Characterisation of institutionalised Portuguese older adult fallers: is there a place for pharmacist intervention? A preliminary study

Main Article Content

Keywords

Older adults, Falls, Pharmacist, Polypharmacy, Potentially inappropriate medications (PIMs), Long-term care facilities

Abstract

Background: Falls are a major public health issue, given their prevalence and social impact. Older adults living in long-term care facilities (LTCF) are at greater risk of injury resulting from a fall due to multiple factors, such as nutritional, functional/cognitive impairment, postural instability, polypharmacy, and the presence of potentially inappropriate medications (PIMs). Medication management in LTCF is complex and often sub-optimal and might be crucial for falls. Pharmacist intervention is important, since they have a unique knowledge of medication. However, studies mapping the impact of pharmaceutical activities in Portuguese LTC settings are scarce. Objective: This study aims to assess the characteristics of older adult fallers living in LTFCs and examine the relationship between falling and several factors in this population. We also intend to explore the prevalence of PIMs and their relationship with the occurrence of falls. Methods: The study was conducted in two long-term care facilities for elderly people, in the central region of Portugal. We included patients aged 65 and older with no reduced mobility or physical weakness and with the ability to understand spoken and written Portuguese. The following information was assessed: sociodemographic characteristics, comorbidities, polypharmacy, fear of falling, functional, nutritional and cognitive status. PIMs were evaluated according to the Beers criteria (2019). Results: A total of 69 institutionalised older adults, 45 women and 24 men, with a mean age of 83.14 ± 8.87 years were included. The prevalence of falls was 21.74% Out of these, 46.67% (n=7) fell once, 13.33% (n=2) fell twice, and 40% (n=6) fell 3 or more times. Fallers were mainly women, had lower levels of education, were well nourished, had moderate to severe levels of dependence, and displayed moderate cognitive impairment. All adult fallers had a fear of falling. The main comorbidities of this population were related to the cardiovascular system. Polypharmacy was present in every patient, and at least one PIM was identified in 88.41% of the subjects. Fear of falling (FOF) and cognitive impairment (in subjects with 1 to 11 years of education) showed statistically significant associations with the occurrence of falls (p=0.005 and p=0.05, respectively). No significant differences were found between fallers and non-fallers for any other factors. Conclusions: This present study is a preliminary contribution to characterise a group of older adult fallers living in Portuguese LTCFs and demonstrated that fear of falling and cognitive impairment are associated with the occurrence of falls in this population. The high prevalence of polypharmacy and PIMs emphasises the need for tailored interventions featuring the collaboration of a pharmacist to optimise medication management in this population.

