Impact of Drug–Drug and Drug–Disease Interactions on Gait Speed in Community-Dwelling Older Adults

Jennifer G. Naples, Zachary A. Marcum, Subashan Perera, Anne B. Newman, Susan L. Greenspan, Shelly L. Gray, Douglas C. Bauer, Eleanor Marie Simonsick, Ronald I. Shorr, Joseph T. Hanlon

Research output: Contribution to journalArticle

Abstract

Background: Gait speed decline, an early marker of functional impairment, is a sensitive predictor of adverse health outcomes in older adults. The effect of potentially inappropriate medications, including drug-disease and drug-drug interactions, on gait speed decline is not well known. Objective: The aim of this study was to determine if drug interactions impair functional status as measured by gait speed. Methods: The sample included 2402 older adults with medication and gait speed data from the Health, Aging and Body Composition study. The independent variable was the frequency of drug–disease and/or drug–drug interactions at baseline and 3 additional years. The main outcome was a clinically meaningful gait speed decline of ≥0.1 m/s the year following drug interaction assessment. Adjusted odds ratios and 95 % confidence intervals (CIs) were calculated using multivariate generalized estimating equations for both the overall sample and a sample stratified by gait speed at time of drug interaction assessment. Results: The prevalence of drug–disease and drug–drug interactions ranged from 7.6 to 9.3 and 10.5 to 12.3 %, respectively, with few participants (3.8–5.7 %) having multiple drug interactions. At least 22 % of participants had a gait speed decline of ≥0.1 m/s annually. Drug interactions were not significantly associated with gait speed decline overall or in the stratified sample of fast walkers. There was some evidence, however, that drug interactions increased the risk of gait speed decline among those participants with slower gait speeds, though p values did not reach statistical significance (adjusted odds ratio 1.22; 95 % CIs 0.96–1.56; p = 0.11). Moreover, a marginally significant dose–response relationship was seen with multiple drug interactions and gait speed decline (adjusted odds ratio 1.40; 95 % CIs 0.95–2.04; p = 0.08). Conclusions: Drug interactions may increase the likelihood of gait speed decline among older adults with evidence of preexisting debility. Future studies should focus on frail elders with less physiological reserve who may be more susceptible to the harms associated with potentially inappropriate medications.

Original languageEnglish (US)
Pages (from-to)1-8
Number of pages8
JournalDrugs & Aging
DOIs
StateAccepted/In press - Apr 30 2016
Externally publishedYes

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Independent Living
Drug Interactions
Odds Ratio
Confidence Intervals
Walking Speed
Walkers
Frail Elderly
Health
Body Composition
Pharmaceutical Preparations

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Geriatrics and Gerontology

Cite this

Naples, J. G., Marcum, Z. A., Perera, S., Newman, A. B., Greenspan, S. L., Gray, S. L., ... Hanlon, J. T. (Accepted/In press). Impact of Drug–Drug and Drug–Disease Interactions on Gait Speed in Community-Dwelling Older Adults. Drugs & Aging, 1-8. https://doi.org/10.1007/s40266-016-0373-2

Impact of Drug–Drug and Drug–Disease Interactions on Gait Speed in Community-Dwelling Older Adults. / Naples, Jennifer G.; Marcum, Zachary A.; Perera, Subashan; Newman, Anne B.; Greenspan, Susan L.; Gray, Shelly L.; Bauer, Douglas C.; Simonsick, Eleanor Marie; Shorr, Ronald I.; Hanlon, Joseph T.

In: Drugs & Aging, 30.04.2016, p. 1-8.

Research output: Contribution to journalArticle

Naples, JG, Marcum, ZA, Perera, S, Newman, AB, Greenspan, SL, Gray, SL, Bauer, DC, Simonsick, EM, Shorr, RI & Hanlon, JT 2016, 'Impact of Drug–Drug and Drug–Disease Interactions on Gait Speed in Community-Dwelling Older Adults', Drugs & Aging, pp. 1-8. https://doi.org/10.1007/s40266-016-0373-2
Naples, Jennifer G. ; Marcum, Zachary A. ; Perera, Subashan ; Newman, Anne B. ; Greenspan, Susan L. ; Gray, Shelly L. ; Bauer, Douglas C. ; Simonsick, Eleanor Marie ; Shorr, Ronald I. ; Hanlon, Joseph T. / Impact of Drug–Drug and Drug–Disease Interactions on Gait Speed in Community-Dwelling Older Adults. In: Drugs & Aging. 2016 ; pp. 1-8.
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title = "Impact of Drug–Drug and Drug–Disease Interactions on Gait Speed in Community-Dwelling Older Adults",
abstract = "Background: Gait speed decline, an early marker of functional impairment, is a sensitive predictor of adverse health outcomes in older adults. The effect of potentially inappropriate medications, including drug-disease and drug-drug interactions, on gait speed decline is not well known. Objective: The aim of this study was to determine if drug interactions impair functional status as measured by gait speed. Methods: The sample included 2402 older adults with medication and gait speed data from the Health, Aging and Body Composition study. The independent variable was the frequency of drug–disease and/or drug–drug interactions at baseline and 3 additional years. The main outcome was a clinically meaningful gait speed decline of ≥0.1 m/s the year following drug interaction assessment. Adjusted odds ratios and 95 {\%} confidence intervals (CIs) were calculated using multivariate generalized estimating equations for both the overall sample and a sample stratified by gait speed at time of drug interaction assessment. Results: The prevalence of drug–disease and drug–drug interactions ranged from 7.6 to 9.3 and 10.5 to 12.3 {\%}, respectively, with few participants (3.8–5.7 {\%}) having multiple drug interactions. At least 22 {\%} of participants had a gait speed decline of ≥0.1 m/s annually. Drug interactions were not significantly associated with gait speed decline overall or in the stratified sample of fast walkers. There was some evidence, however, that drug interactions increased the risk of gait speed decline among those participants with slower gait speeds, though p values did not reach statistical significance (adjusted odds ratio 1.22; 95 {\%} CIs 0.96–1.56; p = 0.11). Moreover, a marginally significant dose–response relationship was seen with multiple drug interactions and gait speed decline (adjusted odds ratio 1.40; 95 {\%} CIs 0.95–2.04; p = 0.08). Conclusions: Drug interactions may increase the likelihood of gait speed decline among older adults with evidence of preexisting debility. Future studies should focus on frail elders with less physiological reserve who may be more susceptible to the harms associated with potentially inappropriate medications.",
author = "Naples, {Jennifer G.} and Marcum, {Zachary A.} and Subashan Perera and Newman, {Anne B.} and Greenspan, {Susan L.} and Gray, {Shelly L.} and Bauer, {Douglas C.} and Simonsick, {Eleanor Marie} and Shorr, {Ronald I.} and Hanlon, {Joseph T.}",
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T1 - Impact of Drug–Drug and Drug–Disease Interactions on Gait Speed in Community-Dwelling Older Adults

