Medication use and falls in community-dwelling older persons

Kelly, Kaven D.; Pickett, Will; Yiannakoulias, Nikolaos; Rowe, Brian H.; Schopflocher, Don; Svenson, Larry; Voaklander, Don

doi:10.1093/ageing/afg081

Cited by 127 publications

(94 citation statements)

References 16 publications

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“…Despite making references to polypharmacy, five studies did not include a definition. However, polypharmacy was not the primary theme of these studies (9, 11, 19, 20). All but two papers identified links between polypharmacy and falls.…”

Section: Resultsmentioning

confidence: 99%

Polypharmacy and Falls in the Elderly: A Literature Review

Hammond¹,

Wilson

2013

Nurs Midwifery Stud

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A B S T R A C T Context:Medications are taken to ease, control or cure ailments. They are effective and safe if used correctly. In the elderly, disorders that occur as a result of ageing, frequently require treatment, resulting in increased use of medications. Polypharmacy is common among the elderly and although it can be therapeutic in nature, is linked to adverse events such as falls. Evidence Acquisition: A review of the literature was conducted. English articles in Cinahl, Medline and Healthsource (2000-2012) were searched for links between polypharmacy and falls in older adults aged 65 years old and over. Articles not meeting the age criterion were excluded. Search terms included falls, polypharmacy, medications, multiple medications, medicines, elderly, aged. A total of 120 articles were retrieved from the Literature search. Results: Sixteen articles were included in the literature review. Four literature reviews, three observational prospective cohort, three cross-sectional, three case-control, one longitudinal study and two retrospective cohort studies were examined. Many studies were able to demonstrate a link between the number of medications taken and risk of falls however the potential for bias resulting from confounding by indication was high due to study design in many cases. Conclusions: Polypharmacy as an independent variable has been linked to falls in older people, however there appears to be a stronger link between falls and the type of medications taken (e.g. medications known to increase risk of falls), rather than polypharmacy on its own. Polypharmacy can sometimes be therapeutic and it may be more beneficial to consider terms such as 'inappropriate prescribing' or potentially inappropriate medications' when considering the effects of medication on falls in older adults. Polypharmacy in older people is often viewed in a negative light due to the increased risk of adverse events, including falls. This article examined current knowledge on the characteristics that define polypharmacy, its effect on falls in elderly people and provided recommendations for future research. Further research utilizing prospective and intervention studies are needed to clarify the causal relationship between polypharmacy, comorbidities and fall risk. Falls affect approximately one third of older people. Falls can cause moderate to severe injuries, such as hip fractures and head injuries, and can increase the risk of early death and reduce quality of life. Fortunately, falls are a public health problem that is largely preventable. The link between multiple medicine use and falls in the elderly is often discussed but not widely investigated, partly because older people do not always discuss their falls with their health care provider. To reduce the risk of falls, health professionals need to understand the causative factors and learn to be anticipatory when conducting assessments. As people age their use of medications generally increase, therefore research into the adverse effects of medication use on the mortali...

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Section: Resultsmentioning

confidence: 99%

Polypharmacy and Falls in the Elderly: A Literature Review

Hammond¹,

Wilson

2013

Nurs Midwifery Stud

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“…(13,14) Conversely, a large study of over 11,000 patients failed to find an increased risk of falls in patients with cancer when falls were ascertained using administrative data. (34) Thus, the method of falls ascertainment may impact the results.…”