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References

1. Pordata. Base de dados Portugal Contemporâneo. Indicadores de envelhecimento segundo os Censos. Dados estatísticos. 2021. https://www.pordata.pt/Portugal/Indicadores+de+envelhecimento+segundo+os+Censos++-525%20
2. World Health Organization. Ageing and health. 2021. https://www.who.int/news-room/fact-sheets/detail/ageing-and-health 
3. Relatório Mundial de Envelhecimento e Saúde. World Health Organization. 2015. www.who.int
4. Kalache A, Lunenfeld B. Men, Ageing and Health: Achieving health across the life span. World Health Organization. World Health Organization; 2001.
5. Bell V, Pita JR. A importância do farmacêutico na gestão dos medicamentos nas Estruturas Residenciais para Pessoas Idosas em Portugal. 2021.
6. Lavrador AM. Avaliação de medicação inapropriada em idosos institucionalizados. 2015.
7. Moura SV. Fatores sociais que contribuem para o acolhimento institucional de idosos. Barbarói. 2020;(57):204-217. https://doi.org/10.17058/barbaroi.v0i57.15212
8. Direção-Geral da Segurança Social (DGSS) / Direção de Serviços de Instrumentos de Aplicação (DSIA). Proteção Social - Pessoas
Idosas. 2022. http://www.seg-social.pt/dgss-direccao-geral-da-seguranca-social
9. Lusardi MM, Fritz S, Middleton A, et al. Determining Risk of falls in community dwelling older adults: A systematic review and
meta-analysis using posttest probability. J Geriatr Phys Ther. 2017;40(1):1-36. https://doi.org/10.1519/JPT.0000000000000099
10. Portaria n.o 67/2012, de 21 de março de 2012. MINISTÉRIO DA SOLIDARIEDADE E DA SEGURANÇA SOCIAL. Diário da República,1a série. Mar 21, 2012;1324-1329.
11. de Guzman AB, Ines JLC, Inofinada NJA, et al. Nutrition, Balance and Fear of Falling as Predictors of Risk for Falls Among FilipinoElderly in Nursing Homes: A Structural Equation Model (SEM). Educational Gerontology. 2013;39(6):441-453. https://doi.org/10.1080/03601277.2012.661337
12. Sakellarides C, Correia C, Alves S, et al. Tropeções, quedas e trambolhões. Ministério da Saúde. 2017. https://www.sns.gov.pt/noticias/2017/12/19/tropecoes-quedas-e-trambolhoes/
13. Fuller GF. Falls in the Elderly. Am Fam Physician. 2000;61(7):2159-2168.
14. de Almeida ST, Soldera LC, de Carli GA, et al. Analysis of extrinsic and intrinsic factors that predispose elderly individuals to fall.
Rev Assoc Med Bras. 2012;58(4):427-433.
15. Lee FS, Sararaks S, Yau WK, et al. Fall determinants in hospitalised older patients: a nested case control design - incidence,
extrinsic and intrinsic risk in Malaysia. BMC Geriatr. 2022;22(1):179. https://doi.org/10.1186/s12877-022-02846-6
16. de Souza LNN, de Carvalho PHB, Ferreira MEC. Quality of life and subjective well-being of physically active elderly people: A
systematic review. J Sport Health Sci. 2018;18(3):1615-1623.
17. Souza LHR, Brandão JC da S, Fernandes AKC, et al. Queda em idosos e fatores de risco associados. Revista Brasileira Ciências
da Saúde - USCS. 2017;15(54). https://doi.org/10.13037/ras.vol15n54.4804
18. Rebelatto JR, De Castro AP, Sako FK, et al. Equilíbrio estático e dinâmico em indivíduos senescentes e o índice de massacorporal. Fisioterapia Em Movimento (Physical Therapy in Movement). 2017;23(3).
19. Torres-De-Araújo JR, Tomaz-De Lima RR, Ferreira-Bendassolli IM, et al. Functional, nutritional and social factors associated with mobility limitations in the elderly: A systematic review. Salud Publica Mex. 2018;60(5):579-585. https://doi.org/10.21149/9075
20. Esquivel MK. Nutritional Assessment and Intervention to Prevent and Treat Malnutrition for Fall Risk Reduction in Elderly Populations. Am J Lifestyle Med. 2017;12(2):107-112. https://doi.org/10.1177/1559827617742847
