This cross-sectional study examines the relationship of polypharmacy to health-related quality of life (HRQoL) among a group of older American Indians. An in-home interview and survey were administered to 63 community-dwelling American Indians aged 50 or older who were taking four or more prescription medications regularly. With the component summary scores from the Medical Outcomes Study Short Form-36 instrument analyzed as dependent variables, only the Physical Component Summary (PCS) score (r = .30, p = .02), and not the Mental (r = .06, p = .67), was associated with degree of polypharmacy. This association with PCS score remained significant even after controlling for age, sex, and chronic disease score (adjusted β = -.91, p = .045). This study is the first to describe the relationship between polypharmacy and HRQoL among a group of American Indians, and the results support the need for larger and more comprehensive studies of medication use in this special population.
Al-Windi, A., Elmfeldt, D., & Svardsudd, K. (2000). The relationship between age, gender, well-being and symptoms, and the use of pharmaceuticals, herbal medicines and self-care products in a Swedish municipality. European Journal of Clinical Pharmacology, 56(4), 311-317.
2.
Balducci, L., & Beghe, C. (2000). The application of the principles of geriatrics to the management of the older person with cancer. Critical Review of Oncology Hematology, 35(3), 147-154.
3.
Bardel, A., Wallander, M. A., & Svardsudd, K. (2000). Reported current use of prescription drugs and some of its determinants among 35- to 65-year-old women in mid-Sweden: A population-based study. Journal of Clinical Epidemiology, 53(6), 637-643.
4.
Bates, D. W., Spell, N., Cullen, D. J., Burdick, E., Laird, N., Petersen, L. A., et al. (1997). The costs of adverse drug events in hospitalized patients. Adverse Drug Events Prevention Study Group. JAMA, 277(4), 307-311.
5.
Bauman, H. C., & Arthur, H. M. (1997). Relationship between functional exercise capacity and general quality of life in nonsurgical patients with lower-extremity peripheral arterial disease. Journal of Vascular Nursing, 15(1), 21-28.
6.
Beals, J., Welty, T. K., Mitchell, C. M., Rhoades, D. A., Yeh, J.-L., Henderson, J. A., et al. (in press). Psychometric properties and factor structure of the SF36 among older American Indians: The Strong Heart Study. Journal of Clinical Epidemiology.
7.
Bernstein, L. R., Folkman, S., & Lazarus, R. S. (1989). Characterization of the use and misuse of medications by an elderly, ambulatory population. Medical Care, 27(6), 654-663.
8.
Beusterien, K. M., Steinwald, B., & Ware, J. E., Jr. (1996). Usefulness of the SF-36 Health Survey in measuring health outcomes in the depressed elderly. Journal of Geriatric Psychiatry and Neurology, 9(1), 13-21.
9.
Bjerrum, L., Sogaard, J., Hallas, J., & Kragstrup, J. (1998). Polypharmacy: Correlations with sex, age and drug regimen. A prescription database study. European Journal of Clinical Pharmacology, 54(3), 197-202.
10.
Blazer, D., Hybels, C., Simonsick, E., & Hanlon, J. T. (2000). Sedative, hypnotic, and antianxiety medication use in an aging cohort over ten years: A racial comparison. Journal of the American Geriatric Society, 48(9), 1073-1079.
11.
Burns, R., Nichols, L. O., Graney, M. J., & Cloar, F. T. (1995). Impact of continued geriatric out-patient management on health outcomes of older veterans. Archives of Internal Medicine, 155(12), 1313-1318.
12.
Cheadle, A., Pearson, D., Wagner, E., Psaty, B. M., Diehr, P., & Koepsell, T. (1994). Relationship between socioeconomic status, health status, and lifestyle practices of American Indians: Evidence from a Plains reservation population. Public Health Report, 109(3), 405-413.
13.
Chen, Y. F., Dewey, M. E., & Avery, A. J. (2001). Self-reported medication use for older people in England and Wales. Journal of Clinical Pharmacology Therapy, 26(2), 129-140.
14.
Chrischilles, E. A., Foley, D. J., Wallace, R. B., Lemke, J. H., Semla, T. P., Hanlon, J. T., et al. (1992). Use of medications by persons65 and over: Data from the established populations for epidemiologic studies of the elderly. Journal of Gerontology, 47(5), M137-M144.
15.
Classen, D. C., Pestotnik, S. L., Evans, R. S., Lloyd, J. F., & Burke, J. P. (1997). Adverse drug events in hospitalized patients. Excess length of stay, extra costs, and attributable mortality. JAMA, 277(4), 301-306.
16.
Eggen, A. E. (1994). Pattern of drug use in a general population—Prevalence and predicting factors: The Tromso study. International Journal of Epidemiology, 23(6), 1262-1272.