Section: Discussionmentioning

confidence: 99%

Systematic review of falls in older adults with cancer

Wildes

Dua

Fowler

et al. 2015

Journal of Geriatric Oncology

145

119

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Objectives lder adults frequently experience falls, at great cost to themselves and society. Older adults with cancer may be at greater risk for falls and have unique risk factors. Materials and Methods We undertook a systematic review of the available medical literature to examine the current evidence regarding factors associated with falls in older adults with cancer. PubMed, Embase, CINAHL, CENTRAL, DARE, Cochrane Database of Systematic Reviews and clinical trials.gov were searched using standardized terms for concepts of oncology/cancer, people 60 and older, screening, falls and diagnosis. Eligible studies included cohort or case-control studies or clinical trials in which all patients, or a subgroup of patients, had a diagnosis of cancer and in which falls were either the primary or secondary outcome. Results We identified 31 studies that met our inclusion criteria. Several studies suggest that falls are more common in older adults with a diagnosis of cancer than those without. Among the 11 studies that explored factors associated with outpatient falls, some risk factors for falls established in the general population were also associated with falls in older adults with cancer, including dependence in activities of daily living and prior falls. Other factors associated with falls in a general population, such as age, polypharmacy and opioid use, were not predictive of falls among oncology populations. Falls among older adults with cancer in the inpatient setting were associated with established risk factors for falls in people without cancer, but also with factors unique to an oncology population, such as brain metastases. Conclusions Falls in older adults with cancer are more common than in the general population, and are associated with risk factors unique to people with cancer. Further study is needed to establish methods of screening older adults with cancer for fall risk and ultimately implement interventions to reduce their risk of falls. Identifying which older adults with cancer are at greater risk for falls is a requisite step to ultimately intervene and prevent falls in this vulnerable population.

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“…Approximately 28%–35% of people aged 65 years and older fall each year [2], and a study found that fall-related trauma accounts for 5.3% of all hospitalisations in this age range [3]. The risk of falls is multifactorial, and medications are modifiable extrinsic risk factors [4, 5]. Meta-analyses and systematic reviews have reported that some classes of medications, such as benzodiazepines (BZDs), increase the risk of falls in older people [6–8].…”

Section: Introductionmentioning

confidence: 99%

Association of benzodiazepine and Z-drug use with the risk of hospitalisation for fall-related injuries among older people: a nationwide nested case–control study in Taiwan

Chen

Tsai

et al. 2017

BMC Geriatr

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BackgroundNon-benzodiazepine hypnotics (Z-drugs) are advocated to be safer than benzodiazepines (BZDs). This study comprehensively investigated the association of BZD and Z-drug usage with the risk of hospitalisation for fall-related injuries in older people.MethodsThis study used the Taiwan National Health Insurance Database with a nested matched case-control design. We identified 2238 elderly patients who had been hospitalised for fall-related injuries between 2003 and 2012. They were individually matched (1:4) with a comparison group by age, sex, and index year. Conditional logistic regression was used to determine independent effects of drug characteristics (type of exposure, dosage, half-life, and polypharmacy) on older people.ResultsOlder people hospitalisation for fall-related injuries were significantly associated with current use of BZDs (adjusted odds ratio [AOR] = 1.32, 95% confidential interval [CI] = 1.17–1.50) and Z-drugs (AOR = 1.24, 95%CI = 1.05–1.48). At all dose levels of BZDs, high dose levels of Z-drugs, long-acting BZD, and short-acting BZD use were all significantly increased the risk of fall-related injuries requiring hospitalisation. Polypharmacy, the use of two or more kinds of BZDs, one kind of BZD plus Z-drugs and two or more kinds of BZDs plus Z-drugs, also significantly increased the risk (AOR = 1.61, 95% CI = 1.38–1.89; AOR = 1.65, 95% CI = 1.08–2.50, and AOR = 1.58, 95% CI = 1.21–2.07).ConclusionsDifferent dose levels and half-lives of BZDs, a high dose of Z-drugs, and polypharmacy with BZDs and Z-drugs were associated with an increased risk of fall-related injury requiring hospitalisation in older people. Physicians should balance the risks and benefits when prescribing these drug regimens to older people considering the risk of falls.

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Medication use and falls in community-dwelling older persons

Cited by 127 publications

References 16 publications

Polypharmacy and Falls in the Elderly: A Literature Review

Polypharmacy and Falls in the Elderly: A Literature Review

Systematic review of falls in older adults with cancer

Association of benzodiazepine and Z-drug use with the risk of hospitalisation for fall-related injuries among older people: a nationwide nested case–control study in Taiwan

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