AU - Naples, Jennifer G.

AU - Marcum, Zachary A.

AU - Perera, Subashan

AU - Newman, Anne B.

AU - Greenspan, Susan L.

AU - Gray, Shelly L.

AU - Bauer, Douglas C.

AU - Simonsick, Eleanor Marie

AU - Shorr, Ronald I.

AU - Hanlon, Joseph T.

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N2 - Background: Gait speed decline, an early marker of functional impairment, is a sensitive predictor of adverse health outcomes in older adults. The effect of potentially inappropriate medications, including drug-disease and drug-drug interactions, on gait speed decline is not well known. Objective: The aim of this study was to determine if drug interactions impair functional status as measured by gait speed. Methods: The sample included 2402 older adults with medication and gait speed data from the Health, Aging and Body Composition study. The independent variable was the frequency of drug–disease and/or drug–drug interactions at baseline and 3 additional years. The main outcome was a clinically meaningful gait speed decline of ≥0.1 m/s the year following drug interaction assessment. Adjusted odds ratios and 95 % confidence intervals (CIs) were calculated using multivariate generalized estimating equations for both the overall sample and a sample stratified by gait speed at time of drug interaction assessment. Results: The prevalence of drug–disease and drug–drug interactions ranged from 7.6 to 9.3 and 10.5 to 12.3 %, respectively, with few participants (3.8–5.7 %) having multiple drug interactions. At least 22 % of participants had a gait speed decline of ≥0.1 m/s annually. Drug interactions were not significantly associated with gait speed decline overall or in the stratified sample of fast walkers. There was some evidence, however, that drug interactions increased the risk of gait speed decline among those participants with slower gait speeds, though p values did not reach statistical significance (adjusted odds ratio 1.22; 95 % CIs 0.96–1.56; p = 0.11). Moreover, a marginally significant dose–response relationship was seen with multiple drug interactions and gait speed decline (adjusted odds ratio 1.40; 95 % CIs 0.95–2.04; p = 0.08). Conclusions: Drug interactions may increase the likelihood of gait speed decline among older adults with evidence of preexisting debility. Future studies should focus on frail elders with less physiological reserve who may be more susceptible to the harms associated with potentially inappropriate medications.

AB - Background: Gait speed decline, an early marker of functional impairment, is a sensitive predictor of adverse health outcomes in older adults. The effect of potentially inappropriate medications, including drug-disease and drug-drug interactions, on gait speed decline is not well known. Objective: The aim of this study was to determine if drug interactions impair functional status as measured by gait speed. Methods: The sample included 2402 older adults with medication and gait speed data from the Health, Aging and Body Composition study. The independent variable was the frequency of drug–disease and/or drug–drug interactions at baseline and 3 additional years. The main outcome was a clinically meaningful gait speed decline of ≥0.1 m/s the year following drug interaction assessment. Adjusted odds ratios and 95 % confidence intervals (CIs) were calculated using multivariate generalized estimating equations for both the overall sample and a sample stratified by gait speed at time of drug interaction assessment. Results: The prevalence of drug–disease and drug–drug interactions ranged from 7.6 to 9.3 and 10.5 to 12.3 %, respectively, with few participants (3.8–5.7 %) having multiple drug interactions. At least 22 % of participants had a gait speed decline of ≥0.1 m/s annually. Drug interactions were not significantly associated with gait speed decline overall or in the stratified sample of fast walkers. There was some evidence, however, that drug interactions increased the risk of gait speed decline among those participants with slower gait speeds, though p values did not reach statistical significance (adjusted odds ratio 1.22; 95 % CIs 0.96–1.56; p = 0.11). Moreover, a marginally significant dose–response relationship was seen with multiple drug interactions and gait speed decline (adjusted odds ratio 1.40; 95 % CIs 0.95–2.04; p = 0.08). Conclusions: Drug interactions may increase the likelihood of gait speed decline among older adults with evidence of preexisting debility. Future studies should focus on frail elders with less physiological reserve who may be more susceptible to the harms associated with potentially inappropriate medications.

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