17.
Espino, D. V., Lichtenstein, M. J., Hazuda, H. P., Fabrizio, D., Wood, R. C., Goodwin, J., et al. (1998). Correlates of prescription and over-the-counter medication usage among older Mexican Americans: The Hispanic EPESE study. Established Population for the Epidemiologic Study of the Elderly. Journal of the American Geriatric Society, 46(10), 1228-1234.
18.
Ferrendelli, J. A. (1995). Relating pharmacology to clinical practice: The pharmacologic basis of rational polypharmacy. Neurology, 45(3 Suppl. 2), S12-S16.
19.
Fillenbaum, G. G., Horner, R. D., Hanlon, J. T., Landerman, L. R., Dawson, D. V., & Cohen, H. J. (1996). Factors predicting change in prescription and nonprescription drug use in a community-residing Black and White elderly population. Journal of Clinical Epidemiology, 49(5), 587-593.
20.
Fincke, B. G., Miller, D. R., & Spiro, A., III. (1998). The interaction of patient perception of overmedication with drug compliance and side effects. Journal of General Internal Medicine, 13(3), 182-185.
21.
Fossa, S. D., & Dahl, A. A. (2002). Short Form 36 and Hospital Anxiety and Depression Scale. A comparison based on patients with testicular cancer. Journal of Psychosomatic Research, 52(2), 79-87.
22.
Furner, S. E., Rudberg, M. A., & Cassel, C. K. (1995). Medical conditions differentially affect the development of IADL disability: Implications for medical care and research. Gerontologist, 35(4), 444-450.
23.
Furu, K., Straume, B., & Thelle, D. S. (1997). Legal drug use in a general population: Association with gender, morbidity, health care utilization, and lifestyle characteristics. Journal of Clinical Epidemiology, 50(3), 341-349.
24.
Gilliland, F. D., Mahler, R., & Davis, S. M. (1998). Health-related quality of life for rural American Indians in New Mexico. Ethnic Health, 3(3), 223-229.
25.
Gupchup, G. V., Hubbard, J. H., Teel, M. A., Singhal, P. K., Tonrey, L., Riley, K., et al. (2001). Developing a community-specific health-related quality of life (HRQOL) questionnaire for asthma: The Asthma-Specific Quality of Life Questionnaire for Native American Adults (AQLQ-NAA). Journal of Asthma, 38(2), 169-178.
26.
Hamdy, R. C., Moore, S. W., Whalen, K., Donnelly, J. P., Compton, R., Testerman, F., et al. (1995). Reducing polypharmacy in extended care. Southern Medical Journal, 88(5), 534-538.
27.
Hanlon, J. T., Fillenbaum, G. G., Schmader, K. E., Kuchibhatla, M., & Horner, R. D. (2000). Inappropriate drug use among community-dwelling elderly. Pharmacotherapy, 20(5), 575-582.
28.
Hanlon, J. T., Weinberger, M., Samsa, G. P., Schmader, K. E., Uttech, K. M., Lewis, I. K., et al. (1996). A randomized, controlled trial of a clinical pharmacist intervention to improve inappropriate prescribing in elderly outpatients with polypharmacy. American Journal of Medicine, 100(4), 428-437.
29.
Hershman, D. L., Simonoff, P. A., Fishman, W. H., Paston, F., & Aronson, M. K. (1995). Drug utilization in the old and how it relates to self-perceived health and all-cause mortality. Journal of the American Geriatric Society, 43, 356-360.
30.
Howard, B. V., Lee, E. T., Yeh, J. L., Go, O., Fabsitz, R. R., Devereux, R. B., et al. (1996). Hypertension in adult American Indians. The Strong Heart Study. Hypertension, 28(2), 256-264.
31.
Indian Health Service. (1996). Indian health focus: Elders. Rockville, MD: U.S. Department of Health and Human Services, Author.
32.
Jenkinson, C. (1998). The SF-36 physical and mental health summary measures: An example of how to interpret scores. Journal of Health Service Research Policy, 3(2), 92-96.
33.
Johnson, J. A., & Coons, S. J. (1998). Comparison of the EQ-5D and SF-12 in an adult US sample. Quality of Life Research, 7(2), 155-166.
34.
Johnson, J. A., Nowatzki, T. E., & Coons, S. J. (1996). Health-related quality of life of diabetic Pima Indians. Medical Care, 34(2), 97-102.
35.
Jylha, M. (1994). Ten-year change in the use of medical drugs among the elderly—A longitudinal study and cohort comparison. Journal of Clinical Epidemiology, 47(1), 69-79.
36.
Kohn, L. T., Corrigan, J. M., & Donaldson, M. S. E. (1999). To err is human: Building a safer system. Washington, DC: National Academy Press.
37.
