RESUMEN
BACKGROUND: Fractures have serious health consequences in older adults. While some medications are individually associated with increased risk of falls and fractures, it is not clear if this holds true for the use of many medications (polypharmacy). We aimed to identify what is known about the association between polypharmacy and the risk of fractures in adults aged ≥65 and to examine the methods used to study this association. METHODS: We conducted a systematic review with narrative synthesis of studies published up to October 2023 in PubMed, Embase, CINAHL, PsychINFO, Cochrane Library, Web of Science, and the grey literature. Two independent reviewers screened titles, abstracts, and full texts, then performed data extraction and quality assessment. RESULTS: Among the 31 studies included, 11 different definitions of polypharmacy were used and were based on three medication counting methods (concurrent use 15/31, cumulative use over a period 6/31, daily average 3/31, and indeterminate 7/31). Overall, polypharmacy was frequent and associated with higher fracture risk. A dose-response relationship between increasing number of medications and increased risk of fractures was observed. However, only seven studies adjusted for major confounders (age, sex, and chronic disease). The quality of the studies ranged from poor to high. CONCLUSIONS: Polypharmacy appears to be a relevant modifiable risk factor for fractures in older individuals that can easily be used to identify those at risk. The diversity of medication calculation methods and definitions of polypharmacy highlights the importance of a detailed methodology to understand and compare results.
RESUMEN
Accelerometry is widely used to evaluate physical activity in toddlers however recommendations regarding wear time are needed to understand physical activity behaviours in this age group. This study aimed to determine the minimum wear time to reliably evaluate physical activity in toddlers. Children from the 3D Birth Cohort (n = 255, 49.8% boys, 2.1 ± 0.2 years) were asked to wear an accelerometer (GT3X+, ActiGraph) for 7 days. Physical activity was expressed in active time (min/day) and counts per minute (CPM). Single day intraclass correlation coefficients (ICCs) were calculated to assess the effect of varying minimal wear time on reliability estimates. The Spearman-Brown formula was used to determine wear time required to achieve reliability levels of 70%, 80% and 90%. For active time, a reliability of 72.1% was achieved with wearing the accelerometer for ≥ 4 days of ≥ 6 h, which comprised 85.9% of the sample. For CPM, ≥ 4 days of ≥ 6 h provided a reliability of 74.7% and comprised 85.9% of the children. Results differed slightly when girls and boys were analysed separately, but restricting analyses to children with a weekend day did not. In summary, a minimum of 4 days with ≥ 6 h of accelerometry data provides a reliable estimate of physical activity in 2-year toddlers.
