Association of Polypharmacy and Potentially Inappropriate Medications With Frailty Among Older Adults With Blood Cancers

Background: Polypharmacy and potentially inappropriate medica-tions (PIMs) are common among older adults with blood cancers, but their association with frailty and how to manage them optimally re-main unclear. Patients and Methods: From 2015 to 2019, patients aged ???75 years presenting for initial oncology consult underwent screening geriatric assessment. Patients were determined to be ro-bust, prefrail, or frail via deficit accumulation and phenotypic ap-proaches. We quantified each patient???s total number of medications and PIMs using the Anticholinergic Risk Scale (ARS) and a scale we generated using the NCCN Medications of Concern called the Geriatric Oncology Potentially Inappropriate Medications (GO-PIM) scale. We assessed cross-sectional associations of PIMs with frailty in multivariable regression models adjusting for age, gender, and co -morbidity. Results: Of 785 patients assessed, 603 (77%) were taking ???5 medications and 421 (54%) were taking ???8 medications; 201 (25%) were taking at least 1 PIM based on the ARS and 343 (44%) at least 1 PIM based on the GO-PIM scale. Among the 468 (60%) patients on active cancer treatment, taking ???8 medications was associated with frailty (adjusted odds ratio [aOR], 2.82; 95% CI, 1.92???4.17). With each additional medication, the odds of being pref-rail or frail increased 8% (aOR, 1.08; 95% CI, 1.04???1.12). With each 1-point increase on the ARS, the odds of being prefrail or frail in-creased 19% (aOR, 1.19; 95% CI, 1.03???1.39); with each additional PIM based on the GO-PIM scale, the odds increased 65% (aOR, 1.65; 95% CI, 1.34???2.04). Conclusions: Polypharmacy and PIMs are preva-lent among older patients with blood cancers; taking ???8 medications is strongly associated with frailty. These data suggest careful medica-tion reconciliation for this population may be helpful, and deprescrib-ing when possible is high-yield, especially for PIMs on the GO-PIM scale.