Lassila, H. C., Stoehr, G. P., Ganguli, M., Seaberg, E. C., Gilby, J. E., Belle, S. H., et al. (1996). Use of prescription medications in an elderly rural population: The MoVIES Project. Annals of Pharmacotherapy, 30(6), 589-595.
38.
Lazarou, J., Pomeranz, B. H., & Corey, P. N. (1998). Incidence of adverse drug reactions in hospitalized patients: A meta-analysis of prospective studies. JAMA, 279(15), 1200-1205.
39.
Marbella, A. M., Harris, M. C., Diehr, S., & Ignace, G. (1998). Use of Native American healers among Native American patients in an urban Native American health center. Archives of Family Medicine, 7(2), 182-185.
40.
May, F. E., Stewart, R. B., Hale, W. E., & Marks, R. G. (1982). Prescribed and nonprescribed drug use in an ambulatory elderly population. Southern Medical Journal, 75(5), 522-528.
41.
Miller, K. E., Zylstra, R. G., & Standridge, J. B. (2000). The geriatric patient: A systematic approach to maintaining health. American Family Physician, 61(4), 1089-1104.
42.
Morse, C. A., Smith, A., Dennerstein, L., Green, A., Hopper, J., & Burger, H. (1994). The treatment-seeking woman at menopause. Maturitas, 18(3), 161-173.
43.
Mulsant, B. H., Ganguli, M., & Seaberg, E. C. (1997). The relationship between self-rated health and depressive symptoms in an epidemiological sample of community-dwelling older adults. Journal of the American Geriatric Society, 45(8), 954-958.
44.
Nolan, L., & O’Malley, K. (1988). Prescribing for the elderly: Part II. Prescribing patterns: differences due to age. Journal of the American Geriatric Society, 36(3), 245-254.
45.
Ostrom, J. R., Hammarlund, E. R., Christensen, D. B., Plein, J. B., & Kethley, A. J. (1985). Medication usage in an elderly population. Medical Care, 23(2), 157-164.
46.
Pitkala, K. H., Strandberg, T. E., & Tilvis, R. S. (2001). Is it possible to reduce polypharmacy in the elderly? A randomised, controlled trial. Drugs and Aging, 18(2), 143-149.
47.
Satish, S., Winograd, C. H., Chavez, C., & Bloch, D. A. (1996). Geriatric targeting criteria as predictors of survival and health care utilization. Journal of the American Geriatric Society, 44(8), 914-921.
48.
Schneider, B., & Varghese, R. K. (1995). Scores on the SF-36 scales and the Beck Depression Inventory in assessing mental health among patients on hemodialysis. Psychological Reports, 76(3 Pt 1), 719-722.
49.
SPSS. (1998). SPSS for PC (Version 10.0.4). Chicago: Author.
50.
Stewart, A. L., Greenfield, S., Hays, R. D., Wells, K., Rogers, W. H., Berry, S. D., et al. (1989). Functional status and well-being of patients with chronic conditions. Results from the Medical Outcomes Study. JAMA, 262(7), 907-913.
51.
Stewart, R. B., Moore, M. T., May, F. E., Marks, R. G., & Hale, W. E. (1991). A longitudinal evaluation of drug use in an ambulatory elderly population. Journal of Clinical Epidemiology, 44(12), 1353-1359.
52.
Wachtel, T. J., Fulton, J. P., & Goldfarg, J. (1987). Early prediction of discharge disposition after hospitalization. The Gerontologist, 27(1), 98-103.
53.
Ware, J. E., Jr., Kosinski, M., Bayliss, M. S., McHorney, C. A., Rogers, W. H., & Raczek, A. (1995). Comparison of methods for the scoring and statistical analysis of SF-36 health profile and summary measures: Summary of results from the Medical Outcomes Study. Medical Care, 33(4 Suppl.), AS264-AS279.
54.
Welty, T. K., Lee, E. T., Cowan, L., Fabsitz, R., Howard, B. V., Le, N-A., et al. (1992). The Strong Heart Study: A study of cardiovascular disease and its risk factors in American Indians. IHS Primary Care Provider, 17(2), 32-33.
55.
Whittington, F. J., Petersen, D. M., Dale, B., & Dressel, P. L. (1981). Sex differences in prescription drug use of older adults. Journal of Psychoactive Drugs, 13(2), 175-183.
56.
Woo, J., Ho, S. C., Yuen, Y. K., & Lau, J. (1995). Druguse in an elderly Chinese population: Prevalence and associated factors. Gerontology, 41(2), 98-108.
57.
Yang, J. C., Tomlinson, G., & Naglie, G. (2001). Medication lists for elderly patients: Clinic-derived versus in-home inspection and interview. Journal of General Internal Medicine, 16(2), 112-115.
