Associations Between Drug Burden Index and Falls in Older People in Residential Aged Care

Wilson, Nicholas; Hilmer, Sarah N.; March, Lyn; Cameron, Ian D.; Lord, Stephen R.; Seibel, Markus J.; Mason, Rebecca S.; Chen, Jian; Cumming, Robert G.; Sambrook, Philip N.

doi:10.1111/j.1532-5415.2011.03386.x

Cited by 193 publications

(205 citation statements)

References 25 publications

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“…T 20,2016 Thirty-nine participants (85%) reported having had a DXA scan within the last 5 years before the current study, with nearly equal prevalence in each group (Table II). Thirty-three patients (72%) were actively taking calcium and vitamin D supplements, and 4 patients (9%) were actively taking prescription medication for osteoporosis, again with no differences between groups.…”

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confidence: 99%

“…Specific medications known to contribute to falls in this population did not differ significantly among the groups, including diuretics for treatment of hypertension (12 patients in the fracture group compared with 14 patients in the control group; p = 0.532), hypoglycemic agents for diabetes mellitus (3 patients in the fracture group compared with 1 patient in the control group; p = 0.608), and psychoactive Flow diagram demonstrating the selection of patients for the fracture group. 1178 medications (7 patients in the fracture group compared with 6 patients in the control group; p = 0.743) 19,20 . The fracture group and the control group did not differ in their prevalence of potential musculoskeletal confounders (p = 1.00 for both) in the lower extremity (4 patients in the fracture group compared with 3 patients in the control group) or spine (4 patients in the fracture group compared with 3 patients in the control group).…”

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confidence: 99%

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Postural Stability in Older Adults with a Distal Radial Fracture

Louer

Boone

Guthrie

et al. 2016

The Journal of Bone and Joint Surgery

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Background: The physical risk factors leading to distal radial fractures are poorly understood. The goal of this study was to compare postural stability between older adults with and without a prior distal radial fragility fracture. Methods: This case-control evaluation was performed at a single tertiary institution. The fracture cohort comprised 23 patients treated for a low-energy distal radial fracture within 6 to 24 months prior to this study. Twenty-three age and sex-matched control participants, without a prior fragility fracture, were selected from an outpatient clinic population. All participants completed a balance assessment with a computerized balance platform device. Dynamic motion analysis (DMA) scores ranging from 0 to 1,440 points are produced, with lower scores indicating better postural stability. Participants also completed validated questionnaires for general health quality (EuroQol-5D-3L [EQ-5D-3L]) and physical activity (Physical Activity Scale for the Elderly [PASE]) and comprehensive health and demographic information including treatment for compromised balance or osteoporosis. Statistical analysis compared data between cases and controls using either the Student t test or the Mann-Whitney U test. Results: There were no significant differences (p > 0.05) in age, sex, body mass index, physical activity score, or EQ-5D-3L general health visual analog scale score between participants with or without prior distal radial fracture. The fracture cohort demonstrated poorer balance, with higher DMA scores at 933 points compared with 790 points for the control cohort (p = 0.008). Nineteen patients (83%) in the fracture cohort reported having dual x-ray absorptiometry (DXA) scans within 5 years prior to this study, but only 2 patients (9%) had ever been referred for balance training with physical therapy. Conclusions: Older adults who sustain low-energy distal radial fractures demonstrate impaired postural stability compared with individuals of a similar age who have not sustained such fractures. Following a distal radial fracture, these patients may benefit from interventions to improve postural stability. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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confidence: 99%

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confidence: 99%

Postural Stability in Older Adults with a Distal Radial Fracture

Louer

Boone

Guthrie

et al. 2016

The Journal of Bone and Joint Surgery

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“…Anticholinergic drugs have the potential to trigger serious adverse effects, particularly among the elderly, such as falls, cognitive dysfunction and delirium [1][2][3][4][5][6][7][8][9][10][11]14 . They also contribute to increased mortality in this age group 1,3,6,9 .…”

Section: Discussionmentioning

confidence: 99%

“…Anticholinergic drugs often have adverse effects on elderly persons [1][2][3][4] . However, they are part of the drug treatment of several situations and diseases, such as urinary incontinence and Parkinson's disease, which are common among this age group 3 .…”

Section: Introductionmentioning

confidence: 99%

Applicability of Anticholinergic Risk Scale in hospitalized elderly persons

Gorzoni¹,

Fabbri²

2017

Rev. bras. geriatr. gerontol.

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Objective: to define the applicability of the Anticholinergic Risk Scale (ARS) as a risk indicator of delirium in hospitalized elderly persons. Method: the medical records of elderly patients hospitalized in the medical wards of a teaching hospital were analyzed with the ARS, translated and adapted for medicines used in Brazil. The version of the Confusion Assessment Method (CAM) for the clinical diagnosis of delirium translated and validated by Fabbri et al. was used. Individuals aged ≥60 years were included in the evaluation of drug use. The sample was divided by gender and age to analyze the effect of these variables on the use of anticholinergic drugs based on the ARS, and association with delirium. Results: 123 elderly persons, 47 men and 76 women, with a mean age of 72.7(±9.2) years were included. The average consumption of drugs not listed in the ARS (some with anticholinergic action as Ipratropium and Scopolamine) was 6.1(±3.0) and the average number of drugs used listed in the ARS (Metoclopramide, Ranitidine, Atropine, Haloperidol and Risperidone) was 0.9±0.6. Four elderly persons had a score ≥3 (3.3% of total cases). Delirium was observed in 27 patients (21.9% of the total), none of whom scored more than two ARS points. There was no statistical significance regarding gender, age and delirium. Conclusion: the average score of the ARS was low among this population, and did not correlate with delirium. The ARS does not cover all anticholinergics, meaning this study should be repeated in a geriatric ward for comparison.

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“…This medication review should be particularly focused on benzodiazepines, other psychotropic medications, and medicines that contribute to a high drug burden index (ie, those with anticholinergic or sedative properties). 6,[32][33][34] Other interventions to prevent falls have been multifactorial in nature and have addressed risk factors pertaining to the individual (eg, strength and balance training) as well as his or her ability to safely interact with the environment. A meta-analysis by Cameron et al 35 reported that multifactorial interventions reduce falls and risk of falling in hospitals and may do so in nursing care facilities.…”

Section: Nonpharmacologicalmentioning

confidence: 99%