The Impact of Polypharmacy and Potentially Inappropriate Medications on Intrinsic Capacity Decline in Community‐Dwelling Older Adults

BACKGROUND: Intrinsic capacity (IC) is a clinically meaningful and potentially modifiable outcome that predicts dependence, hospital admission, and mortality in older adults. Research on the relationships among polypharmacy, potentially inappropriate medications (PIMs), and IC in older adults remains scarce. We therefore examined the associations of polypharmacy and PIM use with IC decline in community-dwelling older adults. METHODS: In this cross-sectional study, we analyzed data from the World Health Organization (WHO) Integrated Care for Older People (ICOPE) screening and corresponding medical records collected during annual senior health examinations in Taiwan. Participants were adults aged ≥ 65 years who completed the WHO ICOPE screening. IC was scored across six domains-locomotion; sensory function (vision and hearing); vitality; psychological well-being; and cognition-yielding a total score from 0 to 6. An IC score ≤ 4 denoted decline. Polypharmacy was defined as the concurrent use of ≥ 5 medications, and PIMs were identified according to the 2019 Beers Criteria. RESULTS: Among 394 participants (mean age 72.0 ± 6.7 years; 51.8% female), the average daily medication count was 6.4 ± 7.1. More than 50% of participants received ≥ 1 PIM, and 36.8% met criteria for polypharmacy. The mean IC score was 4.5 ± 1.1, and 43.9% of participants exhibited IC decline. After adjustment for age, gender, and number of comorbidities, PIM use was associated with a 2.06-fold increase and polypharmacy with a 2.46-fold increase in the risk of IC decline, respectively. CONCLUSION: Polypharmacy and PIM use are highly prevalent among community-dwelling older adults and are significantly associated with an increased risk of IC decline. These findings underscore the need for medication review and deprescribing strategies to preserve intrinsic capacity in this population.