ORIGINAL RESEARCH ARTICLE

Drugs Aging 2009; 26 (12): 1039-1048

1170-229X/09/0012-1039/$49.95/0

2009 Adis Data Information BV. All rights reserved.

Polypharmacy Status as an Indicator of

Mortality in an Elderly Population
Johanna Jyrkka,1,2,3 Hannes Enlund,4 Maarit J. Korhonen,1,5 Raimo Sulkava1
and Sirpa Hartikainen3,6,7
1
2
3
4
5
6
7

School of Public Health and Clinical Nutrition, University of Kuopio, Kuopio, Finland
Department of Social Pharmacy, University of Kuopio, Kuopio, Finland
Kuopio Research Centre of Geriatric Care, University of Kuopio, Kuopio, Finland
Department of Pharmacy Practice, Kuwait University, Kuwait City, Kuwait
Department of Pharmacology, Drug Development and Therapeutics, University of Turku, Turku, Finland
Faculty of Pharmacy, University of Kuopio, Kuopio, Finland
Leppavirta Health Centre, Leppavirta, Finland

Abstract

Background: Increased use of drugs has raised concern about the risks of
polypharmacy in elderly populations. Adverse outcomes, such as hospitalizations and falls, have been shown to be associated with polypharmacy. So
far, little information is available on the association between polypharmacy
status and mortality.
Objective: To assess whether polypharmacy (six to nine drugs) or excessive
polypharmacy (ten or more drugs) could be indicators of mortality in elderly
persons.
Methods: This was a population-based cohort study conducted between 1998
and 2003 with mortality follow-up through to 2007. The data in this study
were derived from the population-based Kuopio 75+ Study, which involved
elderly persons aged 75 years living in the city of Kuopio, Finland. The
initial sample (sample frame n = 4518, random sample n = 700) was drawn
from the population register. For the purpose of this study, two separate
analyses were carried out. In the first phase, participants (aged 75 years,
n = 601) were followed from 1998 (baseline) to 2002. In the second phase,
survivors (aged 80 years, n = 339) were followed from 2003 to 2007. Current
medications were determined from drug containers and prescriptions during
interviews conducted by a trained nurse. The Kaplan-Meier method and Cox
proportional hazards regression were used to examine the association between polypharmacy status and mortality.
Results: In the first phase, 28% (n = 167) belonged to the excessive polypharmacy group, 33% (n = 200) to the polypharmacy group, and the remaining 39% (n = 234) to the non-polypharmacy (05 drugs) group. The
corresponding figures in the second phase were 28% (n = 95), 39% (n = 132)

Jyrkka et al.

1040

and 33% (n = 112), respectively. The mortality rate was 37% in the first phase
and 40% in the second phase. In both phases, the survival curves showed a
significant difference in all-cause mortality between the three polypharmacy
groups. In the first phase, the univariate model showed an association between excessive polypharmacy and mortality (hazard ratio [HR] 2.53, 95% CI
1.83, 3.48); however, after adjustment for demographics and other variables
measuring functional and cognitive status, this association did not remain
statistically significant (HR 1.28, 95% CI 0.86, 1.91). In the second phase, the
association between excessive polypharmacy and mortality (HR 2.23, 95% CI
1.21, 4.12) remained significant after adjustments. Age, male sex and dependency according to the Instrumental Activities of Daily Living screening
instrument were associated with mortality in both phases.
Conclusion: This study points to the importance of excessive polypharmacy as
an indicator for mortality in elderly persons. This association needs to be
confirmed following adjustment for co-morbidities.

