<p>Polypharmacy and injurious falls in older adults: a nationwide nested case-control study</p>

Abstract

Objective To determine whether or not the exposure to multiple drugs (polypharmacy) increases the risk of fall-related injury among older adults, beyond the effect of fall-risk increasing drugs and chronic multimorbidity. Methods Nested case-control study using linked register data with national coverage in Sweden. We defined cases as older adults (≥70 years) who had an incident non-elective admission due to a fall between 1 January and 31 December 2013. Cases were matched 1:1 on sex, age and index date to randomly selected controls from the general population. The number of prescription drugs during the 7 days preceding the index date was the main exposure. Results A total of 49,609 cases were included and matched to an equal number of controls. The number of prescription drugs was higher among cases than among controls (mean difference 1.2, 95% CI 1.16–1.26). While adjusting for potential confounders, we found that the risk of injurious falls increased in a nearly linear fashion for each additional drug (OR, 1.02; 95% CI, 1.01–1.03). When using a cut-off value of ≥4 drugs to define polypharmacy, the population attributable fraction for injurious falls was 5.2% (95% CI 2.8–7.6). Conclusion This study shows a monotonic dose-response relationship between the number of drugs and the risk of injurious falls. However, after comprehensive adjustment for known confounders (including fall-risk increasing drugs and chronic multimorbidity), this association is substantially weaker than previously reported. Moreover, even if the relationship between polypharmacy and injurious falls is really causal, the population attributable risk fraction is low.

Helicobacter pylori Related Diseases and Osteoporotic Fractures (Narrative Review)

“…The prevalence of suspected medication-related falls is about 41% [ 555 ] to 49% [ 556 ]. Increased risk of falls was documented in users of anxiolytics/hypnotics, opioids, sedatives, antihypertensives (especially alpha-blockers), antidepressants, antiparkinsonian medications, antiepileptics and antiarrhythmics [ 557 , 558 , 559 , 560 , 561 , 562 , 563 , 564 , 565 , 566 , 567 , 568 , 569 , 570 , 571 , 572 , 573 , 574 , 575 , 576 , 577 , 578 , 579 , 580 , 581 , 582 , 583 ]; polypharmacy is strongly associated with injurious falls and fractures [ 574 , 582 , 584 , 585 , 586 , 587 , 588 ].…”

Chronic polypharmacy impairs explorative behavior and reduces synaptic functions in young adult mice

“…Moreover, age-related changes in pharmacodynamics and pharmacokinetics contribute to stronger effects of many drugs and therefore the risk of negative outcomes [9]. In epidemiological studies, polypharmacy has been associated with enhanced risks of adverse events in older people which comprise falls, hospitalization and higher mortality [10][11][12][13]. Increased chances of developing cognitive disturbances and decline have also been linked with inappropriate use of multiple medications in older AGING adults [14][15][16].…”

Physical Frailty and Fall Risk in Community-Dwelling Older Adults: A Cross-Sectional Study

“…A review of relevant literature showed polypharmacy to have a variable link to falling in older adults [ 66 ]. However another, nationwide nested case-control study found a direct relationship between polypharmacy and injurious falls [ 67 ].…”