Factors associated with use of falls risk–increasing drugs among patients of a geriatric oncology outpatient clinic in Australia: a cross‐sectional study

Abstract

Older people with cancer are at increased risk of falling. Falls risk-increasing drugs (FRIDs), comprising psychotropics and medications that cause orthostatic hypotension, are a potentially modifiable risk factor for falls. The objective of this study was to determine the prevalence and factors associated with use of FRIDs in older people with cancer. Patients aged ≥70 years who presented to a hospital outpatient clinic between January 2009 and July 2010 were included in the study. Information on current medication use, falls in previous 6 months, and frailty criteria was collected. Multinomial logistic regression was used to compute odds ratios (OR) and 95% confidence intervals (CIs) for factors associated with levels of FRID use. Overall, 76.1% (n = 293) of 383 patients used FRIDs. This comprised psychotropics (31.2%, n = 120) and medications causing orthostatic hypotension (69.9%, n = 269). In total, 24.0% (n = 92) patients reported falling in the previous 6 months. Risk factors for falling were associated with use of psychotropics but not orthostatic hypotension drugs. Patients with a history of falls had increased odds of using psychotropics (≥3 psychotropics; OR 13.50; 95%CI, 2.64-68.94). Likewise, frail patients had increased odds of using psychotropics (≥3 psychotropics; OR 27.78; 95%CI, 6.06-127.42). Risk factors for falling were associated with the use of psychotropics. This suggests that clinicians either do not recognize or underestimate the contribution of medications to falls in this high-risk patient group. Further efforts are needed to rationalize medication regimens at the time of patients' first presentation to outpatient oncology services.

Use of Falls Risk Increasing Drugs in Residents at High and Low Falls Risk in Aged Care Services

“…It is accepted that good clinical practice would involve not initiating an FRID in an older adult at high falls risk unless it is absolutely necessary. However, previous research has suggested clinicians may under-recognize the contribution of medications to falls (Bell et al, 2015;Turner et al, 2017). Whether clinicians consider residents' falls risk when initiating FRIDs has important implications because medications are a modifiable risk factor for falling, and avoidance of FRIDs may be an important strategy to minimize the risk of falls and fall-related injuries.…”

“…Yang et al, 2017). There has been little previous research in the use of FRIDs in residents who are at risk of falls (Turner et al, 2017).…”

A Comprehensive Evaluation of Studies on the Adverse Effects of Medications in Australian Aged care Facilities: A Scoping Review

“…Further studies are needed to establish the efficacy of the FRID tools and to rationalize or simplify medication regimens for elderly patients who are prescribed medications associated with orthostatic hypotension and psychotropics [9]. Further research will be required to determine whether de-prescribing fall risk-inducing medications will effectively reduce the risk of falls in older people [9].…”

“…Turner at al. [9] conducted a cross-sectional study to review the fall risk resulting from psychotropics and medications that cause orthostatic hypotension. This study involved 383 Australian older people whose medications were analysed with the Fall-Risk-Increasing Drugs (FRIDs) tool [9].…”

“…[9] conducted a cross-sectional study to review the fall risk resulting from psychotropics and medications that cause orthostatic hypotension. This study involved 383 Australian older people whose medications were analysed with the Fall-Risk-Increasing Drugs (FRIDs) tool [9]. In comparison to older patients who were not frail, the outcome of this study identified that the risk of falls was underestimated or not recognised with respect to the contribution to risk for those drugs [9].…”