Background
In recent years, there has been a growing awareness of the risks associated with polypharmacy in
elderly populations.[1,2] Polypharmacy is a well
known risk factor for adverse outcomes such
as hospitalizations[3] and falls,[4] mainly because
elderly persons are more prone to drug-drug interactions, adverse reactions and medical errors in
dosing.[5-7] In addition, polypharmacy may contribute to poor adherence, which may have major
clinical consequences.[8]
Polypharmacy poses a major concern regarding the quality of drug treatment. Recent studies
reported that more than half of elderly persons
using five or more different drugs daily were
taking unnecessary drugs, including drugs without a clear indication, ineffective drugs and drugs
that represent therapeutic duplication.[9,10] Medication problems typically begin when druginduced symptoms are interpreted as a new disease,
leading to prescription of additional drugs.[11] On
the other hand, there are also reports of untreated
conditions in elderly persons.[12] Finding the right
balance between benefits and harms determines
the quality of overall treatment.
Information about the relationship between
polypharmacy status and mortality is scarce.
Some previous studies have shown weak asso 2009 Adis Data Information BV. All rights reserved.

ciations with mortality,[13-15] although none of

them have looked at the association between
mortality and excessive polypharmacy, defined as
the use of ten or more drugs concomitantly. The
aim of this study was to assess whether polypharmacy (six to nine drugs in use) or excessive
polypharmacy (ten or more drugs in use) could
act as indicators of mortality in elderly persons.
Methods
Study Population

The data in this study are derived from the

Kuopio 75+ Study, which has been described in
detail elsewhere.[16] Briefly, the population-based
Kuopio 75+ Study is a multidisciplinary health
survey on the clinical epidemiology of diseases,
drug use and functional capacity among elderly
persons. To be eligible for the study, participants
had to be aged 75 years and living in the city of
Kuopio, Finland, at the time of recruitment into
the study on 1 January 1998. The original cohort
consisted of 700 elderly persons randomly selected from all eligible inhabitants (n = 4518). Of
this cohort, 15 died before the examination and
84 refused to participate or could not be contacted, yielding a participation rate of 86%.
Baseline examinations were conducted for the
Drugs Aging 2009; 26 (12)

Polypharmacy Status and Mortality in an Elderly Population

remaining 601 participants in 1998. By the time

the follow-up study was conducted in 2003, 262
participants had been lost (233 died, 29 refused or
could not be contacted), leaving a cohort of
339 participants remaining in the study.
All participants or their close relatives provided written informed consent before taking
part in the Kuopio 75+ Study. The study protocol
was approved and granted by the ethical committee of the Hospital District of Northern Savo
and the University of Kuopio, Kuopio, Finland.
Data Collection

At baseline in 1998, participants underwent a

structured clinical examination and interview.
During these assessments, a trained nurse and a
geriatrician examined the participants health status and checked their medical records. Participants current medications were recorded during
the interview on the basis of information on drug
containers and prescriptions. In addition, the information about their medications was confirmed
by referral to available medical records from
Kuopio University Hospital, municipal hospitals,
local hospitals and the home nursing service. The
follow-up examinations conducted in 2003 used
the same set of procedures as the baseline
examination, except that there was no clinical
examination by a geriatrician.
Study Design

The outcome of interest in this prospective cohort study was death over a 5-year period, measured in two separate survival analyses. In the first
phase, an analysis was carried out in 601 elderly
participants who were aged 75 years at the beginning of follow-up. Their survival was monitored
from 1998 to 2002. In the second phase, the analysis included 339 survivors aged 80 years at the
time of re-examinations in 2003. Their survival was
monitored between 2003 and 2007.
Ascertainment of Mortality

The dates of death were derived from Statistics

Finland, which is the official National Health
Register Authority maintaining an archive of
2009 Adis Data Information BV. All rights reserved.

