the ability of certain medications to mitigate frailty, this is the first to look at differences in frailty between people who stop taking medication and those who remain on it.

“In terms of preventive medicines, participants who stopped using any preventive medicines had a greater increase in mean frailty score than those who continued using the medicine,” the study concludes.

The research used data from 2087 participants of the Australian Longitudinal Study of Ageing over a three year period.

It found that stopping common preventive medicines, such as beta blockers and potassium-sparing diuretics, was associated with a higher frailty score.

Chicken or egg questions

The researchers note that while the study found an association between frailty and stopping medicine use, further research is needed to work out if the progression of frailty is actually caused by stopping the medicine.

“We just can’t untangle whether stopping the preventive medicines is causing the frailty, or are people stopping because they are becoming more frail” supervising researcher Professor Libby Roughead told Community Care Review.

“You have to go that next step to talk to doctors and patients, and that wasn’t in our data set.”

Professor Roughead says there is an established association between medication and frailty but it also remains unclear whether medicines are contributing to frailty and what the mechanism might be, or if people are on medicines because they are frail.

“So we were looking at what happened when people stopped and when people continued and I think what we know is that medicines do make some contribution to the development of frailty,” she told Community Care Review.

A precursor for health decline

The study also found “a significant” association between frailty and the number of medicines used, and showed that people on preventive medicines like antihypertensives had lower frailty scores than people on symptom-relief medications – such as opioids – or inappropriate medicines.

It found no difference in frailty between people who stopped using potentially inappropriate medications and those who continued using them.

Lead researcher, Dr Imaina Widagdo says frailty is a “clinically recognisable state of weakened ability to cope with everyday stressors” as well as a precursor for significant health decline.

She says the research highlights the need to discuss any medication changes with a health care professional before stopping.

“Managing medicines can be complicated, especially for older people who often juggle multiple prescriptions and doses,” Dr Widagdo said.

“But stopping a medicine without prior medical advice can be dangerous and has the potential to lead to adverse health outcomes, including falls, hospitalisations, and even death.

“By detecting the potential for frailty associated with medicine use, we’re able to better inform both older Australians and practitioners, so that together, we can help people live better for longer.”

Dr Wigado says the research is consistent with previous studies showing that some medications can contribute to frailty but contributes a new dimension in terms of the effect on frailty of stopping certain medications.

Better understanding the relationship between medicines and frailty can help provide more answers to improve the quality of older peoples’ lives, Dr Wigado said.

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