Polypharmacy is associated with more falls and slower gait speed in older people with HIV, study reports

Among older people living with HIV, polypharmacy itself—not just the health issues underlying it—is associated with walking slowly or falling repeatedly, according to a recent U.S. study. Reducing the number of medications taken and increased monitoring of potential drug interactions may help prevent such adverse outcomes, the authors suggest.

About This Study

“Polypharmacy is associated with slow gait speed and recurrent falls in older people with HIV” was published online on Dec. 22, 2023, in Clinical Infectious Diseases. The lead author is Priya Kosana, B.S., of the Department of Epidemiology of Microbial Diseases at Yale School of Public Health in New Haven, Connecticut.

Key Research Findings

Researchers analyzed data on 977 virally suppressed people living with HIV aged ≥40 years to ascertain the relationship between polypharmacy (≥5 prescription medications excluding antiretroviral therapy) and walking slowly (gait speed <1 m/sec) or self-reported fall frequency (in the past six months). Median participant age was 51 years, 65% of participants were white, and 19% of participants were women. This research was part of a large, multicenter cohort of men and women with virologically-suppressed HIV.

Twenty-four percent of participants had polypharmacy and 4% of participants took ≥10 prescription medications in addition to their HIV treatment, defined as hyperpolypharmacy. These percentages increased with age, with 36% of participants ≥60 years old with polypharmacy compared to 22% of participants <60 years old. Polypharmacy was also more common among women than men, and 16% of women reported opioid use compared to 8% of men.

Overall, 40% of participants walked slowly and 5% of participants reported two or more falls during the prior six months. Both outcomes were more common among participants with polypharmacy than those with fewer medications, and the risk of falls was even higher among those with hyperpolypharmacy. Findings remained after adjustment for comorbidities, alcohol and substance use, body mass index, and other variables.

Discussion Highlights and Implications for Practice

Study limitations reported included a lack of information on mental health diagnoses, as well as some medical comorbidities not managed by prescription medications, medication adherence, and no data on indications for the prescriptions.

The researchers said that these results suggest that polypharmacy itself, regardless of any underlying comorbidities, is associated with reduced gait speed and more frequent falls. Providers should pay more attention to medication management, and interventions to reduce polypharmacy in this population should be developed, study authors recommended. Further research into the impact of prescribing practices on health outcomes among people living with HIV is also needed, the researchers said.

By Barbara Jungwirth