1041

death certificates for the Finnish population.[17]

The statistics on deaths are compiled annually on
the basis of data from death certificates and
supplemental data from the Central Population
Register. The data for the dates of death are
comprehensive because death certificates are obligatory for all persons who are domiciled in
Finland at their time of death.
In the first phase, survival was defined as the
time from the date of examination in 1998 until
death or the end of the follow-up period on 31
December 2002. For surviving participants, the
second phase covered the time from the date of
examination in 2003 until death or the end of the
follow-up period on 31 December 2007.
Definitions and Measures

In this study, drugs and vitamins taken regularly or on an as-needed basis, excluding herbal
remedies, were counted as drugs. Polypharmacy
status was determined by dividing the participants
into three groups based on the number of drugs in
use. In this classification, excessive polypharmacy
was defined as use of ten or more drugs concomitantly; polypharmacy was defined as use of
six to nine drugs. The non-polypharmacy group
included persons using five or fewer drugs concomitantly. These cut-off points were chosen based
on previous studies and current treatment patterns
of elderly populations. Although there is as yet no
consensus or commonly used cut-off point for excessive polypharmacy, ten or more drugs has been
used to define excessive polypharmacy in recent
studies.[18,19] To define polypharmacy, earlier studies have mostly used four or five drugs as a cut-off
point.[12,20-22] Reflecting the expanding opportunities for drug treatment of elderly persons, we
chose a higher cut-off point for polypharmacy.
Inclusion of nonprescription drugs and vitamins in
our study justified this decision; in contrast, several
other studies have taken into account only prescribed drugs.[23-26]
Residential status was determined on the basis
of living conditions at the time of examination.
Home living status was coded for those subjects
living in their own home or in sheltered accommodation. Institutional care included nursing
Drugs Aging 2009; 26 (12)

Jyrkka et al.

1042

homes, residential homes and long-term hospital

care. Self-reported health was measured on a
5-point scale as a part of the structured study
protocol. In order to avoid small subgroups,
health status was reclassified into three classes:
good (= very good/good); moderate; and poor
(= fairly poor/poor).
The Mini-Mental State Examination (MMSE)
screening test was used to measure cognitive status.[27] This 30-point questionnaire samples various functions of cognition, including arithmetic,
memory and orientation. In this study, cognitive
impairment was coded as present if the subject
scored 24 on the MMSE test and absent if the
score was >24.
Functional status was evaluated by the Instrumental Activities of Daily Living (IADL) screening instrument, as introduced by Lawton and
Brody.[28] The IADL scale contains eight items,
with scores ranging from 0 points for low function
to 8 points for high function. The measure includes
questions on using the telephone, grocery shopping, meal preparation, housekeeping, doing the
laundry, mode of transportation, taking care of
medications and managing money. The IADL
points were dichotomized to reflect those expressing significant difficulties in daily tasks (IADL
score 06) and those able to function without
severe difficulties (IADL score 78).
Statistical Analysis

Descriptive statistics are expressed as proportions and means with standard deviations.
When comparing the distributions of categorical
variables across polypharmacy groups, crosstabulations were used, and the differences were
tested using the chi-squared (w2) test. For continuous variables, the statistical significance
in means was determined by ANOVA with the
post hoc Tukey test.
The Kaplan-Meier method was used to estimate survival in the three groups. Furthermore,
the statistical significance of differences between
survival curves was assessed with the log-rank
test. The analysis of indicators for mortality was
performed using the Cox proportional hazards
model to calculate crude and adjusted hazard
2009 Adis Data Information BV. All rights reserved.

ratios (HRs). In addition, 95% confidence intervals

are reported. The assumption of proportional hazards was assessed graphically using log-minus-log
graphs. Data management and analyses were performed using Statistical Package for Social Sciences (SPSS) for Windows, version 14.0 (SPSS
Inc., Chicago, IL, USA).
Results
Participants with excessive polypharmacy
were somewhat older, were more likely to selfreport poor health, were more likely to have
cognitive impairment and were more likely to
have lower functional status (IADL score) than
the other groups (table I). In addition, participants in the excessive polypharmacy group were
more likely to be in institutional care.
Drug Use and Polypharmacy Status

