Fall-risk-increasing adverse reactions—is there value in easily accessible drug information? A case-control study

Schiek, Susanne; Hildebrandt, Katja; Zube, Olaf; Bertsche, Thilo

doi:10.1007/s00228-019-02628-x

Cited by 6 publications

(9 citation statements)

References 43 publications

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“…Around 2% of patients experienced an AE, a frequency similar to those recorded in previous reports [7,11,[26][27][28][29]. In addition, 2.2% of patients died during hospitalization, again in line with other studies reporting rates ranging between 1-5% [9,30,31].…”

Section: Discussionsupporting

confidence: 88%

Care complexity individual factors associated with adverse events and in-hospital mortality

et al. 2020

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Introduction Measuring the impact of care complexity on health outcomes, based on psychosocial, biological and environmental circumstances, is important in order to detect predictors of early deterioration of inpatients. We aimed to identify care complexity individual factors associated with selected adverse events and in-hospital mortality. Methods A multicenter, case-control study was carried out at eight public hospitals in Catalonia, Spain, from January 1, 2016 to December 31, 2017. All adult patients admitted to a ward or a step-down unit were evaluated. Patients were divided into the following groups based on the presence or absence of three adverse events (pressure ulcers, falls or aspiration pneumonia) and in-hospital mortality. The 28 care complexity individual factors were classified in five domains (developmental, mental-cognitive, psycho-emotional, sociocultural and comorbidity/complications). Adverse events and complexity factors were retrospectively reviewed by consulting patients' electronic health records. Multivariate logistic analysis was performed to identify factors associated with an adverse event and in-hospital mortality. Results A total of 183,677 adult admissions were studied. Of these, 3,973 (2.2%) patients experienced an adverse event during hospitalization (1,673 [0.9%] pressure ulcers; 1,217 [0.7%] falls and 1,236 [0.7%] aspiration pneumonia). In-hospital mortality was recorded in 3,996 patients (2.2%). After adjustment for potential confounders, the risk factors independently associated with both adverse events and in-hospital mortality were: mental status impairments, impaired adaptation, lack of caregiver support, old age, major chronic disease, hemodynamic instability, communication disorders, urinary or fecal incontinence, vascular

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Section: Discussionsupporting

confidence: 88%

Care complexity individual factors associated with adverse events and in-hospital mortality

et al. 2020

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“… 66 In some studies, more than one tool was used. 8 , 15 , 17 , 21 , 23 – 25 , 28 , 34 , 36 , 37 , 43 , 47 – 50 , 52 , 55 , 56 , 59 Table 2 shows the associations between inappropriate medication prescriptions and physical function. Table 3 provides an illustrative summary of the associations between inappropriate medication prescriptions and physical function.…”

Section: Resultsmentioning

confidence: 99%

“…Out of 30 studies, 21 showed a significant positive association between PIMs and risk of falls. 14 – 18 , 22 – 24 , 26 , 28 – 32 , 49 , 51 , 53 , 56 , 57 , 62 One study showed a positive predictive value of 25% for the proportion of patients with PPO-related admissions for a fall with a fracture. 56 Benzodiazepine, opiate and sedative use were common PIMs associated with falls.…”

Section: Resultsmentioning

confidence: 99%

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Inappropriate medications and physical function: a systematic review