21. Fritsch MA, Shelton PS. Geriatric Polypharmacy: Pharmacist as Key Facilitator in Assessing for Falls Risk: 2019 Update. ClinGeriatr Med. 2019;35(2):185-204. https://doi.org/10.1016/j.cger.2019.01.010
22. Karani MV, Haddad Y, Lee R. The role of pharmacists in preventing falls among America’s older adults. Front Public Health. 2016;4:250. https://doi.org/10.3389/fpubh.2016.00250
23. Mott DA, Martin B, Breslow R, et al. Impact of a medication therapy management intervention targeting medications associatedwith falling: Results of a pilot study. J Am Pharm Assoc (2003). 2016;56(1):22-28. https://doi.org/10.1016/j.japh.2015.11.001
24. Blalock SJ, Casteel C, Roth MT, et al. Impact of enhanced pharmacologic care on the prevention of falls: A randomized controlled trial. Am J Geriatr Pharmacother. 2010;8(5):428-440. https://doi.org/10.1016/j.amjopharm.2010.09.002
25. Weir CB, Jan A. BMI Classification Percentile and Cut Off Points. In: In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2022. https://www.ncbi.nlm.nih.gov/books/NBK541070/
26. Ordem dos Enfermeiros. Instrumentos de colheita de dados para a documentação dos Cuidados Especializados em Enfermagemde Reabilitação. 2016; https://www.ordemenfermeiros.pt
27. Farias IPSE, Ldas M, Wanderley RL, et al. Physical and psychological states interfere with health-related quality of life of institutionalized elderly: A cross-sectional study. BMC Geriatr. 2020;20(1):386. https://doi.org/10.1186/s12877-020-01791-6
28. Morgado J, Rocha CS, Maruta C, et al. Sinapse. 2nd ed. Sociedade Portuguesa de Neurologia. 2009;9. www.sinapse.pt
29. Elm EV, Altman DG, Egger M, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE)
statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008;61(4):344-349. https://doi.org/10.1016/j.
jclinepi.2007.11.008
30. Kao C-C. Nutritional Care of Older Adult Residents Living in Long-Term Care Facilities. Hu Li Za Zhi. 2021;68(3):26-32. https://doi.org/10.6224/JN.202106_68(3).05
31. By the 2019 American Geriatrics Society Beers Criteria® Update Expert Panel (2019). American Geriatrics Society 2019 Updated
AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc. 2019;67(4). https://doi.org/10.1111/jgs.15767
32. de pinho TAM, Silva AO, Tura LFR, et al. Avaliação do risco de quedas em idosos atendidos em Unidade Básica de Saúde. RevEsc Enferm USP. 2012;46(2). https://doi.org/10.1590/S0080-62342012000200008
33. Liu-Ambrose T, Davis JC, Best JR, et al. Effect of a Home-Based Exercise Program on Subsequent Falls Among Community-Dwelling High-Risk Older Adults After a Fall: A Randomized Clinical Trial. JAMA. 2019;321(21):2092-2100. https://doi.org/10.1001/jama.2019.5795
34. Gaspar ACM, da Silva JFG, Mufato LF, et al. Socio-demographic profile and health conditions of elderly people who have suffered falls / Perfil sociodemográfico e condições de saúde dos idosos que sofreram quedas. Revista de Pesquisa Cuidado é Fundamental Online. 2018;10(4):1070-1076. https://doi.org/10.9789/2175-5361.2018.v10i4.1070-1076
35. Vu HM, Nguyen LH, Tran TH, et al. Effects of Chronic Comorbidities on the Health-Related Quality of Life among Older Patients
after Falls in Vietnamese Hospitals. Int J Environ Res Public Health. 2019;16(19).
36. Instituto Nacional de Estatística. Censos 2021 - Divulgação dos resultados provisórios. 2021.
37. Stevens JA, Sogolow ED. Gender differences for non-fatal unintentional fall related injuries among older adults. Inj Prev.
2005;11(2):115-119. https://doi.org/10.1136/ip.2004.005835
38. Lee YY, Chen CL, Lee IC, et al. History of falls, dementia, lower education levels, mobility limitations, and aging are risk factors
for falls among the community-dwelling elderly: A cohort study. Int J Environ Res Public Health. 2021;18(17):9356. https://doi.org/10.3390/ijerph18179356
39. Sherrington C, Fairhall N, Kwok W, et al. Evidence on physical activity and falls prevention for people aged 65+ years: systematic
