Medication use and risk of falls

Neutel, C. Ineke; Perry, Sheril; Maxwell, Colleen J.

doi:10.1002/pds.686

Cited by 149 publications

(111 citation statements)

References 32 publications

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“…Similar findings have been reported for elderly who suffer with depression [15] and dementia [1,9,16], take antidepressant medication [17,18], or medication for behavioural changes in dementia (e.g. benzodiazepines and antipsychotics) [19,20]. We also report higher rates of depression among hip fracture patients than would be expected in the community, similar to previous studies [21,22].…”

Section: Discussionsupporting

confidence: 90%

Depression, Dementia and Delirium in Older Adults Presenting with Hip Fractures to Orthopaedic Services at a General Hospital

2012

Maced J Med Sci

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Aim: A survey to address psychiatric morbidity in older adults admitted with hip fracture, involvement of liaison psychiatric services for older adults and evaluate change of level of care.Methods: Information about mental and physical health prior to and during admission, referrals to Geriatrician or Liaison Old Age Psychiatry (LOAP) team, duration of hospital stay and level of care was collected for 43 consecutive admissions of older adults for hip fracture over 6 months period.Results: Depression, dementia and delirium were present in 28%, 42% and 23% patients respectively. A pre admission diagnosis of depression was associated with lower Barthel scores on admission, whereas dementia and delirium with lower Barthel scores on both admission and at 48 hours post surgery. Pre admission diagnosis of depression or dementia and the occurrence of delirium did not affect the duration of stay in the orthopaedic ward or alter the level of care after discharge. Conclusions:There are high rates of psychiatric morbidity in older adults presenting with hip fracture to orthopaedic services. Active involvement of the LOAP team would facilitate their prompt identification and treatment post fracture and improve outcomes for these patients.

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Section: Discussionsupporting

confidence: 90%

Depression, Dementia and Delirium in Older Adults Presenting with Hip Fractures to Orthopaedic Services at a General Hospital

2012

Maced J Med Sci

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“…37 Another study also showed particular risk for falling (OR 6.1) in patients taking 10+ drugs. 38 Patients who are taking many different types of medications are high-risk groups, where increased monitoring or tailored drug regimens is necessary.…”

Section: Effects Of Characteristics Of Medication Use On Fall Risk Numentioning

confidence: 99%

Effects of drug pharmacokinetic/pharmacodynamic properties, characteristics of medication use, and relevant pharmacological interventions on fall risk in elderly patients

Zhou¹,

Chen²,

Zhu³

2014

OTT

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Background: Falls among the elderly are an issue internationally and a public health problem that brings substantial economic and quality-of-life burdens to individuals and society. Falls prevention is an important measure of nursing quality and patient safety. Numerous studies have evaluated the association of medication use with fall risk in elderly patients. However, an upto-date review has not been available to summarize the multifaceted pharmaceutical concerns in the prevention of medication-related falls. Materials and methods: Relevant literature was identified by performing searches in PubMed, Web of Science, and the Cochrane Library, covering the period until February 2014. We included studies that described an association between medications and falls, and effects of drug pharmacokinetic/pharmacodynamic properties, characteristics of medication use, and pharmacological interventions on fall risk in elderly patients. The full text of each included article was critically reviewed, and data interpretation was performed. Results: Fall-risk-increasing drugs (FRIDs) include central nervous system-acting agents, cough preparations, nonsteroidal anti-inflammatory drugs, anti-Alzheimer's agents, antiplatelet agents, calcium antagonists, diuretics, α-blockers, digoxin, hypoglycemic drugs, neurotoxic chemotherapeutic agents, nasal preparations, and antiglaucoma ophthalmic preparations. The degree of medication-related fall risk was dependent on one or some of the following factors: drug pharmacokinetic/pharmacodynamic properties (eg, elimination half-life, metabolic pathway, genetic polymorphism, risk rating of medications despite belonging to the same therapeutic class) and/or characteristics of medication use (eg, number of medications and drug-drug interactions, dose strength, duration of medication use and time since stopping, medication change, prescribing appropriateness, and medication adherence). Pharmacological interventions, including withdrawal of FRIDs, pharmacist-conducted clinical medication review, and computerized drug alerts, were effective in reducing fall risk. Conclusion: Based on the literature review, clear practical recommendations for clinicians to prevent falls in the elderly included making a list of FRIDs, establishing a computerized alert system for when to e-prescribe FRIDs, seeking an alternative drug with lower fall risk, withdrawing FRIDs if clinically indicated, taking pertinent cautions when the use of FRIDs cannot be avoidable, paying attention to prescribing appropriateness, simplifying the medication regimen, strengthening pharmacist-conducted clinical medication review, ensuring the label of each FRID dispensed contains a corresponding warning sign, being careful when medication change occurs, enhancing medication adherence, and mandating for periodic reassessment of potential risk associated with the patient's medication regimen. Further studies should be conducted in this area, such as investigating whether medication reconciliation and improving medication adherence could ...

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“…Regardless of setting, the majority of studies have found that polypharmacy and exposure to specific drug classes are associated with an increased risk of recurrent and single falls [Tinetti and Kumar, 2010;Leipzig et al 1999aLeipzig et al , 1999b. Specifically, exposure to antipsychotics [Hien le et al 2005], selective serotonin reuptake inhibitors [Kallin et al 2004;Arfken et al 2001] and hypnotics [Avidan et al 2005;Neutel et al 2002] are established risk factors for falls in residents of nursing homes.…”

Section: Risk Assessment Toolsmentioning

confidence: 99%

Medication safety in residential aged-care facilities: a perspective

Wilson

March

Sambrook

et al. 2010

Therapeutic Advances in Drug Safety

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Medication safety must be tailored to the distinctive issues in residential aged-care facilities (RACFs). The health and functional characteristics of their residents are different to those of hospital inpatients and community-dwelling older adults, and there are unique staffing and management issues. Understanding the aetiology and epidemiology of drug-related problems is vital in developing methods to improve patient safety. In this perspective review, we discuss tools that are used to quantify exposure to 'high-risk' medications and their evaluation in residential aged-care settings. Drug withdrawal interventions are described as a potential way to reduce adverse drug events in RACFs. Multidisciplinary professional interventions, education programs and improved communication between health professionals have been shown to improve medication safety in RACFs. Technological advances and other administrative strategies may also improve resident safety. This perspective addresses issues in medication safety facing RACFs and methods to improve the safety of medicines for their residents.

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Medication use and risk of falls

Abstract: Residents who took many different types of medications, as well as residents starting a new BZD/antipsychotics were at greatly increased risk of falling. These are high risk groups where increased monitoring or adjustments to drug regimens could lead to prevention of falls.

Cited by 149 publications

References 32 publications

Depression, Dementia and Delirium in Older Adults Presenting with Hip Fractures to Orthopaedic Services at a General Hospital

Depression, Dementia and Delirium in Older Adults Presenting with Hip Fractures to Orthopaedic Services at a General Hospital

Effects of drug pharmacokinetic/pharmacodynamic properties, characteristics of medication use, and relevant pharmacological interventions on fall risk in elderly patients

Medication safety in residential aged-care facilities: a perspective

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