The participants studied in the first phase were

using a mean 7.1 (range 028) drugs. Of these, a
mean 4.6 (range 016) were used regularly and a
mean 2.5 (range 012) on an as-needed basis. By
the second phase, the mean number of drugs in use
had increased to 7.5 (range 018) and, of these, a
mean 5.6 (range 016) were used regularly and a
mean 1.9 (range 09) on an as-needed basis. In
the first phase, 28% of participants belonged to the
excessive polypharmacy group and 33% to the
polypharmacy group (table I). The remainder
(39%) comprised the non-polypharmacy group.
The corresponding figures in the second phase
were 28%, 39% and 33%, respectively.
Mortality during the Two Phases

In the first phase, the mean follow-up time was

3.62 years between 1998 and 2002. A total of 221
deaths occurred during this 5-year period, yielding a mortality rate of 37%. For participants in
the second phase, the mean follow-up time was
3.79 years between 2003 and 2007. The mortality
rate over this period was 40% (n = 137).
The Kaplan-Meier survival curves showed
a significant difference in all-cause mortality
between the three groups in both phases (logrank test, p < 0.001 in both phases) [figure 1].
Drugs Aging 2009; 26 (12)

1998 (n = 601)

2003 (n = 339)
polypharmacy
(n = 200)

excessive
polypharmacy
(n = 167)

162 (69)

150 (75)

133 (80)

79 (70)

94 (71)

81 (85)

72 (31)

50 (25)

34 (20)

33 (30)

38 (29)

14 (15)

80.6 (4.2)

81.4 (4.6)

83.3 (4.8)

84.1 (3.7)

84.9 (3.5)

86.0 (4.2)

Sex [n (%)]
women
men

Age, mean [y (SD)]

p-valuea

nonpolypharmacy
(n = 234)

nonpolypharmacy
(n = 112)

excessive
polypharmacy
(n = 95)

0.060

<0.001

113 (48)

81 (41)

41 (25)

8084

77 (33)

66 (33)

55 (33)

70 (63)

63 (48)

38 (40)

85

44 (19)

53 (26)

71 (42)

42 (37)

69 (52)

57 (60)

227 (97)

177 (89)

119 (71)

109 (97)

119 (90)

61 (64)

7 (3)

23 (11)

48 (29)

3 (3)

13 (10)

34 (36)

good

108 (48)

60 (32)

28 (19)

67 (63)

58 (50)

22 (28)

moderate

101 (44)

91 (49)

69 (46)

30 (28)

42 (36)

32 (41)

19 (8)

35 (19)

52 (35)

9 (9)

17 (14)

24 (31)

161 (69)

112 (56)

70 (42)

85 (81)

90 (74)

42 (52)

73 (31)

88 (44)

97 (58)

20 (19)

32 (26)

39 (48)

156 (67)

104 (53)

52 (32)

74 (66)

58 (44)

16 (17)

75 (33)

93 (47)

112 (68)

38 (34)

73 (56)

77 (83)

home
institution

<0.001

Self-reported health statusb [n (%)]

poor

normal
impaired

<0.001

<0.001

<0.001

p-Values for categorical variables were measured with a chi-squared (w2) test and for continuous variables with ANOVA.

Missing values: n = 38 in 1998, n = 38 in 2003.

c Missing values: n = 31 in 2003.

Missing values: n = 9 in 1998, n = 3 in 2003.

1043

Drugs Aging 2009; 26 (12)

difficulties

<0.001

<0.001

Functional statusd [n (%)]

independent

<0.001

<0.001

Cognitive statusc [n (%)]

0.001

0.004

7579

Residential status [n (%)]

p-valuea

0.023

<0.001

Age group (y) [n (%)]

polypharmacy
(n = 132)

Polypharmacy Status and Mortality in an Elderly Population

2009 Adis Data Information BV. All rights reserved.

Table I. Characteristics of the study population in 1998 (aged 75 years) and in 2003 (aged 80 years) according to polypharmacy status
Characteristic

Jyrkka et al.

