Suboptimal medication use and mortality in an older adult community-based cohort: Results from the Hispanic EPESE study

Background. Numerous methods have been used to evaluate medication management quality in older adults; however, their predictive validities are unknown. Major medication quality indicators include polypharmacy, drug-drug interactions, and inappropriate medication use. To date, no study has attempted to evaluate the three approaches systematically or the effect of each approach on mortality in a Hispanic population. Our objective was to evaluate the relationship between polypharmacy, drug-drug interactions, and inappropriate medication use on the mortality of a community-based population of Mexican American older adults. Methods. We used a life table survival analysis of a longitudinal survey of a representative sample of 3050 older Mexican Americans of whom 1823 were taking prescription and over-the-counter medications. Results. After adjustment for relevant covariates, use of more than four different medications (polypharmacy) was independently associated with mortality. The presence of major drug interactions and the use of inappropriate medications were not significantly associated with mortality in our study sample. Conclusion. Polypharmacy (> 4 medications) is significantly associated with mortality in Mexican American older adults. This community-based study is the first to demonstrate a direct association between polypharmacy and mortality in this population.