Manias

Kabir

Maier

2021

Therapeutic Advances in Drug Safety

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Background and aims: Inappropriate medication prescription is highly prevalent in older adults and is associated with adverse health outcomes. The aim of this study was to examine the associations between potentially inappropriate medications (PIMS) and potential prescribing omissions with physical function in older adults situated in diverse environments. Methods: A systematic search was completed using the following databases: MEDLINE, CINAHL, PsycINFO, EMBASE and COCHRANE. Results were extracted from the included studies. Results: In total, 55 studies reported on 2,767,594 participants with a mean age of 77.1 years (63.5% women). Study designs comprised 26 retrospective cohort studies, 21 prospective cohort studies and 8 cross-sectional studies. Inappropriate medications in community and hospital settings were significantly associated with higher risk of falls (21 out of 30 studies), higher risk of fractures (7 out of 9 studies), impaired activities of daily living (ADL; 8 out of 10 studies) and impaired instrumental ADL (IADL) score (4 out of 6 studies). Five out of seven studies also showed that PIMs were associated with poorer physical performance comprising the Timed Up and Go test, walking speed, grip strength, time to functional recovery, functional independence and scale of functioning. Many medication classes were implicated as PIMs in falls, fractures and impairment in physical performance including antipsychotic, sedative, anti-anxiety, anticholinergic, antidiabetic, opioid and antihypertensive medications. For patients not receiving musculoskeletal medications, such as calcium, vitamin D and bisphosphonates, older adults were found to be at risk of a hospital admission for a fall or fracture. Conclusion: Inappropriate medication prescriptions are associated with impaired physical function across longitudinal and cross-sectional studies in older adults situated in diverse settings. It is important to support older people to reduce their use of inappropriate medications and prevent prescribing omissions. Plain language summary Inappropriate medications and physical function Background and aims: The use of inappropriate medications is very common in older adults and is associated with harmful health problems. The aim was to examine associations between potentially inappropriate medications and potential prescribing omissions with physical function in older adults situated in diverse environments. Methods: Library databases were examined for possible studies to include and a systematic search was completed. Relevant information was obtained from the included studies. Results: In total, 55 studies reported on 2,767,594 participants who were an average age of 77.1 years and about 6 out of 10 were women. A variety of different study designs were used. Inappropriate medication prescriptions in community and hospital settings were significantly associated with higher risk of falls (21 out of 30 studies), higher risk of fractures (7 out of 9 studies), problems with activities of daily living (ADL), such as eating, bathing, dressing, grooming, walking and toileting (8 out of 10 studies) and problems with instrumental ADL such as managing medications, house cleaning and shopping (4 out of 6 studies). Five out of seven studies also showed that inappropriate medications were associated with poorer physical performance involving the Timed Up and Go test, walking speed, grip strength, time to functional recovery, functional independence and scale of functioning. Many types of medication classes were shown to be associated with a risk of falls, fractures and problems with physical performance. Omitted medications were also associated with falls and fractures. Conclusion: Inappropriate medication prescriptions are associated with problems relating to physical function. It is important to support older people to reduce their use of inappropriate medications and prevent prescribing omissions.

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“…For some ADRs, it has been shown that the number of specific drugs causes their clinical manifestations. For example, patients are exposed to an increased risk of falling when they take two or more drugs which increase the risk of falling [ 14 ]. Concerning anticholinergic ADRs, it is common to calculate an anticholinergic burden to quantify the risk for an adverse outcome [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

Considering additive effects of polypharmacy

Lexow

Wernecke

Schmid

et al. 2020

Wien Klin Wochenschr

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Summary Background Potential additive effects of polypharmacy are rarely considered in adverse events of geriatric patients living in long-term care facilities. Our aim, therefore, was to identify adverse events in this setting and to assess plausible concomitant drug causes. Methods A cross-sectional observational study was performed in three facilities as follows: (i) adverse event identification: we structurally identified adverse events using nurses’ interviews and chart review. (ii) Analysis of the concomitantly administered drugs per patient was performed in two ways: (ii.a) a review of summary of product characteristics for listed adverse drug reactions to identify possible causing drugs and (ii.b) a causality assessment according to Naranjo algorithm. Results (i) We found 424 adverse events with a median of 4 per patient (range 1–14) in 103 of the 104 enrolled patients (99%). (ii.a) We identified a median of 3 drugs (range 0–11) with actually occurring adverse events listed as an adverse drug reaction in the summary of product characteristics. (ii.b) Causality was classified in 198 (46.9%) of adverse events as “doubtful,” in 218 (51.2%) as “possible,” in 7 (1.7%) as “probable,” and in 1 (0.2%) adverse event as a “definitive” cause of the administered drugs. In 340 (80.2%) of all identified adverse events several drugs simultaneously reached the highest respective Naranjo score. Conclusion Patients in long-term facilities frequently suffer from many adverse events. Concomitantly administered drugs have to be frequently considered as plausible causes for adverse events. These additive effects of drugs should be more focused in patient care and research.

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Fall-risk-increasing adverse reactions—is there value in easily accessible drug information? A case-control study

Cited by 6 publications

References 43 publications

Care complexity individual factors associated with adverse events and in-hospital mortality

Care complexity individual factors associated with adverse events and in-hospital mortality

Inappropriate medications and physical function: a systematic review

Considering additive effects of polypharmacy

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