Association of medication use with falls among older adults
Main Article Content
Keywords
Falls, Elderly, Nursing homes, Medications, FRIDs
Abstract
Introduction: Falls are an increasing public health problem because of ageing populations worldwide. One-third of people aged over 65 years live with comorbidities and take five or more regular medicines (polypharmacy). There is clear evidence that polypharmacy and the use of psychotropic drugs as well as in combination with cardiovascular medications increase the risk of falls. Objective: The aim of this study was to explore how polypharmacy, defined by the number of medications used is associated with the incidence of falls and related consequences and to examine associations with fall riskincreasing drugs (FRIDs) use with falls. Methods: We performed a cross-sectional study of 125 residents from nursing homes. Data collection and clinical assessments for the present study was conducted between June 1 2024 and October 15 2024. The participants were interviewed using a structured questionnaire, which contained questions on demographic, lifestyle, and medical variables. Participant characteristics were described for the whole group and subgroups were categorized according to fallers and non-fallers. Primary outcome measures were incidence of falls as well as numbers of FRIDs in fallers and non-fallers. Results: The mean age of the participants was 76.52 (SD 7.83) years and 66% of included patients were women. The most frequent number of falls within the previous 6 months was 1 (IQR 1–2). Twenty-six percent of these patients reported at least one fall in the six months prior to the evaluation. More women (N = 49) reported falls during the past six months as compared to men (N = 18), but this difference was not significant, χ2 (4, N = 125) = 6.79, p = .15. A multiple linear regression analyses showed positive associations between the number of FRIDs and the total number of prescribed drugs and falls. Conclusion: Older age and medications were associated with increased incidence of falls. Fallers had a higher number of FRIDs. Numbers of FRIDs were associated with the total number of drugs dispensed and falls.
References
Resulted in Emergency Department Visits in the United States, 2015. Am J Lifestyle Med. 2020;15(6):590-597. https://
doi: 10.1177/1559827620942187
2. Ambrose AF, Paul G, Hausdorff JM. Risk factors for falls among older adults: A review of the literature, Maturitas. 2013;
75(1):51-61. https://doi: 10.1016/j.maturitas.2013.02.009
3. de Jong MR, Van der Elst M, Hartholt KA. Drug-related falls in older patients: implicated drugs, consequences, and possible prevention strategies. Therapeutic Advances in Drug Safety. 2013;4(4):147-154. https://doi: 10.1177/2042098613486829
4. Tinetti ME, Kumar C. The patient who falls: “it’s always a trade-off”. JAMA 2010; 303: 258–266. https://doi: 10.1001/
jama.2009.2024
5. Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. What is polypharmacy? A systematic review of definitions. BMC Geriatr.
2017;17(1):230. https://doi.org/10.1186/s12877-017-0621-2
6. Morley JE, Vellas B, van Kan GA, Anker SD, Bauer JM, Bernabei R, et al. Frailty consensus: a call to action. J Am Med Dir Assoc.
2013;14(6):392–7. https://doi.org/10.1016/j.jamda.2013.03.022.
7. Christensen M, Lundh A. Medication review in hospitalised patients to reduce morbidity and mortality. Cochrane Database
Syst Rev. 2016;2(2). https://doi: 10.1002/14651858.CD008986.pub3.
8. Beunza-Sola M, Hidalgo-Ovejero AM, Martí-Ayerdi J et al. Study of fall risk-increasing drugs in elderly patients before and after
a bone fracture. Postgrad Med J 2018; 94: 76–80. https://doi: 10.1136/postgradmedj-2017-135129
9. Ibrahim K, Cox NJ, Stevenson JM, Lim S, et al. A systematic review of the evidence for deprescribing interventions among older
people living with frailty. BMC Geriatrics. 2021;21:258. https://doi: 10.1186/s12877-021-02208-8.
10. Tanaka M, Suemaru K, Ikegawa Y, Tabuchi N, Araki H: Relationship between the risk of falling and drugs in an academic hospital.
Yakugaku Zasshi 2008, 128(9):1355–1361. https://doi: 10.1248/yakushi.128.1355
11. Lee J, Negm A, Peters R et al. Deprescribing fall-risk increasing drugs (FRIDs) for the prevention of falls and fall-related complications: a systematic review and meta-analysis. BMJ Open 2021; 11: e035978. https://doi: 10.1136/bmjopen-2019-035978.
12. Sternberg SA, Rochon PA, Gurwitz JH. Focusing on medications that increase the risk of falls in older adults. European Geriatric
Medicine. 2021;12:671–672. https://doi.org/10.1007/s41999-021-00448-w
13. Moreland B, Kakara R, Henry A. Trends in Nonfatal Falls and Fall-Related Injuries Among Adults Aged ≥65 Years — United
States, 2012–2018. US Department of Health and Human Services/Centers for Disease Control and Prevention. MMWR.
2020;69(27):875-881. https://doi: 10.15585/mmwr.mm6927a5
14. Gillespie LD, Robertson MC, Gillespie WJ et al. Interventions for preventing falls in older people living in the community.
Cochrane Database Syst Rev 2012;(9):CD007146. https://doi: 10.1002/14651858.CD007146.pub3.
15. Dhalwani NN, Zaccardi F, O’Donovan G, Carter P, Hamer M, Yates T, Davies M, Khunti K. Association Between Lifestyle Factors
and the Incidence of Multimorbidity in an Older English Population. J Gerontol A Biol Sci Med Sci. 2017;72(4):528-534. https://
doi: 10.1093/gerona/glw146.
