Polifarmasinin Yaşlı Bireylerde Bilişsel Fonksiyon, Depresyon, Fonksiyonellik ve Yaşam Kalitesi Üzerindeki Çok Boyutlu Etkisi: Kesitsel Bir Çalışma

Öz

Amaç: Bu çalışmanın amacı, 65 yaş ve üzeri bireylerde polifarmasinin bilişsel fonksiyon, depresyon düzeyi, günlük yaşam aktiviteleri ve yaşam kalitesi üzerindeki etkilerini değerlendirmektir. Gereç ve Yöntem: Kesitsel tipteki bu çalışmaya, bir üniversite hastanesinin geriatri polikliniğine başvuran ve yaş ortalaması 73 olan toplam 164 yaşlı birey dahil edildi. Katılımcılar, kullandıkları ilaç sayısına göre polifarmasi (≥5 ilaç) ve polifarmasi olmayan (0–4 ilaç) olmak üzere iki gruba ayrıldı. Bilişsel işlevler Mini-Mental Durum Testi (MMSE), depresyon Geriatrik Depresyon Ölçeği (GDS), günlük yaşam aktiviteleri Barthel İndeksi (BI) ve yaşam kalitesi WHOQOL-OLD ölçeği ile değerlendirildi. Bulgular: Gruplar arasında bilişsel işlev (p = 0,910), depresyon düzeyi (p = 0,585) ve günlük yaşam aktiviteleri (p = 0,656) açısından istatistiksel olarak anlamlı bir fark saptanmadı. Ancak, polifarmasi olmayan grupta WHOQOL-OLD toplam puanı (p = 0,013) ile sosyal katılım (p = 0,038), ölüme ilişkin tutumlar (p = 0,046) ve yakın ilişkiler (p = 0,046) alt ölçeklerinde anlamlı düzeyde daha yüksek skorlar elde edildi. Sonuç: Polifarmasi, yaşam kalitesini olumsuz yönde etkileyebilmektedir; ancak bilişsel ve fonksiyonel etkiler örneklem özelliklerine bağlı olarak değişkenlik gösterebilir. Bulgular, yaşlı bireylerde polifarmasiye ilişkin değerlendirmelerin kapsamlı ve bireye özgü yapılmasının önemini vurgulamaktadır.

Anahtar Kelimeler

• yaşlılar
• bilişsel işlevler
• depresyon
• Polifarmasi
• yaşam kalitesi

Multidimensional Impact of Polypharmacy on Cognitive Function, Depression, Functionality, and Quality of Life in Older Adults: A Cross-Sectional Study

Öz

Objective: This study aimed to evaluate the effects of polypharmacy on cognitive function, depression levels, activities of daily living, and quality of life in individuals aged 65 years and older. Material and Methods: This cross-sectional study included a total of 164 older adults (mean age: 73 years) who presented to the geriatric outpatient clinic of a university hospital. Participants were divided into two groups based on the number of medications used: the polypharmacy group (≥5 medications) and the non-polypharmacy group (0–4 medications). Cognitive function was assessed using the Mini-Mental State Examination (MMSE), depression with the Geriatric Depression Scale (GDS), activities of daily living with the Barthel Index (BI), and quality of life with the WHOQOL-OLD scale. Results: No statistically significant differences were found between the groups in terms of cognitive function (p = 0.910), depression levels (p = 0.585), or activities of daily living (p = 0.656). However, the non-polypharmacy group showed significantly higher scores in the WHOQOL-OLD total score (p = 0.013), as well as in the subdomains of social participation (p = 0.038), death and dying (p = 0.046), and intimacy (p = 0.046). Conclusion: Polypharmacy may negatively affect quality of life in older adults; however, its cognitive and functional effects may vary depending on sample characteristics. These findings highlight the importance of conducting comprehensive and individualized assessments of polypharmacy in geriatric populations.

Anahtar Kelimeler

• aged
• cognition
• depression
• Polypharmacy
• quality of life

Kaynakça

1. Mannucci PM, Nobili A, Pasina L, Mannucci PM, Nobili A, Tettamanti M, et al. Polypharmacy in older people: lessons from 10 years of experience with the REPOSI register. Intern Emerg Med. 2018 Dec1;13(8):1191–200.
2. Pazan F, Wehling M. Polypharmacy in older adults: a narrative review of definitions, epidemiology and consequences. Eur Geriatr Med.2021 Jun;12(3):443–52.
3. Ahmed B, Nanji K, Mujeeb R, Patel MJ. Effects of polypharmacy on adverse drug reactions among geriatric outpatients at a tertiary care hospital in Karachi: a prospective cohort study. PLoS One.2014;9(11):e112133.
4. Maher RL, Hanlon J, Hajjar ER. Clinical consequences of polypharmacy in elderly. Expert Opin Drug Saf. 2014 Jan;13(1):57–65.
5. Salh HJH, Aziz TA, Mahwi TO, Hussen NH, Aziz DF. The relation between polypharmacy, potentially inappropriate medications, organ function, and quality of life in elderly patients with Type 2 Diabetes. Hosp Pharm. 2025 May 11;00185787251337592.
6. Grajeda-León G, Azurin-Gonzales V, Mamani-Condori Z, Ñaña-Cordova AM, Bustamante-Ordoñez MA, Neyra-Cordova F, et al. Factors associated with anxiety symptoms in older adults attending an outpatient geriatric service: a cross-sectional study. Aging Med (Milton). 2025 Apr;8(2):99–106.
7. Khezrian M, McNeil CJ, Murray AD, Myint PK. An overview of prevalence, determinants and health outcomes of polypharmacy. Ther Adv Drug Saf. 2020;11:2042098620933741.
8. Wastesson JW, Morin L, Tan ECK, Johnell K. An update on the clinical consequences of polypharmacy in older adults: a narrative review. Expert Opin Drug Saf. 2018 Dec;17(12):1185–96.