1044

05 drugs
69 drugs
10 drugs
b
1.0

0.8

0.8
Cumulative survival

Cumulative survival

a
1.0

0.6

0.4

0.6

0.4

0.2

0.2
Log-rank p < 0.001

Log-rank p < 0.001

0

0
0

1.0

2.0
3.0
Time to death (y)

4.0

5.0

1.0

2.0
3.0
Time to death (y)

4.0

5.0

Fig. 1. Kaplan-Meier survival curves for excessive polypharmacy (ten or more drugs), polypharmacy (six to nine drugs) and non-polypharmacy (five
or fewer drugs) groups in (a) the first phase (n = 601, aged 75 years) between 1998 and 2002 and (b) the second phase (n = 339, aged 80 years)
between 2003 and 2007.

Participants in the non-polypharmacy group had

the highest survival rate, whereas the shortest survival time was observed in persons with excessive
polypharmacy. In terms of polypharmacy status,
the mortality rate from all causes was higher in
subjects with excessive polypharmacy (55% in the
first phase, 61% in the second phase) than in those
with polypharmacy (33% and 40%, respectively) or
non-polypharmacy (27% and 23%, respectively).
Indicators of Mortality

In the first phase, the univariate model showed

an association between excessive polypharmacy and
mortality (HR 2.53, 95% CI 1.83, 3.48) [table II].
However, after adjustment for several co-variates
(including sex, age, residential status, self-reported
health status, functional status and cognitive status),
this association attenuated and was no longer statistically significant (HR 1.28, 95% CI 0.86, 1.91).
Other variables associated with mortality in the
multivariate model were age, male sex, difficulties in
IADL and impaired cognitive status.
In the second phase, there was a significant
association between excessive polypharmacy and
mortality (HR 2.23, 95% CI 1.21, 4.12) in the
multivariate model after adjustments (table II).
2009 Adis Data Information BV. All rights reserved.

Similarly, as in the first phase, age, male sex and

difficulties according to IADL were associated
with mortality; however, impaired cognitive status was not. In addition, poor health status was
statistically significantly associated with mortality in the second phase.

Discussion
This study found excessive polypharmacy to
be an indicator of 5-year mortality in elderly
persons (aged 80 years) after adjustment for
demographics and variables measuring functional and cognitive status. Of the other factors,
age, male sex and difficulties in IADL were associated with mortality in both phases of the study.
Previous studies concerning polypharmacy and
mortality[13-15] have not differentiated between
polypharmacy and excessive polypharmacy; therefore, our results are not directly comparable with
the results of these studies. An American study on
people aged 65 years reported an approximate
30% increased risk of 8-year mortality among
those taking four or more drugs after adjustment
for several demographic, disease status and
functional status variables.[14] A substantially
Drugs Aging 2009; 26 (12)

Polypharmacy Status and Mortality in an Elderly Population

higher risk was reported in a Japanese study, in

which the 1-year postdischarge mortality of people
aged 85 years using six or more drugs was over
3-fold compared with those using two or fewer
drugs.[15] The variables adjusted for included
demographics, use of specific drug categories,
Charlson co-morbidity index score and other
variables indicating impaired health status of
participants.
In the first phase, both impaired cognitive status
and lower functional status were associated with
mortality, whereas in the second phase only IADL
status remained significant. Our findings about
IADL status are consistent with those of previous
studies reporting that low IADL status is a predictor of several negative health outcomes, in-

1045

cluding mortality, in elderly populations.[29,30] The

current study adds evidence concerning the association between cognitive status and mortality,
reporting a stronger association in younger participants (aged 75 years) than in older participants
(aged 80 years). Parallel results were obtained in a
previous study, which reported cognitive decline to
be a stronger predictor of mortality among those
aged <80 years than those aged 80 years.[31] The
stronger association in younger subjects may
reflect increasing morbidity with aging, meaning
that other diseases take the major role in predicting
mortality.
It is obvious that in elderly persons, polypharmacy and excessive polypharmacy occur
mostly because of increased morbidity. The main

