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Nonlinear Associations Between Frailty and Medication Burden in Hospitalized Older Adults
Hiroyuki Umegaki1,2, Hirotaka Nakashima1, Fumihiko Mizokami3,4
1Department of Community Healthcare and Geriatrics, Graduate School of Medicine, Nagoya University, Nagoya, Japan.
Geriatrics & Gerontology International
|June 10, 2026
Summary
Medication burden in older adults nonlinearly increases with frailty. Moderate frailty shows the steepest rise, suggesting a key period for medication review and deprescribing in hospitalized patients.
Area of Science:
- Geriatric Medicine
- Clinical Pharmacy
- Internal Medicine
Background:
- Medication burden is a significant concern in older adults, particularly those who are hospitalized.
- Frailty is a common condition in older adults and is associated with adverse health outcomes.
- Understanding the relationship between frailty and medication burden is crucial for optimizing patient care.
Purpose of the Study:
- To investigate the association between frailty stages and medication burden in hospitalized older adults.
- To explore potential nonlinear relationships between frailty and medication indicators, including total medication count, potentially inappropriate medications (PIMs), and anticholinergic burden.
- To identify specific frailty stages where medication burden is most pronounced, informing targeted interventions.
Main Methods:
- Analysis of a multicenter cohort of hospitalized adults aged 65 years and older.
- Frailty assessment using the preadmission Clinical Frailty Scale (CFS).
- Evaluation of associations between CFS and medication counts (total, PIMs, anticholinergic burden) using restricted cubic spline models, adjusted for age, sex, and Charlson Comorbidity Index.
Main Results:
- Significant nonlinear associations were observed between CFS and all medication-related indicators (p < 0.05).
- The steepest increase in medication burden occurred in moderate frailty stages, with some attenuation in more severe stages.
- A consistent transition in medication burden patterns was noted around CFS 5-6, independent of age, sex, and comorbidity burden.
Conclusions:
- Medication burden is strongly and nonlinearly associated with frailty in hospitalized older adults.
- Moderate frailty (CFS 5-6) represents a critical window for medication review and deprescribing.
- Frailty-stratified approaches to medication management are recommended in acute care settings.
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