Investigation of Balance, Kinesiophobia, and Mobility in Older Adults Exposed to Polypharmacy

Year 2025, Volume: 27 Issue: 2, 123 - 129, 30.08.2025

Yasemin Salkın , Aysun Kazak Saltı , Sema Erden Ertürk , Pınar Müge Altınkaya

https://doi.org/10.18678/dtfd.1585896

Abstract

Aim: Older adults often face significant issues related to functionality, balance, and fall risk. This study aimed to investigate balance, kinesiophobia, and mobility in older adults exposed to polypharmacy.
Material and Methods: This cross-sectional study included a total of 75 individuals aged 65 years and over who were exposed to polypharmacy and presented to a university hospital between November 2023 and March 2024, and with a standardized mini-mental test (SMMT) score of 25 and above. Data were collected using the patient introduction and medication use questionnaire, the Berg balance scale (BBS), the Tampa kinesiophobia scale (TKS), and the timed up and go (TUG) test.
Results: Individuals who completed the TUG test within 0-1414 seconds exhibited higher BBS scores when compared to those who completed the test in more than 14 seconds (p=0.001), while the TKS scores were lower (p=0.001). Furthermore, it was observed that individuals with a history of falls had higher TKS (p=0.001) and TUG test (p=0.001) scores than those without a history of falls. Additionally, the number of chronic diseases showed a negative correlation with BBS scores (rs=-0.319, p=0.005), while exhibiting a positive correlation with TKS scores (rs=0.263, p=0.023) and TUG test (rs=0.316, p=0.006) durations.
Conclusion: The findings of the study indicate that polypharmacy has a deleterious effect on balance and mobility in older adults. It is imperative to evaluate the suitability of the prescribed medications and to take into account the patient's current medications prior to the initiation of new medications.

Keywords

Balance , kinesiophobia , mobility , older adults , polypharmacy

Polifarmasisi Olan Yaşlı Bireylerde Denge, Kinezyofobi ve Mobilitenin İncelenmesi

Abstract

Amaç: Yaşlı yetişkinler sıklıkla fonksiyonel bozukluklar, denge ve düşme riskiyle ilgili önemli problemlerle karşı karşıya kalmaktadır. Bu çalışmanın amacı, polifarmasisi olan yaşlı bireylerde denge, kinezyofobi ve mobilitenin araştırılmasıdır.
Gereç ve Yöntemler: Bu kesitsel çalışmaya, polifarmasisi olan ve Kasım 2023 ve Mart 2024 tarihleri arasında bir üniversite hastanesine başvuran ve standart mini mental test (SMMT) puanı 25 ve üzeri olan 65 yaş ve üzeri toplam 75 kişi dahil edildi. Veriler hasta tanıtımı ve ilaç kullanımı anketi, Berg denge ölçeği (BDÖ), Tampa kinezyofobi ölçeği (TKÖ) ve zamanlı kalk ve yürü (ZKY) testi kullanılarak toplandı.
Bulgular: ZKY testini 0-14 saniye içinde tamamlayan kişiler, testi 14 saniyeden daha uzun sürede tamamlayanlara kıyasla daha yüksek BDÖ puanlarına sahipti (p=0,001), bu grupta TKÖ puanları ise daha düşüktü (p=0,001). Ayrıca, düşme öyküsü olan bireylerin düşme öyküsü olmayanlara kıyasla daha yüksek TKÖ (p=0,001) ve daha yüksek ZKY testi (p=0,001) puanlarına sahip olduğu görüldü. Ek olarak, kronik hastalık sayısı BDÖ puanları ile negatif korelasyon (rs=-0,319; p=0,005) gösterirken, TKÖ puanları (rs=0,263; p=0,023) ve ZKY testi süreleri (rs=0,316; p=0,006) ile pozitif korelasyon gösterdi.
Sonuç: Çalışmanın bulguları, yaşlı bireylerde polifarmasinin denge ve mobilite üzerine olumsuz etkileri olduğunu göstermiştir. Yeni bir tedavi protokolü oluşturulmadan önce reçete edilen ilaçların endikasyon uygunluğunun değerlendirilmesi ve hastanın düzenli kullandığı ilaçların da dikkate alınması oldukça önemlidir.