Table II. Univariate and multivariate Cox proportional hazard models for elderly participants in 1998 (aged 75 years) and for survivors in
2003 (aged 80 years)
Characteristic

1998

2003

univariate
HR (95% CI) [n = 601]

multivariate
HR (95% CI) [n = 556]

univariate
HR (95% CI) [n = 339]

multivariate
HR (95% CI) [n = 289]

05

1.00

1.00

1.00

1.00

69

1.30 (0.92, 1.83)

0.98 (0.67, 1.43)

1.95 (1.22, 3.12)

1.57 (0.90, 2.72)

10

2.53 (1.83, 3.48)

1.28 (0.86, 1.91)

3.71 (2.33, 5.90)

2.23 (1.21, 4.12)

women

1.00

1.00

1.00

1.00

men

1.12 (0.83, 1.50)

1.44 (1.03, 2.00)

1.33 (0.92, 1.92)

1.91 (1.21, 3.00)

Age (y)

1.15 (1.12, 1.18)

1.09 (1.06, 1.13)

1.12 (1.07, 1.16)

1.07 (1.02, 1.13)

home

1.00

1.00

1.00

1.00

institution

4.03 (2.99, 5.42)

1.48 (0.97, 2.25)

3.75 (2.59, 5.44)

1.61 (0.84, 3.09)

good

1.00

1.00

1.00

1.00

moderate

0.90 (0.64, 1.25)

0.66 (0.46, 0.93)

1.29 (0.82, 2.02)

1.04 (0.64, 1.68)

poor

1.72 (1.19, 2.48)

1.16 (0.78, 1.75)

2.79 (1.73, 4.48)

1.84 (1.08, 3.13)

normal

1.00

1.00

1.00

1.00

impaired

3.40 (2.57, 4.49)

1.54 (1.10, 2.17)

2.60 (1.81, 3.74)

1.24 (0.78, 1.96)

independent

1.00

1.00

1.00

1.00

need for assistance

4.74 (3.46, 6.50)

2.49 (1.72, 3.60)

4.40 (2.88, 6.71)

2.13 (1.25, 3.61)

Polypharmacy (drugs) [n]

Sex

Residential status

Self-reported health statusa

Cognitive statusb

Functional statusc

Missing values: n = 38 in 1998, n = 38 in 2003.

Missing values: n = 9 in 1998, n = 3 in 2003.

Missing values: n = 31 in 2003.

HR = hazard ratio.

2009 Adis Data Information BV. All rights reserved.

Drugs Aging 2009; 26 (12)

Jyrkka et al.

1046

drawback of our study was the incomplete data

on co-morbidities, which in turn did not allow for
adjustment for co-morbidities. However, other
studies have reported that polypharmacy remains
a predictor of mortality, independent of chronic
diseases.[14,15]
Some previous studies have reported that
persons taking multiple drugs are more likely to
experience problems with their medications.[32,33]
Common consequences of polypharmacy in
elderly populations include adverse drug effects,
drug-drug interactions and drug-disease interactions. A recent study found that elderly persons
using five or more drugs are over three times
more likely to receive inappropriate drugs than
those taking fewer drugs.[34] Furthermore, adverse drug effects as a result of inappropriate
prescribing have been shown to lead to hospitalizations and increased mortality.[35] We cannot
draw any conclusions about the appropriateness
or rationality of the medications being taken by
our study participants because of the incomplete
data on diagnosis and the lack of medication
reviews. However, based on previous study results,[18,32,36] it seems reasonable to assume that
inappropriate medications at least partly explain
the indicative value of polypharmacy status for
mortality observed in our study.
Finding the balance between the benefits and
harms of drug therapy is a challenging task for
clinicians in the care of elderly persons. To some
extent, polypharmacy can even be seen as an iatrogenic problem when adverse effects caused by
drugs are not recognized as such, resulting in new
unnecessary prescriptions. In addition, polypharmacy and excessive polypharmacy may be
consequences of unnecessary drug use resulting
from unnecessary repeat prescribing and lack of
monitoring. In Finland and other Nordic countries, one of the factors contributing to increases in
polypharmacy and excessive polypharmacy is the
reimbursement system, which allows for universal
access to prescription drugs by refunding and subsidizing the costs of drugs for all citizens equally.[37]
The association between polypharmacy status
and mortality found in this study calls for interventions to ensure optimal medication for elderly
persons receiving healthcare. Unnecessary drugs
2009 Adis Data Information BV. All rights reserved.

