Evidence map›Paper›PMID 28905359›Full record

Observational studyJournal of the American Geriatrics Society2017

Guideline-Recommended Medications and Physical Function in Older Adults with Multiple Chronic Conditions.

Gail McAvay, Heather G Allore, Andrew B Cohen, Danijela Gnjidic, Terrence E Murphy, Mary E Tinetti

Open access · greenAbstract readObservational Study
In one paragraph

Observational study in Journal of the American Geriatrics Society, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed, 1 pooled it
0.5field-weighted citation impact, top 29% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 1 synthesis or guideline pooled it, 6 citations in OpenAlex.

  1. Pooled it
  2. Trial
  3. Trial
  4. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors at 2 institutions in 2 countries.

Gail McAvayDepartment of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut.
Heather G AlloreDepartment of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut.
Andrew B CohenDepartment of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut.
Danijela GnjidicFaculty of Pharmacy and Charles Perkins Centre, University of Sydney, Sydney, Australia.
Terrence E MurphyDepartment of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut.
Mary E TinettiDepartment of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut.
Yale University · USUniversity of Sydney · AU

Funding

Yale Clinical and Translational Science Award (U Component)UL1TR001863 · NCATS · YALE UNIVERSITY · PI John H. Krystal, LUCILA OHNO-MACHADO · 2016 to 2026
$102.9M
Yale Study Support Suite (YES3): Dashboard and Web Portal Software Supporting Research Workflow through integrated, customizable REDCap External ModulesP30AG021342 · NIA · YALE UNIVERSITY · PI Terri R. Fried · 2002 to 2026
$37.9M
Health Outcome Effects of Common Medications in Elders with Multiple ConditionsR21AG045148 · NIA · YALE UNIVERSITY · PI ALLORE, HEATHER GWYNN, TINETTI, MARY E · 2013 to 2014
$458k
NCATS NIH HHS UL1 TR001863NIA NIH HHS P30 AG021342NIA NIH HHS R21 AG045148
6 · The paper itself

Abstract

BACKGROUND/

objectivesThe benefit or harm of a single medication recommended for one specific condition can be difficult to determine in individuals with multiple chronic conditions and polypharmacy. There is limited information on the associations between guideline-recommended medications and physical function in older adults with multiple chronic conditions. The objective of this study was to estimate the beneficial or harmful associations between guideline-recommended medications and decline in physical function in older adults with multiple chronic conditions.

designProspective observational cohort.

settingNational.

participantsCommunity-dwelling adults aged 65 and older from the Medicare Current Beneficiary Survey study (N = 3,273). Participants with atrial fibrillation, coronary artery disease, depression, diabetes mellitus, or heart failure were included. MEASUREMENTS: Self-reported decline in physical function; guideline-recommended medications; polypharmacy (taking <7 vs ≥7 concomitant medications); chronic conditions; and sociodemographic, behavioral, and health risk factors.

resultsThe risk of decline in function in the overall sample was highest in participants with heart failure (35.4%, 95% confidence interval (CI) = 26.3-44.5) and lowest for those with atrial fibrillation (20.6%, 95% CI = 14.9-26.2). In the overall sample, none of the six guideline-recommended medications was associated with decline in physical function across the five study conditions, although in the group with low polypharmacy exposure, there was lower risk of decline in those with heart failure taking renin angiotensin system blockers (hazard ratio (HR) = 0.40, 95% CI = 0.16-0.99) and greater risk of decline in physical function for participants with diabetes mellitus taking statins (HR = 2.27, 95% CI = 1.39-3.69).

conclusionsIn older adults with multiple chronic conditions, guideline-recommended medications for atrial fibrillation, coronary artery disease, depression, diabetes mellitus, and heart failure were largely not associated with self-reported decline in physical function, although there were associations for some medications in those with less polypharmacy.

Indexed as

Geriatric AssessmentAged, 80 and overFemaleHumansMaleMultiple Chronic ConditionsPolypharmacyPractice Guidelines as TopicProspective Studiesguideline-recommended medicationsmultiple chronic conditionsphysical functionpolypharmacy

Identifiers

PMID28905359
PMCPMC5729049
OpenAlexW2755922208

What Socratic holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.