Abstract
Background Geriatric falls are leading causes of hospital trauma admissions and injury-related deaths. Medication use is a crucial element among extrinsic risk factors for falls. To reduce fall risk and the prevalence of adverse drug reactions, potentially inappropriate medication (PIM) lists are widely used. Objective Our aim was to investigate the possible predictors of geriatric falls annualized over a 5-year-long period, as well as to evaluate the medication use of nursing home residents. Setting Nursing home residents were recruited from the same institution between 2010 and 2015 in Szeged, Hungary. Method A retrospective epidemiological study was performed. Patient data were analysed for the first 12 months of residency. Chi-squared test and Fisher’s-test were applied to compare the categorical variables, Student’s t test to compare the continuous variables between groups. Binary logistic regression analysis was carried out to determine the association of falls with other variables found significant in univariate analysis. Microsoft Excel, IBM SPSS Statistics (version 23) and R (3.2.2) programs were used for data analysis. Main outcome measure Falls affected by age, gender, number of chronic medications, polypharmacy, PIM meds. Results A total of 197 nursing home residents were included, 150 (76.2%) women and 47 (23.8%) men, 55 fallers (annual fall prevalence rate was 27.9%) and 142 non-fallers. Gender was not a predisposing factor for falls (prevalence in males: 23.4 vs 29.3% in females, p > 0.05). Fallers were older (mean years ± SD; 84.0 ± 7.0) than non-fallers (80.1 ± 9.3, p < 0.01). The age ≥80 years was a significant risk factor for falls (p < 0.001). The number of chronic medications was higher in male fallers (12.4 ± 4.0) than in non-fallers (6.9 ± 4.2, p < 0.001). Polypharmacy (taking four or more chronic medications) was a significant risk factor of falls (p < 0.01). Those PIMs carrying fall risk were taken by 70.9% of fallers and 75.3% of non-fallers (p > 0.05). Taking pantoprazole, vinpocetine or trimetazidine was a significant risk factor for falls. Conclusion Older age, polypharmacy and the independent use of pantoprazole, vinpocetine, and trimetazidine were found to be major risk factors for falls. Further real-life epidemiological studies are necessary to confirm the role of particular active agents, and to help professionals prescribe, evaluate and review geriatric medication use.
References
Centers for Disease Control and Prevention Falls in Nursing Homes. Updated 2015 June 30. http://www.cdc.gov/HomeandRecreationalSafety/Falls/nursing.html. Accessed 2 Feb 2016.
World Health Organization Global Report on Falls Prevention in Older Age. 2007. http://www.who.int/ageing/projects/falls_prevention_older_age/en/. Accessed 22 Jan 2016.
Ambrose AF, Cruz L, Paul G. Falls and fractures: a systematic approach to screening and prevention. Maturitas. 2015;82:85–93.
Hernlund E, Svedbom A, Ivergard M, Compston J, Cooper C, Stenmark J, et al. Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos. 2013;8:136.
Cawthon PM. Gender differences in osteoporosis and fractures. Clin Orthop Relat Res. 2011;469:1900–5.
Bor A, Matuz M, Gyimesi N, Biczok Z, Soos G, Doro P. Gender inequalities in the treatment of osteoporosis. Maturitas. 2015;80:162–9.
Freeland KN, Thompson AN, Zhao Y, Leal JE, Mauldin PD, Moran WP. Medication use and associated risk of falling in a geriatric outpatient population. Ann Pharmacother. 2012;46:1188–92.
Wu TY, Chie WC, Yang RS, Liu JP, Kuo KL, Wong WK, et al. Factors associated with falls among community-dwelling older people in Taiwan. Ann Acad Med Singap. 2013;42:320–7.
Weber V, White A, McIlvried R. An electronic medical record (EMR)-based intervention to reduce polypharmacy and falls in an ambulatory rural elderly population. J Gen Intern Med. 2008;23:399–404.
Willeboordse F, Grundeken LH, van den Eijkel LP, Schellevis FG, Elders PJ, Hugtenburg JG. Information on actual medication use and drug-related problems in older patients: questionnaire or interview? Int J Clin Pharm. 2016;38:380–7.
Chau SH, Jansen AP, van de Ven PM, Hoogland P, Elders PJ, Hugtenburg JG. Clinical medication reviews in elderly patients with polypharmacy: a cross-sectional study on drug-related problems in the Netherlands. Int J Clin Pharm. 2016;38:46–53.
Ziere G, Dieleman JP, Hofman A, Pols HA, van der Cammen TJ, Stricker BH. Polypharmacy and falls in the middle age and elderly population. Br J Clin Pharmacol. 2006;61:218–23.
Zia A, Kamaruzzaman SB, Tan MP. Polypharmacy and falls in older people: balancing evidence-based medicine against falls risk. Postgrad Med. 2015;127:330–7.