should be discontinued so that all drugs an elderly

person is taking are effective and have the correct
indication without any therapeutic duplication.[9]
Optimizing medication may also include prescribing new drugs for untreated conditions.[38] Based
on the results of our study, these efforts should be
targeted especially towards elderly persons using
ten or more drugs concomitantly in order to prevent adverse outcomes, including mortality associated with polypharmacy. Medication assessment
by multidisciplinary teams seems to be effective for
optimizing medication and preventing unnecessary
polypharmacy, with particular benefits in terms of
drug-drug interactions.[39-41]
Methodological Considerations

The population of this study was a random

sample of the target population with a good participation rate (86%), which increases the reliability
and applicability of the results. For the analysis
between 2003 and 2007, the sample size was only
half (n = 339) of the previous sample because of
numerous deaths, which limited the power of the
multivariate analysis. Overall, the study protocol of
the Kuopio 75+ Study was well designed, especially
concerning the collection of data on the current use
of drugs. However, an important limitation of this
study was that we were unable to adjust the multivariate model for all relevant confounders, such as
co-morbidities. This is because the clinical assessments carried out by the geriatrician were conducted only at baseline, and we had less reliable
data on diagnoses for the second phase.
The major strength of this cohort study was the
long follow-up time (10 years), with inclusion of
drug information from two different points in time.
However, the crossover in polypharmacy groups
during the follow-up period forced us to present
analyses in two separate 5-year phases. Finally,
although the study participants were from a single
community, it seems reasonable to generalize the
results of our study to wider elderly populations.
Conclusions
The results of this study point to the importance
of excessive polypharmacy as an indicator of
Drugs Aging 2009; 26 (12)

Polypharmacy Status and Mortality in an Elderly Population

mortality over a 5-year period in elderly populations. In future studies, this observed association
needs to be verified by adjusting for co-morbidities.
More research is also needed on the role of unnecessary medications in the association between
mortality and polypharmacy status in elderly
persons.
Acknowledgements
The Kuopio 75+ Study was financially supported by the
Nordic Red Feather of the Lions. The authors also express
their gratitude to the Kuopio University Pharmacy Fund and
the Social Insurance of Finland for offering financial support
to data analysis. In addition, the study was supported by
grants from the Jenny and Antti Wihuri Foundation, the
Orion-Farmos Research Foundation and the Finnish Cultural Foundation. The funders had no role in the design of the
Kuopio 75+ Study or the preparation of this article.
The authors wish to thank statistician Piia Lavikainen for
her kind advice regarding this article. We are also grateful to
Ms Paivi Heikura for her role in maintaining and updating the
Kuopio 75+ database.
The authors have no conflicts of interest that are directly
relevant to the content of this study.

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and hospitalization among older home care patients.
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4. Ziere G, Dieleman JP, Hofman A, et al. Polypharmacy and
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Correspondence: Johanna Jyrkka, M.Sc. (Pharm), School of

Public Health and Clinical Nutrition, University of Kuopio,
P.O. Box 1627, 70211 Kuopio, Finland.
E-mail: johanna.jyrkka@uef.fi

Drugs Aging 2009; 26 (12)

Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.