Keywords

Denge , kinezyofobi , mobilite , yaşlı bireyler , polifarmasi

References

• World Health Organization. Medication safety in polypharmacy. Technical report. Geneva: World Health Organization; 2019.
• Midão L, Giardini A, Menditto E, Kardas P, Costa E. Polypharmacy prevalence among older adults based on the survey of health, ageing and retirement in Europe. Arch Gerontol Geriatr. 2018;78:213-20.
• Nicholson K, Liu W, Fitzpatrick D, Hardacre KA, Roberts S, Salerno J, et al. Prevalence of multimorbidity and polypharmacy among adults and older adults: a systematic review. Lancet Healthy Longev. 2024;5(4):e287-96.
• Aydos TR, Emre Aydingöz S, Lux KM, Efe OE, İşli F, Aksoy M, et al. Polypharmacy prevalence among geriatric patients in primary healthcare settings across Turkey: A cross-sectional analysis through the nationwide prescription information system. Turk J Geriatr. 2020;23(2):169-79.
• Pazan F, Wehling M. Polypharmacy in older adults: a narrative review of definitions, epidemiology and consequences. Eur Geriatr Med. 2021;12(3):443-52.
• Canio WC. Polypharmacy in older adults. Clin Geriatr Med. 2022;38(4):621-5.
• Mouazer A, Tsopra R, Sedki K, Letord C, Lamy JB. Decision-support systems for managing polypharmacy in the elderly: A scoping review. J Biomed Inform. 2022;130:104074.
• Pereira KG, Peres MA, Iop D, Boing AC, Boing AF, Aziz M, et al. Polypharmacy among the elderly: a population-based study. Rev Bras Epidemiol. 2017;20(2):335-44.
• Sofulu F, Karadakovan A. Evaluation of knowledge and practices on polypharmacy and drug use of geriatric individuals. İzmir Katip Çelebi Univ Fac Health Sci J. 2022;7(3):529-33. Turkish.
• Kızılkaya N, Saka S. Investigation of the effects of polypharmacy and cardiac risk factors on balance, falling and functional independence in geriatric individuals. J Health Sci. 2022;31(2):198-203. Turkish.
• Frank JS, Earl M. Coordination of posture and movement. Phys Ther. 1990;70(12):855-63.
• Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. N Engl J Med. 1988;319(26):1701-7.
• Robitaille Y, Laforest S, Fournier M, Gauvin L, Parisien M, Corriveau H, et al. Moving forward in fall prevention: an intervention to improve balance among older adults in real-world settings. Am J Public Health. 2005;95(11):2049-56.
• Güngen C, Ertan T, Eker E, Yaşar R, Engin F. Reliability and validity of the standardized Mini Mental State Examination in the diagnosis of mild dementia in Turkish population. Turk Psikiyatri Derg. 2002;13(4):273-81. Turkish.
• Nyenhuis DL, Reckow J. Office- and bedside-based screening for cognitive impairment and the dementias: Which tools to use, interpreting the results, and what are the next steps? Clin Geriatr Med. 2023;39(1):15-25.
• Berg K, Wood-Dauphinee S, Williams JI, Gayton D. Measuring balance in the elderly: Preliminary development of an instrument. Physiotherapy Canada. 1989;41(6):304-11.
• Sahin F, Yilmaz F, Ozmaden A, Kotevoglu N, Sahin T, Kuran B. Reliability and validity of the Turkish version of the Berg Balance Scale. J Geriatr Phys Ther. 2008;31(1):32-7.
• Podsiadlo D, Richardson S. The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991;39(2):142-8.
• Aslankhani MA, Farsi A, Fathirezaie Z, Zamani Sani SH, Aghdasi MT. Validity and reliability of the Timed Up and Go and the Anterior Functional Reach Tests in evaluating fall risk in the elderly. Iran J Ageing. 2015;10(1):16-25. Persian.
• Vlaeyen JW, Kole-Snijders AM, Rotteveel AM, Ruesink R, Heuts PH. The role of fear of movement/(re)injury in pain disability. J Occup Rehabil. 1995;5(4):235-52.
• Tunca Yılmaz Ö, Yakut Y, Uygur F, Uluğ N. Turkish version of the Tampa scale for kinesiophobia and its test-retest reliability. Turk J Physiother Rehabil. 2011;22(1):44-9. Turkish.
• Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale, NJ: Lawrence Erlbaum Associates; 1988.
• Ziere G, Dieleman JP, Hofman A, Pols HA, van der Cammen TJ, Stricker BH. Polypharmacy and falls in the middle age and elderly population. Br J Clin Pharmacol. 2006;61(2):218-23.
• Bareis N, Sando TA, Mezuk B, Cohen SA. Association between psychotropic medication polypharmacy and an objective measure of balance impairment among middle-aged adults: Results from the US National Health and Nutrition Examination Survey. CNS Drugs. 2018;32(9):863-71.
• Hawk C, Hyland JK, Rupert R, Colonvega M, Hall S. Assessment of balance and risk for falls in a sample of community-dwelling adults aged 65 and older. Chiropr Osteopat. 2006;14:3.
• Damián J, Pastor-Barriuso R, Valderrama-Gama E, de Pedro-Cuesta J. Factors associated with falls among older adults living in institutions. BMC Geriatr. 2013;13:6.
• Erbay Ö. Growing ''polypharmacy'' problem in elderly: role of nurses. Türkiye Klinikleri J Nurs Sci. 2018;10(3): 222-7. Turkish.
• Bakırhan S, Unver B, Elibol N, Karatosun V. Fear of movement and other associated factors in older patients with total knee arthroplasty. Ir J Med Sci. 2023;192(5):2217-22.
• Solmaz T, Altay B. Medication use in the elderly and determination of fall factors causing. BAUN Health Sci J. 2019;8(3):129-34. Turkish.
• Acaröz Candan S, Demircioğlu A, Şahin ÜK. Cross-cultural adaptation and psychometric properties of the Fear of Falling Avoidance Behavior Questionnaire in Turkish community-dwelling older adults. Disabil Rehabil. 2021;43(23):3387-94.
• Oğuz S, Ertürk G, Polat MG, Apaydın H. The effect of kinesiophobia on physical activity, balance, and fear of falling in patients with Parkinson’s disease. Physiother Theory Pract. 2023;39(4):865-72.
• Sertel M, Aydoğan Arslan S, Tütün Yümin E, Demirci CS, Tarsuslu Şimşek T. Investigation of the relationship between physical activity, kinesiophobia and fear of falling in older adults with chronic pain. Somatosens Mot Res. 2021;38(3):241-7.
• McColl L, Strassheim V, Linsley M, Green D, Dunkel C, Trundle H, et al. Associations between the Falls Efficacy Scale International (FES-I) and poor strength and balance in community-dwelling older people. Cogent Gerontol. 2024;3(1):2304603.
• Baskan Ö, Kayapınar İ. Investigation of kinesiophobia and mobility and depression levels in geriatric individuals. İzmir Democr Univ Health Sci J. 2024;7(1):81-9. Turkish.
• Gülhan Güner S, Ural N. Fall in the elderly people: Determining the status within the context of dissertations conducted in Turkey. İzmir Katip Çelebi Univ Fac Health Sci J. 2017;2(3):9-15. Turkish.
• Caner Ş, Aydın Avcı İ. Investigation of home care needs and falling with risk, fear, and falling behaviors in elderly. J Samsun Health Sci. 2022;7(1):193-208. Turkish.
• Ozkok S, Aydin CO, Sacar DE, Catikkas NM, Erdogan T, Kilic C, et al. Associations between polypharmacy and physical performance measures in older adults. Arch Gerontol Geriatr. 2022;98:104553.
• Langeard A, Pothier K, Morello R, Lelong-Boulouard V, Lescure P, Bocca ML, et al. Polypharmacy cut-off for gait and cognitive impairments. Front Pharmacol. 2016;7:296.
• Ersoy S, Engin VS. Risk factors for polypharmacy in older adults in a primary care setting: a cross-sectional study. Clin Interv Aging. 2018;13:2003-11.
• Zhao Y, Wang J, Zhu X, Zhang X, Zhang Y, Zhang W, et al. Multimorbidity and polypharmacy in hospitalized older patients: a cross-sectional study. BMC Geriatr. 2023;23(1):423.
• Sengul Aycicek G, Arik G, Kizilarslanoglu MC, Sumer F, Pala OO, Can B, et al. Association of polypharmacy with postural instability and impaired balance in community-dwelling older adults in Turkey. Marmara Med J. 2021;34(1):12-7.