9. 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.
10. Ertan T, Eker E, Şar V. Reliability and validity of the Geriatric Depression Scale in Turkish elderly population. Archives of Neuropsychiatry (Turkey). 1997;34(1):62–71.
11. Küçükdeveci AA, Yavuzer G, Tennant A, Süldür N, Sonel B, Arasil T.Adaptation of the modified Barthel Index for use in physical medicine and rehabilitation in Turkey. Scand J Rehabil Med. 2000 Jun;32(2):87–92.
12. Eser S, Saatli G, Eser E, Baydur H, Fidaner C. The reliability and validity of the Turkish Version of the World Health Organization Quality of Life Instrument-Older Adults Module (WHOQOL-Old. Turk Psikiyatri Derg. 2010;21(1):37–48.
13. Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007 May;39(2):175–91.
14. Skevington SM, Lotfy M, O’Connell KA, WHOQOL Group. The World Health Organization’s WHOQOL-BREF quality of life assessment:psychometric properties and results of the international field trial. A report from the WHOQOL group. Qual Life Res. 2004 Mar;13(2):299–310.
15. Aljeaidi MS, Haaksma ML, Tan ECK. Polypharmacy and trajectories of health-related quality of life in older adults: an Australian cohort study. Qual Life Res. 2022 Sep;31(9):2663–71.
16. Van Wilder L, Devleesschauwer B, Clays E, Pype P, Vandepitte S, De Smedt D. Polypharmacy and health-related quality of life/psychological distress among patients with chronic disease.Prev Chronic Dis. 2022 Aug 18;19:E50.
17. Wastesson JW, Morin L, Laroche ML, Johnell K. How chronic is polypharmacy in old age? A longitudinal nationwide cohort study. J Am Geriatr Soc. 2019 Mar;67(3):455–62.
18. Davies LE, Spiers G, Kingston A, Todd A, Adamson J, Hanratty B. Adverse outcomes of polypharmacy in older people: systematic review of reviews. J Am Med Dir Assoc. 2020 Feb;21(2):181–7.
19. Nivatti J, Halder S, Goel A, Gupta R, Wason R. Elderly population has higher prevalence of polypharmacy associated with poor quality of life and low compliance after recovery from COVID-19. J MidlifeHealth. 2022;13(4):288–93.
20. Sokas C, Herrera-Escobar JP, Klepp T, Stanek E, Kaafarani H, Salim A, et al. Impact of chronic illness on functional outcomes and quality of life among injured older adults. Injury. 2021 Sep;52(9):2638–44.
21. Khezrian M, McNeil CJ, Myint PK, Murray AD. The association between polypharmacy and late life deficits in cognitive, physical and emotional capability: a cohort study. Int J Clin Pharm. 2019 Feb;41(1):251–7.
22. Aljeaidi MS, Tan EC. The association between polypharmacy and cognitive ability in older adults: A national cohort study. Res Social Adm Pharm. 2022 Mar;18(3):2505–9.
23. Wiersema C, Oude Voshaar RC, van den Brink RHS, Wouters H, Verhaak P, Comijs HC, et al. Determinants and consequences of polypharmacy in patients with a depressive disorder in later life. Acta Psychiatr Scand. 2022 Jul;146(1):85–97.
24. Bazargan M, Smith J, Saqib M, Helmi H, Assari S. Associations between polypharmacy, self-rated health, and depression in African American older adults; mediators and moderators. Int J Environ Res Public Health. 2019 May 6;16(9):1574.
25. Bonanno EG, Figueiredo T, Mimoso IF, Morgado MI, Carrilho J, Midão L, et al. Polypharmacy prevalence among older adults based on the survey of health, ageing and retirement in Europe: an update. J Clin Med. 2025 Feb 17;14(4):1330.
26. Nakamura T, Itoh T, Yabe A, Imai S, Nakamura Y, Mizokami Y, et al. Polypharmacy is associated with malnutrition and activities of Daily living disability among daycare facility users: A cross-sectional study. Medicine (Baltimore). 2021 Aug 27;100(34):e27073.