16. Anatomical Therapeutic Chemical (ATC) Classification Index: Anatomical Therapeutic Chemical (ATC) Classification Index.
17. WHO Collaborating Centre for Drug Statistics Methodology. ATC Clas sifcation Index with DDDs. 2020. Available from: https://
www.whocc.no/ atc/structure_and_principles/. Cited 15 Nov 2020.
18. Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the
clinician. J Psychiatr Res. 1975;12(3):189–98. https://doi: 10.1016/0022-3956(75)90026-6.
19. World Health Organization. (2008). WHO global report on falls prevention in older age. World Health Organization.
20. Castaldo A, Giordano A, Antonelli Incalzi R, Lusignani M. Risk factors associated with accidental falls among Italian nursing
home residents: A longitudinal study (FRAILS). Geriatr Nurs. 2020;41(2):75–80. https://doi: 10.1016/j.gerinurse.2019.06.003.
21. Cameron EJ, Bowles SK, Marshall EG, Andrew MK. Falls and long-term care: a report from the care by design observational
cohort study. BMC Fam Pract. 2018;19(1):73. https://doi: 10.1186/s12875-018-0741-6.
22. Dhalwani NN, Fahami R, Sathanapally H, Seidu S et al. Association between polypharmacy and falls in older adults: a longitudinal
study from England. BMJ Open 2017;7(10): e016358. https://doi: 10.1136/bmjopen-2017-016358.
23. 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(9):1188-92. https://doi: 10.1345/aph.1Q689
24. Kalisch Ellett LM, Kassie GM, Pratt NL, Kerr M, Roughead EE. Prevalence and Duration of Use of Medicines Recommended
for Short-Term Use in Aged Care Facility Residents. Pharmacy (Basel). 2019; 7(2): 55. https://doi: 10.3390/pharmacy7020055
25. Jokanovic N, Tan EC, Dooley MJ, Kirkpatrick CM, Bell JS. Prevalence and factors associated with polypharmacy in long-term
care facilities: a systematic review. J Am Med Dir Assoc. 2015;16(6):535.e1-12. https://doi: 10.1016/j.jamda.2015.03.003
26. Onder G, Liperoti R, Fialova D, Topinkova E, Tosato M, Danese P, et al. Poly pharmacy in nursing home in Europe: results from
the SHELTER study. J Gerontol A Biol Sci Med Sci. 2012;67(6):698–704. https://doi: 10.1093/gerona/glr233
27. Watanabe JH. Medication Use, Falls, and Fall-Related Worry in Older Adults in the United States. Consult Pharm. 2016;31(7):385-
93. https://doi: 10.4140/TCP.n.2016.385
28. Marvin V, Ward E, Poots AJ, Heard K, et al. Deprescribing medicines in the acute setting to reduce the risk of falls. Eur J Hosp
Pharm 2017;24:10–15. https://doi: 10.1136/ejhpharm-2016-001003
29. Roitto HM , Aalto UL , Öhman H , Saarela RKT , et al. Association of medication use with falls and mortality among long-term
care residents: a longitudinal cohort study. BMC Geriatrics. 2023; 23:375. https://doi: 10.1186/s12877-023-04096-6
30. Ziere, G., Dieleman, J., Hofman, A., Pols, H., van der Cammen, T. and Stricker, B. Polypharmacy and falls in the middle age and
elderly population. Br J Clin Pharmacol.2006; 61: 218–223. https://doi: 10.1111/j.1365-2125.2005.02543.x.
31. Cox N, Ilyas I, Roberts HC, Ibrahim K. Exploring the prevalence and types of fall-risk-increasing drugs among older people with
upper limb fractures. International Journal of Pharmacy Practice, 2023;31: 106–112. https://doi: 10.1093/ijpp/riac084.
32. Milos V, Bondesson A, Magnusson M , Jakobsson U , Westerlund T, Midlöv P. Fall risk-increasing drugs and falls: a cross-sectional study among elderly patients in primary care. BMC Geriatrics 2014, 14:40. https://doi.org/10.1186/1471-2318-14-40
33. Kerse N, Flicker L, Pfaff JJ, Draper B, Lautenschlager NT, Sim M, Snowdon J,Almeida OP: Falls, depression and antidepressants
in later life: a large primary care appraisal. PLoS One 2008, 3(6):e2423. https://doi: 10.1371/journal.pone.0002423.
34. Seppala LJ, van der Velde N, Masud T, Blain H. EuGMS Task and Finish group on FallRiskIncreasing Drugs (FRIDs): Position
on Knowledge Dissemination, Management, and Future Research. Drugs & Aging. 2019; 36:299–307. https://doi: 10.1007/s40266-018-0622-7.
35. Xu Q, Ou X, Li J. The risk of falls among the aging population: A systematic review and meta-analysis. Front. Public Health.
2022; 10:902599. https://doi: 10.3389/fpubh.2022.902599.
36. Bongue B, Dupré C, Beauchet O, Rossat A, Fantino B, Colvez A: A screening tool with five risk factors was developed for fall-risk
prediction in community-dwelling elderly. J Clin Epidemiol 2011, 64(10):1152–1160. https://doi: 10.1016/j.jclinepi.2010.12.014.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.