review to inform the WHO guidelines on physical activity and sedentary behaviour. Int J Behav Nutr Phys Act. 2020;17(1):144.https://doi.org/10.1186/s12966-020-01041-3
40. Patti A, Zangla D, Sahin FN, et al. Physical exercise and prevention of falls. Effects of a Pilates training method compared witha general physical activity program A randomized controlled trial. Medicine (Baltimore). 2021;100(13):e25289. https://doi.org/10.1097/MD.0000000000025289
41. Çakar E, Durmus O, Dinçer Ü, et al. The effect of marital status on health quality and fall risk of elderly people. Turkish Journal
of Geriatrics. 2011;14(4):331-336.
42. Quach L, Dugan E, Gagnon D, et al. Social determinants of falls among older adults: the role of social support and depression among community-dwelling older adults. Graduate Doctoral Dissertations. 2016;56(3):366. https://doi.org/10.1093/geront/gnw162.1479
43. Costa AGC, De Souza RC, Vitor AF, et al. Acidentes por quedas em um grupo específico de idosos. Rev. Eletr. Enferm.2011;13(3)395-404.
44. Mitchell RJ, Lord SR, Harvey LA, et al. Associations between obesity and overweight and fall risk, health status and quality of life in older people. Aust N Z J Public Health. 2014;38(1):13-18. https://doi.org/10.1111/1753-6405.12152  
45. Neyens J, Halfens R, Spreeuwenberg M, et al. Malnutrition is associated with an increased risk of falls and impaired activity in elderly patients in Dutch residential long-term care (LTC): A cross-sectional study. Arch Gerontol Geriatr. 2013;56(1):265-269. https://doi.org/10.1016/j.archger.2012.08.005
46. Meijers JMM, Halfens RJG, Neyens JCL, et al. Predicting falls in elderly receiving home care: the role of malnutrition and impaired mobility. J Nutr Health Aging. 2012;16(7):654-658. https://doi.org/10.1007/s12603-012-0010-7 
47. Oliveira A, Nossa P, Mota-Pinto A. Assessing functional capacity and factors determining functional decline in the elderly: A cross-sectional study. Acta Med Port. 2019;32(10):654-660. https://doi.org/10.20344/amp.11974
48. Taylor ME, Lord SR, Delbaere K, et al. Physiological fall risk factors in cognitively impaired older people: A one-year prospective study. Dement Geriatr Cogn Disord. 2012;34(3-4):181-189. https://doi.org/10.1159/000343077
49. Makino K, Makizako H, Doi T, et al. Impact of fear of falling and fall history on disability incidence among older adults: Prospective cohort study. Int J Geriatr Psychiatry. 2018;33(4):658-662. https://doi.org/10.1002/gps.4837
50. Akosile CO, Igwemmadu CK, Okoye EC, et al. Physical activity level, fear of falling and quality of life: a comparison between community-dwelling and assisted-living older adults. BMC Geriatr. 2021;21(1):12. https://doi.org/10.1186/s12877-020-01982-1
51. Correia LM, BarroS A, Brazão ML. Polifarmácia, Fármacos Inapropriados e Interacções Medicamentosas nas Prescrições de Doentes Nonagenários. Revista da Sociedade Portuguesa de Medicina Interna. 2017;24(1). https://doi.org/10.24950/rspmi.570
52. Peixoto S, Almeida A, Caramelo A, et al. Application of the 2015 Beers Criteria Operationalized for Portugal in Institutionalized Elderly People: A Cross--Sectional Study. Acta Medica Portuguesa. 2021;34(11). https://doi.org/10.20344/amp.13030 
53. Michalcova J, Vasut K, Airaksinen M, et al. Inclusion of medication-related fall risk in fall risk assessment tool in geriatric care
units. BMC Geriatr. 2020;20(1):454. https://doi.org/10.1186/s12877-020-01845-9
54. de Jong MR, van der ELST M, Hartholt KA. Drug-related falls in older patients: Implicated drugs, consequences, and possible prevention strategies. Ther Adv Drug Saf. 2013;4(4):147-154. https://doi.org/10.1177/2042098613486829 

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