European Journal of Clinical Pharmacology

, Volume 74, Issue 7, pp 961–970 | Cite as

Relationship between frailty, polypharmacy, and underprescription in older adults living in nursing homes

  • Marta Gutiérrez-Valencia
  • Mikel Izquierdo
  • Esther Lacalle-Fabo
  • Itxaso Marín-Epelde
  • María Fernanda Ramón-Espinoza
  • Thamara Domene-Domene
  • Álvaro Casas-Herrero
  • Arkaitz Galbete
  • Nicolás Martínez-Velilla
Pharmacoepidemiology and Prescription



Frailty, polypharmacy, and underprescription are considered a major matter of concern in nursing homes, but the possible relationships between them are not well known. The aim is to examine the possible association between medication underprescription, polypharmacy, and frailty in older people living in nursing homes.


A cross-sectional analysis from a concurrent cohort study, including 110 subjects ≥ 65 years living in two nursing homes. Four frailty scales were applied; polypharmacy was defined as ≥ 5 medications and underprescription was measured with Screening Tool to Alert to Right Treatment (START) criteria. Logistic regression models were performed to assess the associations.


The mean age was 86.3 years (SD 7.3) and 71.8% were female. 73.6% of subjects took ≥ 5 chronic medications and 60.9% met one or more START criteria. The non-frail participants took more medications than the frail subjects according to the imputated frailty Fried criteria (8.1 vs 6.7, p = 0.042) and the FRAIL-NH scale (7.8 vs 6.8, p = 0.026). Multivariate analyses did not find an association between frailty and polypharmacy. Frail participants according to the Fried criteria met a higher number of START criteria (1.9 vs 1.0, p = 0.017), and had a higher prevalence of underprescription (87.5 vs 50.0%), reaching the limit of statistical significance in multivariate analysis.


The positive association found in previous studies between frailty and polypharmacy cannot be extrapolated to institutionalized populations. There is a trend towards higher rates of underprescription in frail subjects. Underprescription in frail older adults should be redefined and new strategies to measure it should be developed.


Frailty Nursing homes Polypharmacy Underprescription 


Authors’ contributions

Gutiérrez-Valencia M and Martínez-Velilla N have contributed to conception and design, acquisition, analysis and interpretation of data, drafting the article, and final approval of the version to be published. Izquierdo M, Lacalle-Fabo E, Marín-Epelde I, Ramón-Espinoza MF, Domene-Domene T, Casas Herrero Á, and Galbete A have contributed to conception and design, analysis and interpretation of data, revising the text, and final approval of the version to be published.

Funding information

This project has been funded by the TransPyrenean Biomedical Research Network (REFBIO) for the establishment of a network of stable collaboration among biomedical research centers in the Pyrenees Area (European Program INTERREG IV POCTEFA-A; REFBIO13/BIOD/002). The funder had no role in study design, data collection, and analysis, decision to publish, or preparation of the manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

228_2018_2452_MOESM1_ESM.doc (24 kb)
ESM 1 (DOC 23 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Marta Gutiérrez-Valencia
    • 1
    • 2
  • Mikel Izquierdo
    • 3
    • 4
  • Esther Lacalle-Fabo
    • 5
  • Itxaso Marín-Epelde
    • 1
  • María Fernanda Ramón-Espinoza
    • 1
  • Thamara Domene-Domene
    • 1
  • Álvaro Casas-Herrero
    • 1
    • 2
  • Arkaitz Galbete
    • 6
    • 7
  • Nicolás Martínez-Velilla
    • 1
    • 2
    • 4
  1. 1.Department of GeriatricsComplejo Hospitalario de NavarraPamplonaSpain
  2. 2.IdiSNa, Navarra Institute for Health ResearchPamplonaSpain
  3. 3.Health Science DepartmentPublic University of NavarraPamplonaSpain
  4. 4.CIBER of Frailty and Healthy AgingMadridSpain
  5. 5.Pharmacy DepartmentComplejo Hospitalario de NavarraPamplonaSpain
  6. 6.Navarrabiomed-Departamento de Salud-UPNAPamplonaSpain
  7. 7.Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC)MadridSpain

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