Hajjar ER, Cafiero AC, Hanlon JT. Polypharmacy in elderly patients. Am J Geriatr Pharmacother. 2007;5:345–51.
Fialova D, Topinkova E, Gambassi G, Finne-Soveri H, Jonsson PV, Carpenter I, et al. Potentially inappropriate medication use among elderly home care patients in Europe. JAMA. 2005;293:1348–58.
Beers MH, Ouslander JG, Rollingher I, Reuben DB, Brooks J, Beck JC. Explicit criteria for determining inappropriate medication use in nursing home residents. UCLA Division of Geriatric Medicine. Arch Intern Med. 1991;151:1825–32.
American Geriatrics Society. Updated beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2015;2015(63):2227–46.
Mercaldo ND, Lau KF, Zhou XH. Confidence intervals for predictive values with an emphasis to case-control studies. Stat Med. 2007;26:2170–83.
Altman DG, Bland JM. Diagnostic tests 2: predictive values. BMJ. 1994;309:102.
Agresti A. Categorical Data Analysis. 2nd ed. New York: Wiley; 2002.
Agresti A, Caffo B. Simple and effective confidence intervals for proportions and difference of proportions result from adding two successes and two failures. Am Stat. 2000;54:280–8.
Laroche ML, Charmes JP, Merle L. Potentially inappropriate medications in the elderly: a French consensus panel list. Eur J Clin Pharmacol. 2007;63:725–31.
Holt S, Schmiedl S, Thurmann PA. Potentially inappropriate medications in the elderly: the PRISCUS list. Dtsch Arztebl Int. 2010;107:543–51.
Mann E, Bohmdorfer B, Fruhwald T, Roller-Wirnsberger RE, Dovjak P, Duckelmann-Hofer C, et al. Potentially inappropriate medication in geriatric patients: the Austrian consensus panel list. Wien Klin Wochenschr. 2012;124:160–9.
Bjerrum L, Rosholm JU, Hallas J, Kragstrup J. Methods for estimating the occurrence of polypharmacy by means of a prescription database. Eur J Clin Pharmacol. 1997;53:7–11.
Rubenstein LZ. Preventing falls in the nursing home. JAMA. 1997;278:595–6.
Stevens JA. Falls among older adults-risk factors and prevention strategies. J Safety Res. 2005;36:409–11.
Centers for Disease Control and Prevention (CDC). Fatalities and injuries from falls among older adults–United States, 1993–2003 and 2001–2005. MMWR Morb Mortal Wkly Rep. 2006;55:1221–1224.
Laurent M, Gielen E, Claessens F, Boonen S, Vanderschueren D. Osteoporosis in older men: recent advances in pathophysiology and treatment. Best Pract Res Clin Endocrinol Metab. 2013;27:527–39.
Gielen E, Vanderschueren D, Callewaert F, Boonen S. Osteoporosis in men. Best Pract Res Clin Endocrinol Metab. 2011;25:321–35.
Fonad E, Wahlin TB, Winblad B, Emami A, Sandmark H. Falls and fall risk among nursing home residents. J Clin Nurs. 2008;17:126–34.
Rubenstein LZ. Falls in older people: epidemiology, risk factors and strategies for prevention. Age Ageing. 2006;35(Suppl 2):ii37–41.
Russell M, Clapperton A, Vu T, Day L. Trends in fall-related hospitalisations in older people living in aged care facilities. Osteoporos Int. 2015;26:1219–24.
Pantoprazole Summary of Product Characteristics. https://www.medicines.org.uk/emc/medicine/2518. Accessed 23 Feb 2016.
Ozdil K, Kahraman R, Sahin A, Calhan T, Gozden EH, Akyuz U, et al. Bone density in proton pump inhibitors users: a prospective study. Rheumatol Int. 2013;33:2255–60.
Vinpocetine Summary of Product Characteristics. https://www.ogyei.gov.hu/gyogyszeradatbazis/index.php?action=show_details&item=16779. Accessed 24 Feb 2016.
Trimetazidine Summary of Product Characteristics. https://www.ogyei.gov.hu/gyogyszeradatbazis/index.php?action=show_details&item=27756. Accessed 24 Feb 2016.
European Medicines Agency Recommendation on restricted use of trime-tazidine-containing medicines. 2012. http://www.ema.europa.eu/ema/index.jsp?curl=pages/news_and_events/news/2012/06/news_detail_001541.jsp&mid=WC0b01ac058004d5c1. Accessed 24 Feb 2016.
Bor A, Matuz M, Doro P, Viola R, Soos G. Drug-related problems in the elderly. Orv Hetil. 2012;153:1926–36.
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Bor, A., Matuz, M., Csatordai, M. et al. Medication use and risk of falls among nursing home residents: a retrospective cohort study. Int J Clin Pharm 39, 408–415 (2017). https://doi.org/10.1007/s11096-017-0426-6
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DOI: https://doi.org/10.1007/s11096-017-0426-6