Medication use and risk of falls among nursing home residents: a retrospective cohort study

Abstract

Background Geriatric falls are leading causes of hospital trauma admissions and injury-related deaths. Medication use is a crucial element among extrinsic risk factors for falls. To reduce fall risk and the prevalence of adverse drug reactions, potentially inappropriate medication (PIM) lists are widely used. Objective Our aim was to investigate the possible predictors of geriatric falls annualized over a 5-year-long period, as well as to evaluate the medication use of nursing home residents. Setting Nursing home residents were recruited from the same institution between 2010 and 2015 in Szeged, Hungary. Method A retrospective epidemiological study was performed. Patient data were analysed for the first 12 months of residency. Chi-squared test and Fisher's-test were applied to compare the categorical variables, Student's t test to compare the continuous variables between groups. Binary logistic regression analysis was carried out to determine the association of falls with other variables found significant in univariate analysis. Microsoft Excel, IBM SPSS Statistics (version 23) and R (3.2.2) programs were used for data analysis. Main outcome measure Falls affected by age, gender, number of chronic medications, polypharmacy, PIM meds. Results A total of 197 nursing home residents were included, 150 (76.2%) women and 47 (23.8%) men, 55 fallers (annual fall prevalence rate was 27.9%) and 142 non-fallers. Gender was not a predisposing factor for falls (prevalence in males: 23.4 vs 29.3% in females, p > 0.05). Fallers were older (mean years ± SD; 84.0 ± 7.0) than non-fallers (80.1 ± 9.3, p < 0.01). The age ≥80 years was a significant risk factor for falls (p < 0.001). The number of chronic medications was higher in male fallers (12.4 ± 4.0) than in non-fallers (6.9 ± 4.2, p < 0.001). Polypharmacy (taking four or more chronic medications) was a significant risk factor of falls (p < 0.01). Those PIMs carrying fall risk were taken by 70.9% of fallers and 75.3% of non-fallers (p > 0.05). Taking pantoprazole, vinpocetine or trimetazidine was a significant risk factor for falls. Conclusion Older age, polypharmacy and the independent use of pantoprazole, vinpocetine, and trimetazidine were found to be major risk factors for falls. Further real-life epidemiological studies are necessary to confirm the role of particular active agents, and to help professionals prescribe, evaluate and review geriatric medication use.

Analysis of Fall Risk Factors in an Aging Population Living in Long-Term Care Institutions in SPAIN: A Retrospective Cohort Study

“…Another important finding is that polypharmacy can be considered a fall risk factor (OR: 1.291, 95% CI: 1.039, 1.604). This is congruent with previous research associating polymedication with an increased rate of falls [ 40 , 41 ]. It is also important to notice that the relationship between medication and falls in the elderly may not only be related to the numbers but also to the types of drugs [ 42 , 43 , 44 , 45 ].…”

Patient safety culture in Norwegian nursing homes

“…These individuals are particularly vulnerable due to their age, cognitive impairment, complex multiple diseases, and non-specific presentation of illnesses [13]. There is also an increased risk of fall injuries and errors due to multiple medication and potential drug interactions [14, 15]. Studies by Soraas et al (2014) and Gulla et al (2016) found that the use of eight or more drugs is frequent in Norwegian nursing homes, leading to increased risk of drug-drug interactions, which in turn may lead to falls, cognitive decline, medication-related problems, and even increased mortality [16–20].…”

Drug burden index, polypharmacy and patient health outcomes in cognitively intact older residents of aged care facilities in Malaysia

“…found the concomitant use of three or more psychotropic drugs, antihypertensives and the regular use of hypnotics as potentially inappropriate medications among Norwegian nursing home residents aged ≥70 years, whereas in Hungary, Bor et al . found that potentially inappropriate medications, such as pantoprazole, trimetazidine and vinpoctine, were significant risk factors for falls among older people in nursing homes . In Finland, Juola et al .…”

“…Nyborg et al 12 found the concomitant use of three or more psychotropic drugs, antihypertensives and the regular use of hypnotics as potentially inappropriate medications among Norwegian nursing home residents aged ≥70 years, whereas in Hungary, Bor et al 13 found that potentially inappropriate medications, such as pantoprazole, trimetazidine and vinpoctine, were significant risk factors for falls among older people in nursing homes. 12,13 In Finland, Juola et al 14 reported a stepwise association between the use of multiple potentially harmful medications and poorer self-rated health, and poorer healthrelated quality of life (HRQoL). 14 However, one study in Malaysia reported on the prevalence of potentially inappropriate medications among RACFs but observed no significant changes in HRQoL.…”